Re-tested, any thoughts on this ?

[Clementik]

Hi, I'm on levo for 2 months but last 6 weeks on 50mcg and been re-tested last week and just get results now but GP only tested TSH nothing else regarding thyroid ... I was feeling not best past two weeks and was hoping for dose adjustment but she said I'm on correct dose, but I feeling bit like before i started Levo

my TSH now is 3,31 mu/L (0,34 - 5,6)

SlowDragon your thoughts on this please ?

[SlowDragon Administrator]

so you need next 25mcg dose increase in Levo up to 75mcg daily

retest again in another 2-3 months

Which brand of Levo are you taking

Ideally don’t change brand when increasing dose

Only change one thing at a time

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).

Likely to need further increase (s) over coming 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

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

[Clementik in reply to SlowDragon]

I'm taking Accord 50mcg, Should i increase to 62,5 or straight to 75 ? how do you feel when increasing ? any worst for some time ?

I can cut Accord tablet to doses i needed as I also have 25mcg tablets MercuryPharma but never mixed two brands

why not to change brands or mix ?

My only issue is my GP want me to keep taking 50mcg so there will be just 56 tablets from her for 8 weeks so if i increase i will miss tablets then, where to i get them ?!

[SlowDragon Administrator in reply to Clementik]

My only issue is my GP want me to keep taking 50mcg

See different GP or thyroid specialist endocrinologist

On Levo TSH should ALWAYS be below 2

Most patients will have TSH around or under 1

Print out guidelines on dose by weight and politely but firmly insist on 25mcg dose increase in Levo with immediate effect

Even if you initially only increase by 12.5mcg for first few weeks

[Clementik in reply to SlowDragon]

I had already today morning 62,5mcg and hopefully will feel better any soon I will retest in 4 weeks to see where I'm ... If nothing change or feel bad again should go straight to 75mcg ? I have some more problems so difficult to say how i feel and what cause my feeling

[SlowDragon Administrator in reply to Clementik]

It’s common to initially feel worse as dose increases

You should start to see improvements after 6-8 weeks on each increase

Likely to need further increase over coming months

[Clementik in reply to SlowDragon]

So for now 62,5mcg but may need in future 75mcg u think ? in 2-3 months time

[SlowDragon Administrator in reply to Clementik]

Testing after 4 weeks is too soon

6-8 weeks minimum

[SlowDragon Administrator]

what vitamins are you now taking

healthunlocked.com/thyroidu...

Retest thyroid and vitamin levels at next test in 2-3 months

[Clementik in reply to SlowDragon]

I'm taking Vitamin D, Folic acid and B12 in the morning then probiotics and Iron in afternoon

[tattybogle]

hope these are useful :

healthunlocked.com/thyroidu... explanation-of-what-*high-tsh-is-telling-us-when-our-ft4-level-is-normal-on-levothyroxine-the-shoe-size-analogy.-*-over-2.5-3-ish

these references are useful to support request for dose increase from GP : healthunlocked.com/thyroidu.... my-list-of-references-recommending-gps-keep-tsh-lower-in-range-

[Clementik in reply to tattybogle]

Thank you, it was very helpful to read that ... is just my GP do not test anything else only TSH, no T3 no T4 so I have to test privately but not sure where as i had two test one from medicheck and one from blue horizon to test morning blood cortisol level and result been different and tooked sample at same time and last week i ordered HbA1c from Blue horizon and results was 40 and 2 days after NHS result was 38, i didnt know GP will test HbA1c otherwise i do not buy few days before from blue horizon