Blood test

[Campy1967]

Hi ive been taking 25mg levothyroxine since Dec 2022 after my TSH was over 5 dont know the other levels question is iam due another thyroid test this Friday just wondering should i ask them to check other thyroid levels as i believe the TSH test alone is bot enough to properly diagnois a underactive thyroid any help thanks all new to me lol .

[Jaydee1507 Administrator]

You can ask them to test FT4 and FT3 as well as TSH but the likelyhood is they won't do it at the lab. It's the lab that gets to decide. That's why many hypo people here pay for private tests to get the results they need to know whats happening.

Do ask your GP for ferritin, folate, B12 and D3 though as they just might test them.

[Campy1967 in reply to Jaydee1507]

Ok will do I've had my D3 tested last year it was slightly reduced Dr told me to take a D3 supplement which i do last time it was tested it was ok plus i had a bone profile blood test as well that came back ok so much to test ?

[Jaydee1507 Administrator in reply to Campy1967]

Sorry what was the question?

[SlowDragon Administrator]

Book test for early morning, ideally just before 9am and last dose levothyroxine should be 24 hours BEFORE test

Standard starter dose levothyroxine is 50mcg

You’re highly likely in need of next dose increase in levothyroxine to 50mcg

Bloods should be retested 6-8 weeks after each dose increase

Typically dose is increased slowly upwards in 25mcg steps over next 6-12 months. Bloods retested 6-8 weeks after EACH increase

This continues until TSH is around 1

Most important results are ALWAYS Ft3 followed by Ft4

Aiming for Ft3 at least 50-60% through range, usually Ft4 is little higher

ESSENTIAL to test vitamin D, folate, ferritin and B12

ALWAYS get actual results and ranges on all tests

NHS only tests for vitamin deficiencies

We need optimal levels

Eg Vitamin D is “normal “ according to NHS if over 50nmol

Optimal vitamin D is at least over 80nmol

Optimal Serum B12 at least over 500

Optimal folate at least half way through range

Ferritin at least over 100

[SlowDragon Administrator]

Have you had thyroid antibodies tested for autoimmune thyroid disease also called Hashimoto’s?

Approx how much do you weigh in kilo

pathlabs.rlbuht.nhs.uk/tft_...

Guiding Treatment with Thyroxine: 

In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months. 

The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).

The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range. 

……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.

The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.

[Campy1967 in reply to SlowDragon]

Iam roughly 16.5 stone old school weight sorry test is booked for 9am Dr started me on 25mg to see how i went etc .

[SlowDragon Administrator in reply to Campy1967]

it’s 25mcg (not 25mg)

Which brand of levothyroxine did you start on

Have you seen any improvements

Levothyroxine doesn’t top up your failing thyroid, due to feedback mechanism with pituitary, levothyroxine very quickly replaces your own thyroid output

Starting on too low a dose can make symptoms worse in some ways …..especially by 6-8 weeks as your body is ready for next dose increase up to 50mcg

So what frequently happens is dose is increased….after 2-3 weeks you start to notice some improvements…..then by 6-8 weeks old symptoms start reappearing…..indicating you’re ready for next increase

16.5 stone = 105kilo

105 kilo x 1.6mcg = 168mcg levothyroxine as the approx dose you might eventually end up on in 1-2 years time

Obviously that’s quite a few 25mcg increases over coming months

[Campy1967 in reply to SlowDragon]

Wockhartd brand sleeping a bit better dont wake up in a morning feeling rough ie headache or feeling sluggish still feel tired towards the afternoon joint pain has gone especially in my knees, have a massive appetite but eating the right foods i take allopurinol for gout and stain and rampiral but low doses it all seems connected?

[SlowDragon Administrator in reply to Campy1967]

yes

High cholesterol is linked to being hypothyroid

Cholesterol should drop as dose levothyroxine slowly increases over coming year

nhs.uk/conditions/statins/c...

If you have an underactive thyroid (hypothyroidism), treatment may be delayed until this problem is treated. This is because having an underactive thyroid can lead to an increased cholesterol level, and treating hypothyroidism may cause your cholesterol level to decrease, without the need for statins. Statins are also more likely to cause muscle damage in people with an underactive thyroid.

[SlowDragon Administrator]

Gout and hypothyroid

pubmed.ncbi.nlm.nih.gov/117...

A significant correlation between thyroid function and purine nucleotide metabolism has been established in hypothyroidism. 

So request vitamin D, folate, ferritin and B12 are tested as well on Friday. Plus thyroid antibodies if not been tested yet.

Also kidney function.

Come back with new post once you get results

You should get dose increase to 50mcg after test results

Wockhardt only make 25mcg tablets

If you have to change to 50mcg tablets suggest you try Mercury Pharma or Accord

Many people find Levothyroxine brands are not interchangeable.

Most easily available (and often most easily tolerated) are Mercury Pharma or Accord

Mercury Pharma make 25mcg, 50mcg and 100mcg tablets 

Mercury Pharma also boxed as Eltroxin. Both often listed by company name on pharmacy database - Advanz

Accord only make 50mcg and 100mcg tablets 

Accord is also boxed as Almus via Boots, and Northstar 50mcg and 100mcg via Lloyds ....but Accord  doesn’t make 25mcg tablets

beware 25mcg Northstar is Teva

 Many patients do NOT get on well with Teva brand of Levothyroxine. Teva is lactose free.

Teva contains mannitol as a filler instead of lactose, which seems to be possible cause of problems. Mannitol seems to upset many people, it changes gut biome

Teva is the only brand that makes 75mcg tablet.

So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half

But for some people (usually if lactose intolerant, Teva is by far the best option)

Aristo (currently 100mcg only) is lactose free and mannitol free.

List of different brands available in U.K.

thyroiduk.org/if-you-are-hy...

Posts that mention Teva

healthunlocked.com/search/p...

Teva poll

healthunlocked.com/thyroidu...

Wockhardt is very well tolerated, but only available in 25mcg tablets. Some people remain on Wockhardt, taking their daily dose as a number of tablets 

Once you find a brand that suits you, best to make sure to only get that one at each prescription.

Watch out for brand change when dose is increased or at repeat prescription.

Government guidelines for GP in support of patients if you find it difficult/impossible to change brands 

gov.uk/drug-safety-update/l...

If a patient reports persistent symptoms when switching between different levothyroxine tablet formulations, consider consistently prescribing a specific product known to be well tolerated by the patient. 

academic.oup.com/jcem/artic...

Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).