Thyroid levels to high on Levothyroxine - Thyroid UK

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Thyroid levels to high on Levothyroxine

Ramblingleftie profile image
6 Replies

My last blood test said my TSH levels are too high. The problem is I’m on 25mg Levothyroxine - so the lowest does.

Interestingly I was taking it at night but found I was still tired, so I thinking it wasn’t effective I started taking it in the Morning. And over a period of time started feeling better.

But now I’m wondering if taking it in the morning is reducing the effectiveness which is effectively lowering my dosage. I definitely have some of the symptoms of high levels but they could very easily be a result of other factors.

I’m about to have another set of blood tests but just wondered if any one has experienced anything silimar?

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6 Replies
helvella profile image
helvellaAdministratorThyroid UK

If your TSH is too high, you need MORE levothyroxine. Not less.

On a dose like 25, you probably run out after, at most, a few hours.

Almost no-one finds such small doses helpful. The simple act of taking 25 could reduce your own production by 25 (maybe a bit less, possibly even a bit more). So could have a net effect close to zero.

It would help if you added some information to your profile - and explained how you have come to be in this situation.

Ramblingleftie profile image
Ramblingleftie in reply to helvella

ahhh right. I’d totally confused myself! I’ll wait to these new results come in and see what the actual numbers are and speak to the doctor.

Lalatoot profile image
Lalatoot

Rambling, if your tsh level is too high it means that your levothyroxine dose is too low. TSH should be under 2 and often nearer to 1 or below when we are on levothyroxine.If you post any results you have we can advise better

Buddy195 profile image
Buddy195Administrator

Ramblingleftieplease share your blood test results with us (plus ranges as these can vary between laboratories) If you don’t have these, please ask your GP surgery for a copy (which you are legally entitled to). As others have said, if TSH is above 2 you will certainly need an increase in thyroid medication. Most members report feeling best with TSH under 1.

SlowDragon profile image
SlowDragonAdministrator

Standard starter dose is 50mcg

Dose is INCREASED in 25mcg steps over first year or two on Levothyroxine

Levothyroxine doesn’t “top up” thyroid, it replaces it, so it’s essential to be on high enough dose

Aim is to be on high enough dose to bring TSH down always below 2

Most people when adequately treated will have TSH around or under one.

Most important results are always Ft3 followed by Ft4. Aiming for Ft3 at least 50-60% through range, usually Ft4 is a little higher

ALWAYS Test thyroid levels early morning and last dose levothyroxine 24 hours before test

How long have you been left on just 25mcg levothyroxine

Being left on inadequate dose levothyroxine frequently results in low vitamin levels

Request GP test vitamin D, folate, B12 and ferritin levels

SlowDragon profile image
SlowDragonAdministrator

Didn’t realise this was your first post

Welcome to the forum

By the way it’s 25mcg (not 25mg)

Which brand of levothyroxine are you currently taking

Even if we frequently don’t start on full replacement dose, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose

NICE guidelines on full replacement dose

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

Also here 

cks.nice.org.uk/topics/hypo...

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.

Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine

 

For full Thyroid evaluation you need TSH, FT4 and FT3 tested 

Also both TPO and TG thyroid antibodies tested at least once 

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high thyroid antibodies 

Autoimmune thyroid disease with goitre is Hashimoto’s

Autoimmune thyroid disease without goitre is Ord’s thyroiditis. 

Both are autoimmune and generally called Hashimoto’s.

Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)

20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis 

In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)

Recommended on here that all thyroid blood tests early morning, ideally just before 9am and last dose levothyroxine 24 hours before test 

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

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