Hi,Hope you are well!
Been now almost 3 years since been diagnosed with underactive thyriod. Still on 50mcg of levothyroxine. Had recent blood works after experiencing palpitation followed by losing conscious for 2-3mins. The blood results showed high ferritin and following results for thyriod. What are your thoughts on recent results. Have a doctors appointment in 2 weeks time. Thanks
You are incredibly under medicated
In need on 25mcg dose increase to 75mcg
Blood should be retested again in another 6-8 weeks
Likely to need further increase in levothyroxine in coming months
Aim of levothyroxine is to increase the dose slowly upwards until TSH is around 1
Most important results are always Ft3 followed by Ft4
Aiming for Ft4 (levothyroxine) at least 70% through range and Ft3 at least 60-70% through range
ALWAYS test thyroid levels early morning and last dose levothyroxine 24 hours before test
Meanwhile request vitamin D, folate and B12 are tested
Likely to be at low levels unless supplementing
50mcg levothyroxine is only the standard starter dose
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.
posts 2 years ago say you were on 100mcg levothyroxine
healthunlocked.com/thyroidu...
When/why was dose levothyroxine reduced to 50mcg?
Thanks SlowDragon, so when i went back with symptom of unable to breathe whilst sleeping (waking up gasping for air) they reverted me back to 50mcg. They said my body can't cope with increase and so it helped with the breathing but i've gained 10kg. My joints ache terribly. Does ferriti.n habe any link with thyriod?
Standard increase in dose is 25mcg ……because many people can’t tolerate increasing too quickly
You should have been prescribed increase to 75mcg
Also
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,
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.
March 2023 - Aristo now called Vencamil
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
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...
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).
Levothyroxine is an extremely fussy hormone and should always be taken on an empty stomach and then nothing apart from water for at least an hour after
Many people take Levothyroxine soon after waking, but it may be more convenient and perhaps more effective taken at bedtime
verywellhealth.com/best-tim...
markvanderpump.co.uk/blog/p...
markvanderpump.co.uk/blog/p...
No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.
Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away
(Time gap doesn't apply to Vitamin D mouth spray)
If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test
If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal
This is so detailed. I didn't think so many brands existed. I will mention it to my gp and read further more with what you've shared. Thank you.
So you need dose increase to 75mcg ….but having been left terribly under medicated for at least 2 years, you may need to increase SLOWLY
Initially to 75mcg and 50mcg alternate days for 6-8 weeks (or possibly better option….cut 25mcg in half to get 12.5mcg and take 62.5mcg daily for 6-8/weeks)
Then once use to this …..increase to 75mcg daily
Retest after another 6-8 weeks
Likely to need to increase again up to 100mcg eventually……but it frequently has to be done slowly in small increments
Essential to test vitamin D, folate, ferritin and B12
Two years ago B12 was too low and no folate result
On levothyroxine we need optimal vitamin levels
Only Ferritin was tested early April was found slightly high and was asked to repeat earlier this week so waiting results. It was 164. What i've noticed is 2 summers ago my ferritin was 132 but it has increased since then. What is the link of ferritin with thyriod?
How old are you
Pre or post menopause
36, i had an endometrial ablation in 2019 and set me off with perimenopause symptoms.
Heavy periods are extremely common hypothyroid symptom
Usually results in low iron/ferritin too
If no longer getting periods then ferritin will naturally increase
Range on ferritin post menopause is 30-600
this is news to me. Ok, things i need to check with gp. Thanks
There’s no information on your profile
Do you know if you have had TPO and TG thyroid antibodies tested at least once
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)
Having Hashimoto’s causes inflammation
Inflammation can result in high ferritin levels…..but real iron levels can actually be low
Ideally GP should do full iron panel test
If they won’t you might consider testing
Test early morning and fasting. Don’t eat iron rich dinner night before test
Medichecks iron panel test
medichecks.com/products/iro...
Not recently, i think was done several years ago before diagnosis of underactive thyriod. Will request the gp to do them.
Which brand of levothyroxine are you currently taking
Have you always had same brand
Don’t change brands when increasing the dose
I've been with Almus brand since starting.
In case it helps, Almus levothyroxine is actually made by Accord:
helvella's medicines documents (UK and Rest of the World) can be found here:
helvella - Thyroid Hormone Medicines
helvella has created, and tries to maintain, documents containing details of all thyroid hormone medicines in the UK and, in less detail, many others around the world.
This link takes you to a page which has direct links to the documents from Dropbox and Google Drive, and QR codes to make it easy to access from phones.
helvella.blogspot.com/p/hel...
Thank you. Do pharmacies stalk few range of brands ? because, my assigned pharmacy is superdrug.
Some do
Some don’t
If you prefer one brand, or if a particular brand upsets you GP can specify a particular brown prescription…..or add note to say don’t prescribe a particular brand
Which brand are you taking
You are going to need 25mcg tablets added to prescription
Or if taking Accord or Almus - only available as 50mcg and 100mcg tablets
So would need to cut in half to get 25mcg or into 1/4’s to get 12.5mcg
Using pill cutter or sharp craft scalpel
Get a weekly pill dispenser to save spare 1/2’s or 1/4’s for next days
currently taking almus brand
So you will need to explain to GP you don’t want to change brand and that you need extra 50mcg tablets and will cut in half to get 25mcg
But suggest you initially cut into 1/4 to only increase by 12.5mcg …..
Having been left extremely under medicated it can be difficult to tolerate even increasing by 25mcg
I would say you definitely need an increase to 75mcg . My GP was very reluctant to increase . Even when I went up to 75mcg I only found improvement for a short while until I got the worst constipation of my life and felt really ill so they tested my bloods and showed I was undermedicated and put me up to 100mcg . Fingers crossed I'm feeling alright now. I always took the advice of doctor as gospel but now I've started questioning everything now. Hope you sort it out
Recent blood results 
Blood results
Recent blood results 
Recent blood results
Recent blood test results 
