I’ve been on a low dose of Levo for about 3 years. It took ages to get up to 50mg a day as I’m really sensitive to it. Because of palpitations, tummy upsets etc I now split 50mg into two separate doses ; 25mg in morning and 25mg at night and I’ve been fine doing this since December last year. My test results then were
T4 13.1 ( range 12-22). TSH was 4.89 ( range 0.27-4.2).
Last week I had them re done and they were T4 15.7 ( range 11-22) and my TSH was 5.43 ( range 0.27-4.2).
The tests were taken 24 hours after my last Levothyroxine tablet at 9am and I stopped supplementing ( vit D and b12 spray ) one week before.
My GP is calling me on Wednesday morning. I’d like to ask some questions about this and what it means but wondered if anyone could give me an idea on what they think it means? And any intelligent questions I could ask? I generally function ok but get a lot of muscle aches /pains ;( although it might be pushing my yoga too far!)..and I’m really anxious at times; especially with my health.
thanking you in anticipation. 🧘♀️
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MyOrangeDog
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Many people find TSH is around or below 1 when adequately treated
ESSENTIAL to test folate, B12 and ferritin at least annually
Test vitamin D twice year
No need to stop B12 or vitamin D, just don’t take on morning of test
50mcg is only the standard STARTER dose
Guidelines of dose Levo by weight
approx how much do you weigh in kilo
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.
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).
Assuming GP agrees to increase dose to 75mcg
Which brand of Levo is your 50mcg
Ideally stick with same brand for 25mcg
Initially if you want to increase slowly cut 25mcg in half and add 12.5mcg per day
Then after 6-8 weeks…..look at increasing up to 75mcg daily
I find I am really sensitive too. After being on levo for three years and trying different ‘things’ I have (four weeks ago) increased from 100 mcgs to 106.25 mcgs by cutting a 25 mcg pill into four. Even that has had its problems but I think it’s settling now.
I texted my gp last week along with my test results, TSH 4.8. I asked direct for an increase from 50 to 100 in 25mcg steps. Got a text Friday, he agreed and I will pick it up from pharmacy this week. I find with my gp that the direct approach seems best.
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