Latest bloods and increasing Levothyroxine

[Chasing-rainbows]

Please have a look at my latest blood test results. Diagnosed with autoimmune thyroid disease. Currently taking 50mcg.Not currently taking any other vitamins, but happy that I've managed to increase my ferritin from 20 to 51 since my last results.

Any tips on whether I should be taking anything else based on these results?

[SlowDragon Administrator]

FT4: 16.4 pmol/l (Range 12 - 22)

Ft4 only 44.00% through range

FT3: 4.6 pmol/l (Range 3.1 - 6.8)

Ft3 only 40.54% through range

Shows good conversion but inadequate dose levothyroxine

Contact GP for next dose increase in levothyroxine up to 75mcg daily

Which brand of levothyroxine are you currently taking

Retest again 6-8 weeks after increasing dose

[Chasing-rainbows in reply to SlowDragon]

GP has agreed to increase to 75mcg thankfully. My last tsh six months ago was less than 1. Does this suggest thyroid beginning to struggle as time goes by? I'll retest in 6-8 weeks.

Do the vitamin levels look OK?

[SlowDragon Administrator in reply to Chasing-rainbows]

Ferritin you are working on

Folate - are you taking vitamin B complex

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

So it’s normal to need to increase dose levothyroxine

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.

[Chasing-rainbows in reply to SlowDragon]

Not currently taking b complex though have taken Thorne b in the past. Can restart that. Levothyroxine brand is teva currently.

That makes sense about the doses, I'll make sure to keep a more frequent eye on my levels. Surprising how quickly the time seems to pass between blood tests.