Hi guys I forgot to post these a few weeks ago.

[Dshadzz07]

in my last post I spoke about how I was off my meds for a couple weeks I’ve since restarted. However a few weeks back I did get blood tests done and forgot to post them here this is when I was taking medication consistently.

[SlowDragon Administrator]

How much levothyroxine were you taking then

Clearly under medicated and ready for next 25mcg increase in levothyroxine

Vitamin D far too low

How much vitamin D are you currently taking

What about ferritin result?

[Dshadzz07 in reply to SlowDragon]

sorry I’ve been away Yh I feel I’m ready to go to 125mg levo and gonna speak to doc about it. Vit D I stopped as I ran out of spray but was 2000iu a day.

The ferritin result was 82ug/L (40-300)

[SlowDragon Administrator in reply to Dshadzz07]

So get new vitamin D spray

You probably need higher dose than 2000iu per day

Try 3000iu daily

Retest twice a year

Get dose increase in levothyroxine

Ideally get same brand levothyroxine at each prescription

Which brand of levothyroxine are you currently taking

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

Aim is to increase dose levothyroxine until TSH is always below 2

Most people when adequately treated will have TSH around or below one

[Jaydee1507 Administrator]

So how long had you been on a constant dose before getting this blood test? Well done on taking your levo consistently.

Did you do the test as per the protocol recommended here? Test at 9am, fasting, last levo dose 24hrs before the blood draw (if you’re taking Levo) & no biotin containing supplements for 3-7 days (Biotin can interfere with thyroid blood results as it is used in the testing process)?

What supplements are you taking?

You had some very good and comprehensive advice on supplementing your terrible vitamin levels in this post: healthunlocked.com/thyroidu...

Have a good read of that and suggest you start to take the vitamins one at a time for a few weeks before introducing the next one. This allows you to see if there are any issues with that vitamin before adding more.

[SlowDragon Administrator]

Looking at previous posts your a young 21 year old guy and quite heavy

Guidelines on dose levothyroxine by weight is roughly 1.6mcg per kilogram of your weight

So likely to eventually be on at least 150mcg per day …but we need to increase dose slowly up

As dose levothyroxine increases you may find you can start to lose a little weight

[Dshadzz07 in reply to SlowDragon]

Yeah I want to lose weight I hate being like this feels dreadful. I’ll get there.

[SlowDragon Administrator in reply to Dshadzz07]

guidelines on dose levothyroxine by weight

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.

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.