Pill not working?

[Graziella78]

I'm taking levothyroxiene 50 but i have symptoms. Why this is happening?

[Dahliasanddaisies]

Probably because it's not a large enough dose yet. You need to post your blood test results here and one of the moderators will looks at them for you x

[helvella Administrator Thyroid UK]

The most obvious suggestion is that 50 micrograms is an insufficient dose.

Few need that low a dose in the long term - it is most often a starting dose or a step (e.g. from 25 to something like 75, 100 or higher).

Have you had any recent blood tests? Probably a good idea to get hold of results (and reference intervals/ranges) and post again - or reply here - with those.

[Graziella78 in reply to helvella]

they gave me a 75 dose the first 3 months, but in april after anothr blood test he lowered to 50. i think it was better before

[SlowDragon Administrator]

50mcg is only the standard STARTING dose

Which brand have you started on

How long have you been on just 50mcg

Blood should be retested 6-8 weeks after each dose increase

Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Very important to test vitamin D, folate, ferritin and B12

Have these been tested

What vitamin supplements are you taking

[Graziella78 in reply to SlowDragon]

i have been on 50 dose from the end of april. i am taking only vitamin d

[SlowDragon Administrator in reply to Graziella78]

So book early morning test

And get vitamin levels tested

[SlowDragon Administrator]

Typically dose Levo is increased slowly upwards in 25mcg steps over 6-18 months

Retesting 6-12 weeks after each dose increase

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 (typically 1.6mcg levothyroxine per kilo of your weight per day)

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).

[SlowDragon Administrator]

come back with new post once you get results

Likely ready for next increase to 75mcg Levothyroxine daily