Starting Thybon

[Aldo1]

I’m on day 3 of taking 5mg Thybon (aim is to build it up but I’m going very slow) was on eltroxin 50mg but my Doctor recommended me come of that & just go with the Thybon. I had tried NP Thyroid previously but couldn’t handle it - high HR, headache & palpitations - feeling really awful so I went back on eltroxin. That was about 6 months & I decided to try again now. I’m feeling a little off now, HR is normal & have no palpitations but I have some chest pain, a slight headache & feel very tired - is this normal? I can’t stop thinking about it so maybe I’m not helping the situation.

[Buddy195 Administrator]

Welcome to the forum Aldo1,

So we can offer better advice, can you tell us more about your thyroid condition, eg when you were diagnosed, ongoing symptoms, plus blood test results (with ranges in brackets) for:

TSH

FT3

FT4

Plus any antibody and key vitamin tests (ferritin, folate, vitamins D and B12)

Are you taking any Levothyroxine (eltroxin) in a combination dose or did you stop completely to start mono therapy (Liothyronine Thybon)?

[Aldo1 in reply to Buddy195]

Thank you so much for your reply Buddy195.

About 10 years ago my GP said I needed to take eltroxin (25mg) - I never asked any questions & I really didn’t know or think anything of it. I took it all them years but the last 3 years I’ve not been feeling great - my main symptom is constipation & pain, I went to the GP so many times, various other doctors re the constipation & I was told everything was fine/normal but take this or that & nothing ever helped. I also have very dry skin, eyebrows thinning, weight gain & energy levels can be bad at times.

I finally got to see a Doctor who is more informed with the thyroid & this is where I got the NP Thyroid & now the thybon.

I do not have any recent iron or Vit D tests but my iron has always been low from previous tests.

I’m not taking eltroxin now - day 4 of 5mg Thybon & no eltroxin. I had been taking 50mg eltroxin, just less than a year ago I had asked my GP could I increase my eltroxin to see if that would help, which it didn’t.

recent bloods:

TSH - 1.010 (0.35 - 5.5)

FT4 - 16.00 (11.9 -21.6)

FT3 - 4.32 (3.1 - 6.8)

Anti TPO - 57.4 (34.0)

Anti TG - 86.1 (115)

I’m also gone gluten free since I started thybon.

[Buddy195 Administrator in reply to Aldo1]

We recommend you retest thyroid’s 6-8 weeks after being in a consistent new dose. Do share the new results with us when you get them. Definitely also test key thyroid vitamins (at least once a year).

[Aldo1 in reply to Buddy195]

Thank you. Do you think it’s normal to feel kind of worse now until my body gets used to the thybon?

[SlowDragon Administrator in reply to Aldo1]

I had been taking 50mg eltroxin, just less than a year ago I had asked my GP could I increase my eltroxin to see if that would help, which it didn’t.

recent bloods:

TSH - 1.010 (0.35 - 5.5)

FT4 - 16.00 (11.9 -21.6)

FT3 - 4.32 (3.1 - 6.8)

Anti TPO - 57.4 (34.0)

Anti TG - 86.1 (115)

These results were after being on 50mcg levothyroxine?

This is only the standard STARTER dose levothyroxine

Free T4 (fT4) 16 pmol/L (11.9 - 21.6) 42.3%

Free T3 (fT3) 4.32 pmol/L (3.1 - 6.8) 33.0%

These results show you are ready to increase levothyroxine to 75mcg

Retest again in 6-8 weeks

Then likely further increase

ESSENTIAL to test vitamin D, folate, ferritin and B12

What vitamin supplements are you taking

high thyroid antibodies confirms autoimmune thyroid disease

[Aldo1 in reply to SlowDragon]

Hi SlowDragon, yes them results were when I was on 50mg eltroxin only. Due to my reaction to NP thyroid my doctor wanted to try me on Thybon only to start and at a small dose. After 2 weeks I don’t think it’s going to work for me - I’m getting a really bad pain in the top of my stomach, is that a normal side effect?

I didn’t get vit d etc tested but I will now & I’m not taking any supplements at present. I don’t know where to start or what is right or wrong. I thought I’d be feeling better but now all that has happened is my worry has increased as to what the hell I’m going to do. You have to wait weeks on end to hear back from the doctor here.

[SlowDragon Administrator in reply to Aldo1]

Why did you not just get Levo dose increase after this test

50mcg is only standard starting dose

Typically dose Levo is increased slowly upwards until on approximately 1.6mcg per kilo of your weight per day

Hashimoto’s - if not already on gluten free diet

You need coeliac blood test before considering trial on gluten free

[Aldo1 in reply to SlowDragon]

This is what my doctor told me to do, I thought I was doing the right thing. I’ll look for a coeliac blood test too.

[Buddy195 Administrator]

This happens to many members. I never got the ‘eureka’ moment of suddenly feeling well; I had a period of feeling worse before feeling better. Likely you may need more T3 in the long run, but from experience, I would go low and slow when making changes so you don’t miss the sweet spot where you feel most well.

[Aldo1 in reply to Buddy195]

Thank you so much Buddy195.

[SlowDragon Administrator]

which brand levothyroxine is 50mcg

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

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.

Some people need a bit less than guidelines, some a bit more

TSH should be under 2 as an absolute maximum when on levothyroxine

gponline.com/endocrinology-...

Graph showing median TSH in healthy population is 1-1.5

web.archive.org/web/2004060...

Comprehensive list of references for needing LOW TSH on levothyroxine

healthunlocked.com/thyroidu....

onlinelibrary.wiley.com/doi...

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).