Had my second opinion phone call with GP…lovely lovely lady doctor (the gp who started me on levo with no problem…did not alter my prescription (75mcg) when my tsh went below range). She listened, she had empathy, she said she had no problem with me trying an increase from 75 to 100mcg. It was a quicker “yes” than the “no” I had from the other gp last week! She was sooooo helpful and understanding and seemed genuinely happy to help! There are some good ones around!! Yippppeeeeeeee.
Now…small question…I was wondering about starting on alternate doses of 75/100 first before going up to 100. What do you think? I also thought if I was ok on that dose it might not make my tsh bottom-out next blood test on 8 weeks time (*same as it did last year when my tsh was 1.96 and I increased by 25mcg) * edited to add this info in.
Also….#usual panic mode/overthinking mode….my last tsh was 1.96 so do you think an increase will be ok?
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I would never dose by TSH alone, it is not a reliable marker for various reasons and it's high time medics acknowledged that this fixation is causing misery for so many....it is lazy doctoring!!
FT3 is the most important number followed by FT4....these are thyroid hormones
For good health every cell in the body must be flooded with T3 by way of an adequate and constant supply
Low T3 = poor health
TSH on the other hand, is a pituitary hormone, it is a messenger to the thyroid to produce more or less hormone depending on the serum level it detects...but it only detects combined T4 plus T3 level which doesn't give the whole story. For accuracy we need both Frees.
So...come out of panic mode, TSH is not your best guide but alas the NHS rely on it too much so we need to be one step ahead.
When I was first diagnosed TSH, FT4 and FT3 were all measured.....alas, no more!
Normally increasing hormone reduces TSH....but that is only reliable if the HPT axis is robust.
Your dosing protocol seems fine and this GP seems clued up....I would go straight to 100mcg daily and keep a note of your symptoms which must be included in diagnosis.
Adding a couple of links that should help reassure you
Thank you for your reply and your advice. I forgot to say I did a mmh test myself before the nhs tsh and the t3 was 3.4 on a range that I think started at 3.1. I think it may have been lower on this test than when i started levo…I need to look back at the results. I will have a look at the links now. Thanks again.
More or less, the closer you might be to your personal best levothyroxine dose, the slower you should make changes.
75 to 100 is a 33% increase.
75 to 87.5 is a 16.6% increase.
My choice, if your tablets allow, would probably be to increase to 87.5 for a while, a few weeks, then to 100 if you still think you want to. Even if that requires some tablet splitting.
Thanks, Helvella. Sounds like a good plan. I’m still mulling it over, but I might start a bit lower and then get an mmh full test done before i go for the nhs test.
To put a personal experience in there, I was on 100. But I felt under-dosed.
I got one lot of 12.5 (allowing my dose to rise to 112.5) but that formulation did not suit me. Spent ages (months) trying 125, but finding after a while, it felt like too much. So dropped down to 100. Or 100 alternating with 125. Indeed, I found I could cope with 125 for quite a while, then felt over-dosed. Or 100 and then felt under-dosed. And alternating never felt balanced to me - though many others find it acceptable. Eventually realised that splitting a 25 (so I was on 112.5 every day) worked better than any of the other approaches.
However, much later that didn't seem quite enough and I am now happily taking 125 every day and feel that is the best dose for me, at present.
Thank you! Sorry, I only gave half the story(got a bit over excited by the dose increase!). When i had my tsh checked in sept last year it also came back that time as 1.96 and when i increased from 50 to 75 the next test at 8 weeks showed my tsh slightly under range which was noted by the gp, but not acted on at that time because it was the same gp i spoke to today. I think any other gp would jump on the under range tsh and push me to reduce my dose so I’m a bit wary that the same thing might happen again.
Just for clarity, your most recent NHS test for TSH was less than 1.96 after 8 weeks of 75mcg?
How long ago was this test? If it’s been more than 2/3 weeks, I’d suggest retesting before you decide on your course of action. You’d be surprised how much of a difference a couple of weeks makes sometimes!
My latest nhs tsh was 1.96 on the 18th April 2024. I’ve been on 75mcg since September last year. My tsh in sept last year was also 1.96 and that’s when my gp increased levo from 50 to 75mcg and my tsh then dropped below range for a while before rising again.
Gotcha! That’s quite fortunate. Mine was under range with a FT4 at the top of the range at 100mcg, and two months later it was undetectable and my ft4 was over range! I felt awful!
Like helvella , suggested I would increase by 12.5mcg in the first instance. I find a pill cutter useful for this. I like to make low and slow increases.
Thank you, Buddy. I think I might try the low and slow. I know when i originally started 50 levo and then went from 50 to 75, I felt quite rough at first so maybe the smaller increase will make the full transition to 100mcg easier. What pill cutter do you use? I’ve just been looking for one but there are so many!! I need one to chop a small 25mcg in half.
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