These are my latest results from MC today after stopping Levo since end of March, I have only taken supplements to see how I got on, B Complex, Selenium, Zinc, Vit D3/+K2, the odd Biotin and Magnesium when I remembered, last B12 injection middle of March, I have a very slow heartbeat during the night (30-47) according to my samsung watch. I have been feeling well and put on about 4 pounds still under 8 stone, but I think I should start back on 50 Levo?
How do you know if you have Hashimotos?
Test at 9am, stopped all supplements 24hrs, Biotin and BComplex 1 week before.
CRP HS 0.66 mg/L - (< 3)
Ferritin 78 ug/L - (30 - 650)
Folate - Serum 17.4 nmol/L - (8.83 - 60.8)
Vitamin B12 - Active 129 pmol/L - (37.5 - 188) change of reference range 23 Oct 2022
Vitamin D 106 nmol/L - (50 - 250) change of reference range 23 Oct 2022
You obviously need it as you can see your TSH is well above range now, so yes I would recommend re starting Levo.
Your vitamins all look good including the folate that was low last time.
Your previous results showed. Low FT3 and TSH above 1 so in time you may need more than you were on then.
If you had Hashimoto's your antibodies would be above range which yours are not. Thats not definite though that you do not have it as antibodies do fluctuate, also there are a percentage of people that never have positive antibodies yet still have Hashi's.
Likely to need several further increases in levothyroxine over coming 6-12 months
Which brand of levothyroxine did you take before
Retest 6-8 weeks after starting back on levothyroxine
Always test early morning and last dose levothyroxine 24 hours before test
Request GP organise an ultrasound scan of thyroid
guidelines on dose levothyroxine by weight
Even if we frequently start on only 50mcg, 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 started on Wockhardt 25s but I am on Accord now, I did try 75 a couple of years ago, but landed up having to go see a heart specialist as I had herendous palpitations and AF so I stopped Levo for a couple of months before starting back on 50 no palpitations after that, the hear specialist did a scan I seemingly have a leaky valve but nothing to worry about!!!
It might have been the brand rather than the dose levothyroxine
Many patients do NOT get on well with Teva brand of Levothyroxine. Teva is lactose free.
But 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.
Many people find Levothyroxine brands are not interchangeable.
Most easily available (and often most easily tolerated) are Mercury Pharma or Accord
Accord only make 50mcg and 100mcg tablets
Accord is also boxed as Almus via Boots
If/when you increase up beyond 50mcg …..perhaps initially increase to 67.5mcg daily (or 50mcg and 75mcg alternate days)
avoiding Teva for 75mcg dose ask for extra 50mcg tablets to cut in half to make 75mcg
Or cut into 1/4’s to add 12.5mcg daily
Getting up to (and over) 75mcg is often the hardest step.
Mercury Pharma make 25mcg, 50mcg and 100mcg tablets
Mercury Pharma also boxed as Eltroxin.
Both often listed by company name on pharmacy database - Advanz
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
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.
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).
Increasing number of members find it smoother/more tolerable to split levothyroxine as two smaller doses, half dose waking, half dose at bedtime. Might be worth trying if/when get up on to 75mcg daily
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