Levo increase needed

[Dryski]

How can doctors expect hypothyroid patients to feel good with a free t4 at only 50 percent? Doesn't even make sense.

[greygoose]

Doctors don't care how you feel. They just want the numbers to be 'right'. And that means any old where within the range.

[Fruitandnutcase]

I know, I often wonder that myself that but if you look at your results you will find you are most likely ‘within range’.

[SlowDragon Administrator]

Because they don’t understand

Guidelines are clear …..but how many GP’s actually read the guidelines

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

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.

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...

endolri.org.uk/Referral/Hyp...

If TSH level is above 10 then routine levothyroxine replacement is almost always indicated.

·         Aim at full replacement rather than partial replacement.

·         In a patient with no other comorbidities or cardiovascular risk factors:

·         Age <50 and TSH <50 – give levothyroxine 100mcg once daily, then adjust as appropriate in 25mcg increments.

·         Age >50 or TSH > 50 - give levothyroxine 50mcg once daily for 1 month, then increase to 100mcg once daily, then adjust as appropriate in 25mcg increments.

·         Check TFTs for first time approx 2 months after reaching a dose of 100mcg daily

·         In presence of known or suspected ischaemic heart disease or unstable cardiac arrhythmias or cardiac failure:

·         Start with levothyroxine 25mcg daily, increase to 50mcg after 2 weeks if no adverse effects and then increase in 25mcg increments to 100mcg.

·         The aim of therapy is a free T4 and TSH in the normal range (TSH typically in the bottom half of the normal range for optimum replacement).

·         Once normal levels are achieved, TFTs may be monitored at increasing intervals and typically annually in the long term.

·         Achieving a fully euthyroid state biochemically is important prior to any planned pregnancy.

·         If TSH is >5 and <10 then a trial of treatment may be indicated if the patient has symptoms which might feasibly be caused by hypothyroidism (although in most cases they will not resolve and therefore be unrelated).

·         Typically we recommend to commence levothyroxine 100mcg once daily in such cases.

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

Cat_bluenote you might like some of these references for your GP

[Charlie-Farley]

I wrote this yesterday. I think it just about sums up their approach.

healthunlocked.com/thyroidu...

[Insomania]

”If your body needed more T4/T3, it would make more.”

So said patronising NHS/Private endocrinologist, who also agreed my thyroid (with noticeable goitre) was “struggling.”

He had seen patients like me improve with antidepressants.

Ffffffffs

(Got a different Dr who aims for T3 in upper range/optimum based on symptoms.)

[Brightness14]

What would that Dr say to me. I have no thyroid, answers must be polite please.