Following on with update from last few posts...

[Applebud]

GP happy with levels, tried to explain info I've gleaned from advice here about 'range' but she was baffled. I've had a full blood count- all looks OK there. Gp spoke to endocrinology who were also happy with levels but suggested I tried low dose,25g, Levo and get tested in 6 weeks. I'm thinking that might be a good idea? Thoughts anyone? Thanks

[helvella Administrator Thyroid UK]

This is a link to a very good article in the British Medical Journal discussing what the 'normal range' really is. Very readable.

The normal range: it is not normal and it is not a range

helvella.blogspot.com/p/the...

Have to say, while it is possibly OK to start on 25 micrograms, I suspect you'd be OK on 50 micrograms. Do not let things meander along - ask when they will re-test, book appointments for blood test and follow-up, and be ready.

[Applebud in reply to helvella]

Thanks. She's asked me to make appointment for 6wks for more bloods.

[greygoose]

I doubt they'd be happy with those levels if they were their levels!

Unless you're over 65, starting on 25 mcg can be counter-productive. I think 50 would be much better with your low levels. But, I understand that neither your GP nor the endo she consulted have any notion of what it's all about.

but she was baffled.

🤣🤣🤣 Yes, I've seen that baffled look on many a doctors' face. No Idea what's going on!

[Applebud in reply to greygoose]

Not quite 65! I'm 59. Please can I ask why you think that taking 25mg is counter-productive? Also, on the info on the Levothyroxine it seems concerned about being over 50, why is that-do you know? Thanks again

[helvella Administrator Thyroid UK in reply to Applebud]

Typical wording from the Patient Information Leaflets is like this:

Adults over 50 years old, or patients with heart

disease

• for patients aged over 50 years, the starting

dose should be no more than 50 micrograms

per day

• for patients with heart disease, the starting

dose should be no more than 25 micrograms

per day or 50 micrograms on alternate days.

Your doctor may gradually increase your dose by

25 micrograms every four weeks until thyroid

deficiency is corrected.

That allows the starting dose to be 50 if over 50 years of age. Their issue is really heart disease. But even then, they allow the dose to be increased every four weeks.

There are lots of doctors who will keep the initial dose down to 25, and then delay increments to way over four weeks! Both unnecessary according to the actual PIL!

The Summary of Product Characteristics is even more open to higher doses and allows increments at three to four weeks!

Posology and method of administration

Posology

In younger patients, and in the absence of heart disease, a serum Levothyroxine (T4)

level of 70 to 160 nanomols per litre, or a serum thyrotrophin level of less than 5

milli-units per litre should be targeted. A pre-therapy ECG is valuable because ECG

changes due to hypothyroidism may be confused with ECG evidence of cardiac

ischaemia. If too rapid an increase in metabolism is produced (causing diarrhoea,

nervousness, rapid pulse, insomnia, tremors, and sometimes anginal pain where there

is latent cardiac ischaemia,) dosage must be reduced, or withheld, for a day or two,

and then re-started at a lower dose level.

Adults

Initially 50 to 100 micrograms daily, preferably taken on an empty stomach, at least

30 minutes and preferably 1 hour before food, ideally taken before breakfast or your

first meal of the day. Adjust at three to four week intervals by 50 micrograms until

normal metabolism is steadily maintained. The final daily dose may be up to 100 to

200 micrograms. The dose may need to be increased during pregnancy.

Elderly: As for patients aged over 50 years.

For patients over 50 years, initially, it is not advisable to exceed 50 micrograms daily.

In this condition, the daily dose may be increased by 50 micrograms at intervals of

every 3-4 weeks, until stable thyroxine levels are attained. The final daily dose may

be up to 50 to 200 micrograms.

Patients over 50 years with cardiac disease:

Where there is cardiac disease, 25 micrograms daily or 50 micrograms on alternate

days is more suitable. In this condition, the daily dosage may be increased by 25

microgram increments at intervals of every 4 weeks, until stable thyroxine levels are

attained. The final daily dose may be up to 50 to 200 micrograms.

For patients aged over 50 years, with or without cardiac disease, clinical response is

probably a more acceptable criteria of dosage rather than serum levels

mhraproducts4853.blob.core....

The problem is that as soon as you start any thyroid hormone, your TSH will drop. When your TSH drops, your own production of thyroid hormone will drop. If that drop were approximately equivalent to the 25 microgram tablet, then you wouldn't have got anywhere! But if you start on 50, then that will pretty certainly actually contribute positively to your thyroid hormone level.

Of course, this does cause a bit of an awkward conundrum in people who do have heart disorder and are over 50!