Hello..
I’ve just joined this community and hoping to get advice along the way on how to manage my hypothyroidism. Only recently been diagnosed and prescribed levothyroxine 75 which has made me even more tired and unable to sleep. I’ve cut the tablet in half which has calmed down my symptoms so I’ll see how I feel in another week before informing my dr. Has anyone else had a similar experience . I know it could take some time before I get the dosage right.
Welcome to the forum CarolMSM
So we can offer better advice, can you tell us more about your thyroid condition, eg 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)
If your GP is unable to complete all the above (eg if TSH is within range, some surgeries may not be able to access FT4 and FT3 tests), you could look to do this privately, as many forum members do, for a better picture of your thyroid health:
thyroiduk.org/help-and-supp...
50mcg is the usual starting dose for Levothyroxine, so likely 75mcg was too much as a first step. You need to ask for a retest of levels 6-8 weeks after being on a consistent dose. Also worth asking GP for thyroid antibodies to be checked (to see if your condition is auto immune, aka Hashimotos) & key vitamins…if not, we recommend private testing for these.
The usualy starter dose is 50 mcg. Some people can tolerate more, some can't. Some even need to start lower. We're all different. But it sounds as if 75 mcg was too much for you as an individual. So, cutting the tablet in half was the right thing to do.
When were you told to go back for a retest? Because to get accurate results, you need to be on the same dose for at least six weeks. 
if your starting dose is 75mcg as a single tablet this will be Teva brand of Levothyroxine
Many people don’t tolerate Teva
So it may be the brand rather than the dose
Most easily available (and often most easily tolerated) are Mercury Pharma or Accord
Mercury Pharma make 25mcg, 50mcg and 100mcg tablets
Mercury Pharma also boxed as Eltroxin. Both often listed by company name on pharmacy database - Advanz
Accord only make 50mcg and 100mcg tablets. Accord is also boxed as Almus via Boots,
Wockhardt is very well tolerated, but only available in 25mcg tablets. Some people remain on Wockhardt, taking their daily dose as a number of tablets
Lactose free brands - currently Teva or Vencamil only
Teva makes 25mcg, 50mcg, 75mcg and 100mcg
Many patients do NOT get on well with Teva brand of Levothyroxine.
Teva is lactose free.But Teva contains mannitol as a filler instead of lactose, which seems to be possible cause of problems. Mannitol seems to upset many people, it changes gut biome
Teva is the only brand that makes 75mcg tablet.
So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half
But for some people (usually if lactose intolerant, Teva is by far the best option)
Vencamil (currently 100mcg only) is lactose free and mannitol free. 25mcg and 50mcg tablets hopefully available from summer 2024
March 2023 - Aristo now called Vencamil
healthunlocked.com/thyroidu...
healthunlocked.com/thyroidu...
Helpful post about different brands
healthunlocked.com/thyroidu...
List of different brands available in U.K.
thyroiduk.org/if-you-are-hy...
Posts that mention Teva
healthunlocked.com/search/p...
Teva poll
healthunlocked.com/thyroidu...
Once you find a brand that suits you, best to make sure to only get that one at each prescription.
Watch out for brand change when dose is increased or at repeat prescription.
Government guidelines for GP in support of patients if you find it difficult/impossible to change brands
gov.uk/drug-safety-update/l...
If a patient reports persistent symptoms when switching between different levothyroxine tablet formulations, consider consistently prescribing a specific product known to be well tolerated by the patient.
academic.oup.com/jcem/artic...
Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).
And here
pharmacymagazine.co.uk/clin...
Discussed here too
healthunlocked.com/thyroidu...
Thanks for the info…my dr has reduced my prescription to 50mcg so will see how I get on…I am gluten intolerant and try to stick to a low fodmap diet so I know mannitol might be a problem ..i’ll ring boots pharmacy tomorrow morning and ask them to not give me the one you mentioned .,thanks so much for your help..much appreciated.
Can you tell me what you think of my test results please.
TSH over 5 and Ft4 near bottom of range
Clearly hypothyroid
No thyroid antibodies or vitamin test results
The fact you are gluten intolerant strongly suggests your hypothyroidism is autoimmune
New 50mcg prescription, avoid Teva unless you know you are lactose intolerant too
Starting levothyroxine - flow chart
gps.northcentrallondonccg.n...
How long have you been gluten intolerant?
Retest thyroid levels and vitamins 6-8 weeks after each increase in dose of levothyroxine
It can take 3-5 months between each increase in dose
You will need several increases in levothyroxine over coming months/year
Typically dose is increased SLOWLY upwards by 25mcg at each increase. But some people have to go slower
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).
Thanks for your advice ..I don’t understand any of this yet but I suppose as time goes on I will
Welcome to the forum Carol! There's a lot to take in at first (especially if your assumptions include brain fog) but it's well worth persevering and reading a few links a day maybe? Don't try to read everything in one go but do keep trying if you can, it's well worth understanding as much as you can about the condition
Thankyou so much for your help and info…I’m hoping 50 mcg will just get me back to feeling normal then I can take it from there.
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