I’ve recently increased Levothyroxine to 50mg, was on 25mg since 2015 but symptoms much worse now. I had recent lids done in 12 March and having next one in May. Unfortunately my blood test was done mid afternoon as only one available at the time, next is early morning.
I’ve put my results in the calculator but not sure how to interpret them. My symptoms are no better.
TSH: 9.4 mU/l (Range 7 - 17) 24.00%
FT4: 3.19 pmol/1 (Range 0.2 - 4.5) 69.53%
they do not test for T3. Any advice on what I should be asking when I next go would be much appreciated. I am on my knees everyday.
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Elvishaslefttheroom
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Unless extremely petite, likely to need further increase again in few months
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).
thank you, I will check the f4 TSH results as I had just took them from my doctors records. I will read your reply and links once my brain fog clears a little. 😊
Welcome to the forum, didn’t realise this was your first post
Were these tests when on 25mcg levothyroxine
Or have you retested after 6-8 weeks on 50mcg
Which brand of levothyroxine are you taking
You also need vitamin D, folate, ferritin and B12 plus thyroid antibodies tested too to see if your hypothyroidism is autoimmune
About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high TPO and/or high TG 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.
Significant minority of Hashimoto’s patients only have high TG antibodies (thyroglobulin)
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)
Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins
Testing options and includes money off codes for private testing
hi, not sure if I replied to you or not then or if I deleted my reply. I will read again and your links once my brain has cleared a little. Many thanks for your help 🙏
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