Diagnosed with Subclinical hypothyroidism nearly 2 years ago. My symptoms at the time were dizziness, brain fog, and a constant feeling of internal ‘jitters’ which all left me feeling really unwell. Also had the usual weight gain etc. It wasn’t until I was tested for antibodies that I was started on Levothyroxine. I take 50mcg. Recently had TSH checked, which was within range, however about 3 days later I tested positive for Covid. Nearly 2 weeks later being clear of Covid, the dizziness etc are back with vengeance. Any suggestions please?
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Tinker72
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What was tested? TSH isn’t complete enough information to judge treated on.
You can obtain or set up access to results, recommend you do this with every result.
Most feel well when TSH is in lower part of reference range around 1. If it’s higher in range it’s likely too high & thyroid hormone too low.
More importantly the FT4 & FT3 often need to be in the higher in their ranges.
50mcg standard starter dose most need to increase. Do you always have the same brand.
Also important to test folate, ferritin, B12 & vitamin D.
Many use private companies to arrange complete testing as NHS often don’t test FT3 (the active thyroid hormone) or nutrients.
You need optimal nutritents for Levo to work well.
Tests should be early in morning, eg 09.00 fast overnight & delay dose until after draw. Cease any biotin supplements 3 days prior to test as can interfere with test.
thank you both. Only TSH was tested recently, I did request T3/T4 however this was not done. Latest TSH 1.82 mU/L. (Range 0.27-4.2) T4 was in June 2021 which was 13.5 pmol/L (range 11-25). TSH was tested before 9am and 24 hours after last dose. Only water taken that morning.
I was increased to 50mcg in August 2021, started off on 25mcg in June that year. Ferritin etc has not been checked for over a year. I only take one brand of Levo, as symptoms returned when brand new was changed.
I’m 51. Think they started me on 25mcg as was Bradycardic and had to have an Echo etc. My symptoms were much better once I was on 50mcg, however I do have difficult days. The last 3 days I’ve felt like I’m back to square one, I’ve noticed heart rate dropping again too. Thank you for the information.
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
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.
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.
I’ve seen the GP today who said that my TSH is fine, therefore no need to increase dose. I’ve asked them to support my referral to a private Endo as fed up!
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