Todays Results : These are my latest results from... - Thyroid UK

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Todays Results

Albaangel profile image
7 Replies

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

TSH 11.15 mIU/L - (0.27 - 4.2)

Free T3 3.9 pmol/L - (3.1 - 6.8)

Free Thyroxine 11.8 pmol/L - (12 - 22)

Thyroglobulin Antibodies - 13.8 kIU/L - (0 - 115)

Thyroid Peroxidase Antibodies 11.2 kIU/L - (0 - 34)

Advice welcome

Thanks

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Albaangel
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7 Replies
Jaydee1507 profile image
Jaydee1507Administrator

Was there a reason you stopped taking Levo?

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.

Albaangel profile image
Albaangel in reply toJaydee1507

Thanks very much for reply jaydeeStopped to see if my hair would stop dissappearing at temples, thought it might be the Levo.

MC have changed some of their ranges, not sure if that makes a difference to my vits.

Will start back on 50 tomorrow, I'm due my annual bloods from GP but will hang out for 8 weeks will see how the TSH is then.

SlowDragon profile image
SlowDragonAdministrator

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

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.

SlowDragon profile image
SlowDragonAdministrator

Reading your helpful profile……you should have had dose INCREASE up from 50mcg

Levothyroxine doesn’t top up failing thyroid, it replaces it

Being left on just 50mcg standard starter dose is hopeless

Most important results are ALWAYS Ft3 followed by Ft4

Albaangel profile image
Albaangel in reply toSlowDragon

Thanks for you reply SD

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!!!

SlowDragon profile image
SlowDragonAdministrator in reply toAlbaangel

Mitral valve prolapse very common with autoimmune diseases

pubmed.ncbi.nlm.nih.gov/193...

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 

 

List of different brands available in U.K.

thyroiduk.org/if-you-are-hy...

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).

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

Albaangel profile image
Albaangel in reply toSlowDragon

Thanks SD for all your info, very helpful. I can't tolerate Teva, tried that one before.

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