Increase in Levothyroxine

[ChickieBaker]

Hello.I was started on Levo at 75mg about 10 days ago. My doctor wants to do a blood test in 8 weeks. Last time I was given a 2 month trial and because my TSH came down ( they don't care about antibodies so those weren't checked ! ) they took me off the Levo. Now I've gone to a different, much more understanding doctor this time who said I would be on the Levo for the long term so I don't think that going to happen again but my question is, how will he know whether to increase the dose or not ?? My symptoms aren't likely to have changed within 8 weeks I shouldn't think, so I'm not sure what to do. I think it was slowdragon who suggested that I might be on too low a dose but how will he decide what dose I should be on. Perhaps he'll go by both the TSH and my symptoms ? My symptoms may well be related to other problems that I have, large amounts of stress, digestive problems etc. Any suggestions gratefully received.

[Jaydee1507 Administrator]

Of course your TSH reduced on Levothyroxine. That's the whole point of it!

Speaking honestly GP's rarely take symptoms in to account although they really should. They will likely go on blood test numbers, mainly TSH. You should be aiming for a TSH of 1 or just under where most people feel well. However many GPs think that just being within the reference range is good enough. This is wrong.

As a thyroid patient you may well have to arm yourself up with a bit of information about your condition and challenge your GP's beliefs in order to feel well.

Have you had your vitamin levels tested?

When hypo we get low stomach acid which means we cannot absorb vitamins well from our food, regardless of a great diet. For thyroid hormone to work well we need OPTIMAL levels of vitamins. Have you recently or could you ask your GP to test levels of ferritin, folate, B12 & D3? Private tests are available, see link for companies offering private blood tests & discount codes, some offer a blood draw service at an extra cost. thyroiduk.org/help-and-supp...

There is also a new company offering walk in & mail order blood tests in London, Kent, Sussex & Surrey areas. Check to see if there is a blood test company near you. onedaytests.com/products/ul...

Only do private tests on a Monday or Tuesday to avoid postal delays.

It's ideal if you can always get the same brand of levo at every prescription. You can do this by getting GP to write the brand you prefer in the first line of the prescription. Many people find that different brands are not interchangeable.

Always take Levo on an empty stomach an hour away from food or caffeine containing drinks & other meds. Many people find taking it at bedtime works well for them.

Do you know if you had positive thyroid antibodies? Many with autoimmune thyroid disease aka Hashimoto's benefit from a gluten free diet. A smaller percentage of those also need to remove dairy from their diet to feel well. These are intolerances and will not show up on any blood test.

Recommended blood test protocol: Test at 9am (or as close as possible), fasting, last levo dose 24hrs before the blood draw, last T3 dose 8-12 hours before blood draw & no biotin containing supplements for 3-7 days (Biotin can interfere with thyroid blood results as it is used in the testing process)? Testing like this gives consistency in your results and will show stable blood levels of hormone and highest TSH which varies throughout the day. Taking Levo/T3 just prior to blood draw can show a falsly elevated result and your GP/Endo might change your dose incorrectly as a result.

[ChickieBaker in reply to Jaydee1507]

Thank you for that really comprehensive reply 😊 When my TSH numbers came down last time and she told me that I couldn't have anymore I had a right fit and said that obviously they would have come down but that's not the point 🤬🤬 That's why I armed myself with loads of evidence from both the NICE guidelines and the NHS website along with my litany of symptoms and choose a different doctor at my surgery, thankfully he was much more knowledgeable about the situation 😊

O.K so yes, I have Hashies, latest numbers are Thyroglobulin 462 ( range 0-115 ) and Peroxidaise 113 ( range 0-34 ). I have been gluten free for about 2 years, tried dairy free and it doesn't make a difference but I do drink Oatly so don't have a lot of dairy in my duet. My vitamins etc on my test end of July are :

CRP - 5.18 ( range less than 3 )

Ferritin -272 ( range 30-150 )

Folate -40.7 ( range 8.83-60.8 )

Vit B12 active - 150 ( range 37.50-188 )

Vit D -139 ( range 50-250 )

TSH -4.87 ( range 0.27-4.2 )

Free T3 -4 ( range 3.1-6.8 )

Free Thyroxine -13.3 ( range 12-22 )

Had my blood test done with Medichecks.

I do think that if my digestion and stress levels were addressed it would really help but I am just worried that he won't know what dosage I should be on because I certainly don't !!

Thanks again.

[Jaydee1507 Administrator in reply to ChickieBaker]

Your vitamins look good by most ranges alth you haven't included the ranges for them. Your CRP is slightly raised which may mean that your ferritin is falsely raised.

I have no doubt that you will be a lot more resilient to stress and your digestive issues will be much reduced if not cured once you get on the right dose for you of Levo.

Finding the right dose is a step by step process and I'd recommend posting your latest results here in a new post once you have them for members to comment.

The process of finding the right dose is to retest after 6-8 weeks on a stable dose as per our protocol. Increase by 25mcgs (when closer to optimal possibly 12.5mcg or alternate day dosing), repeat bloods in 6-8 weeks. Once you are closer to optimal (TSH at or just under 1) then test FT3 along with TSH & FT4 (may need to do this privately) to make sure you are converting T4 to T3.

Throughout this process you should be monitoring and supplementing vitamin levels as your thyroid hormone cannot work well unless your levels are optimal.

[ChickieBaker in reply to Jaydee1507]

I've edited my comments with the ranges now 😊 Last December when I had been on Levo for 3 months my TSH went down to 1.9, it usually hovers around the 4.5-4.8 I think. I can't really remember but I think I was on a similar dose, we might even have started at 50 and gone up to 75, but memory is not great ! I'll get them done by Medichecks again in 6 weeks and then I can get everything checked.Thanks.