ive been on 25mg of levothyroxine for a few years and my doctor wants me to increase to 50. I was originally prescribed 50 a few years ago but my heart raced taking it so I was advised to take 25mg every 2 days then every other until I could tolerate 25. So I’m really anxious about taking 25 one day then 50 the next as I’ve been advised. Could I try halving a tablet to start with so I’m taking 37.5mg ?
thank you 🙏
I was advised to take 25mg every 2 days then every other until I could tolerate 25.
Is this how you still take it? That is only 12.5 mcg a day. Or are you taking a 25 mcg pill daily now?
Many people split pills if they need doses not available, such as 37.5 mcg.
Just out of curiosity: what is your diagnosis and the reason you were put on levo to begin with? 25 mcg daily is a very low dose, more like a starting dose in children and older people. It is usually not a dose you stay on as it can be enough to lower your own thyroid hormone production (by lowering the TSH) without replacing the missing hormone. 50 mcg is also a starting dose in otherwise healthy adults.
What do your lab results look like on this low dose?
I take 25mg a day atm I was ‘borderline’ when put in this but was symptomatic. I don’t sit any pills at present I just wanted to know if I could split a second tablet so I’m taking 37.5mg to begin increasing my dose to the 50mg the GP wants me to take. I dont have my bloodwork results but am aware I can access them.
If your doctor wants you to increase your daily dose, your lab results must show you are currently undermedicated. Unlike many other hormones, T4 has a long half-life so you do not need to take the same amount every day (or even take daily doses as pointed out). Some people who need say 137.5 mcg daily will take 125 and 150 mcg on alternate days, whereas others will take 125 + 12.5 mcg every day. Just do whatever suits you best and see how it works out for you.
Thank you. Goid advuce 👍
Many people do split pills and take half doses without issue.
Many also have no issue with taking slightly different doses each day. Levo is a storage hormone. In some cases a weekly dose is given, but that is more about testing compliance in patients suspected of not taking med consistently or at all, so not a suggestion just a example of how different daily dosing is not always an issue.
Lots prefer same daily dose as it’s to remember easier. I take an antithyroid and in the past taken different daily doses. I had to use a pill organiser or I wound never have remembered.
Poor nutrients can make Levo difficult to tolerate, do you have any blood test results?
TSH, FT4, FT3. Every had thyroid antibodies tested? Key nutrients are folate, ferritin, B12 & vitamin D.
Thank you for your answer 👍
I may invest in a pill cutter. I dont actually have my blood test results but the GP said I wasn’t making enough hormone. I also remember my original GP saying my antibodies were ‘up’. I’ve recently had folate, b12 and vit D done and was told they were all within range. I take a good quality but B complex as a kind of insurance though.
yes
Initially increase by half tablet per day
What were most recent thyroid results
TSH, Ft4 and Ft3
Standard STARTER dose levothyroxine is 50mcg …..so you are likely very hypothyroid and it can be difficult to increase dose….increasing SLOWLY often necessary
Retest after 6-8 weeks including vitamin D, folate, ferritin and B12
Then assuming sit need further increase then go up to 50mcg per day
what vitamin supplements are you taking
Thank you so much. Will do. I do t have my blood results atm.
I dont actually have my blood test results but the GP said I wasn’t making enough hormone. I also remember my original GP saying my antibodies were ‘up’. I’ve recently had folate, b12 and vit D done and was told they were all within range. I take a good quality but B complex as a kind of insurance though.
ALWAYS get actual results and ranges
Always test
Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results
endo.confex.com/endo/2016en...
endocrinenews.endocrine.org...
In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate folate supplement (eg Jarrow methyl folate 400mcg) and continue separate B12
Post discussing how biotin can affect test results
How old are you
Male or Female?
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.
Female and 62. Thank you for all this info!
Best Levothyroxine brand + can I chew the tablet?
Cutting 20mcg tablet into 4
Cutting Levo tablets 
Cutting Levothyroxin Tablets
cutting tablets into quarters
