Hi I have been taking levothyroxine 50mcg since 2015 my dose has never changed as my GP always says my blood results are within range
I have never felt really well on levothyroxine and also the tinnitus I experience seems to increase a while after I take it. A friend said to try taking it at night but it doesn’t make any difference to when I take it in the morning.
I also have hearing problems am under ENT
I have B12 injections 3 monthly and also take Vit D tablets.
Any advice appreciated thank you
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Dukemaster
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Just being 'in range' is not good enough. It's not the same as optimal. Do you get a print-out of your blood test results? It's your legal right to have one. If you have them, post your results and ranges here and let's have a look. I very much doubt if 50 mcg levo is your optimal dose, it's a starter dose. And tinnitus and hearing problems can be hypo symptoms.
well as 50mcg is only the standard STARTER dose you are very likely in need of dose increase
Also low vitamin levels direct result
ALWAYS get actual results and ranges
Do you have recent results?
Which brand of Levo are you using
Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine
For full Thyroid evaluation you need TSH, FT4 and FT3 tested
Also both TPO and TG thyroid antibodies tested at least once
Very important to test vitamin D, folate, ferritin and B12 at least once year minimum
About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high thyroid antibodies
Autoimmune thyroid disease with goitre is Hashimoto’s
Autoimmune thyroid disease without goitre is Ord’s thyroiditis.
Both are autoimmune and generally called Hashimoto’s.
Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease
20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis
In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)
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)
Request new test via GP including vitamins
Also thyroid antibodies if not been tested
Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins
Testing options and includes money off codes for private testing
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
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.
Looking at previous posts 5 years ago
Extremely low/deficient ferritin
Essential to maintain GOOD vitamin D, folate, ferritin and B12
As you have B12 injections you should be taking a daily vitamin B complex…..are you?
How much vitamin D daily
Retest twice year
vitamin levels likely low BECAUSE only on starter dose levothyroxine
TSH should be under 2 as an absolute maximum when on levothyroxine
If symptoms of hypothyroidism persist despite normalisation of TSH, the dose of levothyroxine can be titrated further to place the TSH in the lower part of the reference range or even slightly below (i.e., TSH: 0.1–2.0 mU/L), but avoiding TSH < 0.1 mU/L. Use of alternate day dosing of different levothyroxine strengths may be needed to achieve this (e.g., 100 mcg for 4 days; 125 mcg for 3 days weekly).
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
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)
Post discussing how biotin can affect test results
Thank you I will look into that as well I’m going to get new private bloods after the holiday period as the next step thank you very much for all the replies and advice
I know when I am underdosed by the level of my tinnitus - for me it is the first sign I need to change my dose.
Never accept the GP "in range" statement. The ranges are wide, and you could be just a smidge off the bottom or just under the top. The difference to how you feel can be huge. Also I know sometimes my GP has not looked at the results.
You are legally entitled to all your results from your GP. Just ask, and there is no charge. That way you can take control of your own health by looking at the results.
You are legally entitled to all your results from your GP. Just ask, and there is no charge. That way you can take control of your own health by looking at the results.
When you see your results…..likely to be astonished at how minimal testing is
Frequently just TSH tested via GP
ESSENTIAL to get vitamin levels tested at least annually
I’m currently taking 50mcg levothyroxine have been since diagnosis 2015
I’m thinking to increase 25 mcg as my T4 is in the higher range to my T3.
Just wanted to see if it makes any difference as the GP doesn’t altar any dose if TSH is within range. I’m also searching for an understanding Endocrinologist looks like there are many out there.
I take 25mcg levothyroxine and 2 x 10mcg Liothyronine per day. I had radioactive iodine in Jan 24. I was given 100mcg levothyroxine in April 24, got hissing in ears and was admitted to A&E with suspected heart attack/ischaemic irregularity 5 hours later. Turns out I have an intolerance to levothyroxine. Since then have hissing tinnitus. Has this happened to anyone else?
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