I’m on daily 50mg Levothyroxine for 8 weeks after private bloods showed the following;
TSH 6.51 (R 0.27-4.2)
T3 4.1 (R 3.1-6.8)
T4 14.6 (R 12-22)
High antibodies so likely Hashimotos. GP was reluctant to prescribe me, but did at the advice of an Endocrinologist.
For reference I am 5ft 7 and 91kg.
Just had my follow up 8 week bloods which shows;
TSH 3.03 (R 0.27-4.2)
T4 16.5 (R 11.0-21.2)
Blood was taken fasted and over 24 hours after last Levothyroxine dose.
So now I am in range, but still feel dreadful. I’ve got b12, iron and vit d supplements to start taking (I didn’t do this earlier as was confused as to whether this would disrupt my levels and affect if my dosage needs to be increased)
So my question is. Should I book an apt with the GP to request thyroxine dose increase as still feel dreadful, or try the vitamins first and then seek thyroxine dose increase if I still feel dreadful?
Through all of this I have never had a follow up with the GP to talk this through (all I got was a text to say I needed the thyroxine prescription), so just feeling a bit lost with next steps.
Thank you.
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Tired_MiddleAged
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The results may be in-range, but your TSH is still far too high, and your FT4 to low, so I imagine your FT3 will be even lower. No wonder you don't feel good. You need and increase in levo now. But, you still need to start the supplements. Nutrients need to be optimal for your body to be able to use the thyroid hormones you're giving it.
If you can get an increase - and you should, because 50 mcg is just a starter dose - you should start that. A week later, start the supplements, but only one at a time, about about two week intervals, so that you know if you can tolerate them or not. I take it you did have your nutrients tested before buying them?
Just one more thing:
* if you are taking vit D, you also need to take magnesium and vit K2-MK7
* if taking B12 you also need a B complex to keep the Bs balanced
* when taking iron you need to take it at least two hours away from everything else - or it will block absorption of everything else - and four hours away from thyroid hormone. You need to take it with vit C to help absorption.
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.
Comprehensive list of references for needing LOW TSH on levothyroxine
Thank you, will book GP apt and request increase. GP is still prescribing 8 weeks worth at a time and not on repeat yet, perhaps they won’t do that until things have stabilised a little.
Levothyroxine brand is Accord. Thank you for those resources, going to have a read now.
yes the GP wasn’t too worried then but perhaps levels were higher than they were in my recent bloods. Will call today and see if I can get that info - thank you!
Has GP tested for Pernicious Anaemia yet …if not why not
You quite likely need B12 injections
See my replies to post above yours on similar terrible B12 levels
Retest vitamin levels at next test in 8 weeks after next increase in levothyroxine
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,
Request extra 50mcg tablets per month and cut in half to get 25mcg per day
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
Lactose free brands - currently Teva or Vencamil only
Teva makes 25mcg, 50mcg, 75mcg and 100mcg
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.
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.
Thank you that’s a great tip. Now the next challenge is to actually get a GP apt! Oh and then convince them to increase the dose as I’m sure they will still keep on about the guidelines!
Hi everyone, just to update, the GP prescribed me an increase in Levothyroxine so have started on 75mg today. Let’s see if that helps. Thanks for all your advice!
Ahh they gave me a different brand - Wockhardt, GP said I shouldn’t notice any difference. But when I re-test after 8 weeks should I request Accord to cut in half? Is there an issue with having two diff suppliers?
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