Levothyroxine and anti depressants

[Bright-eyes]

Hi, I just wondered if it is ok to take anti depressants or anti anxiety medication with Levo?

Has been suggested before that propranolol can affect abosorbtion of Levo.

Many Thanks

[Jaydee1507 Administrator]

Propranalol affects conversion of T4 to T3, not absorption. The boggest thing to affect absorption are PPI's.

Antidepressants are OK to take when taking levo although should be 4 hours away from it as levo is a very fussy hormone and doesn't like company.

Did you get a dose increase after the last results you posted? 25mcgs is a starter dose for an elderly person.

How much do you weigh in kilos?

Are you still taking the B complex. You may need to take a separate B12 as your last results looked on the low side.

[Bright-eyes in reply to Jaydee1507]

Thanks for your reply.

yes, I am now on 50 mg. I take all the recommended vitamins as suggested on this forum including B complex & B12.

I weigh 95 kilos

[SlowDragon Administrator in reply to Bright-eyes]

50mcg is only the standard starter dose levothyroxine

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

How long since you increased to 50mcg levothyroxine

Which brand of levothyroxine are you taking

Are you taking vitamin supplements well away from levothyroxine

Likely to need several further increases in levothyroxine over coming months

[Jaydee1507 Administrator in reply to Bright-eyes]

So according to this very rough guide calculation the approx amount of Levo you will eventually require is 152 mcgs a day.

weight in kilos x 1.6 = estimated final dose.

You need to get some information from here to take to your doctor as evidence that you need a dose increase. You could also ask a different doctor at the same practice who might be more helpful.

Well done on working on the vitamin levels.

[SlowDragon Administrator]

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.