Update from 'thyroxine dosage' posted 7 days ago

[annofcloves]

Just got results from Monitor my health.

TSH- 1.96 (0.27-4.2)

T4- 16.8 ( 12-22)

T3- 4.3 ( 3.1-6.8)

Had taken 12 and a half levo from 27 May to 9 Jun, and on 22 and 23 June. Wonder if this dose is adequate as don,t feel any better if take more.

[SlowDragon Administrator]

standard STARTER dose levothyroxine is 50mcg daily unless over 65 years old.

Suggest you increase to 25mcg levothyroxine daily and retest in 8 weeks

Likely to need several further increases over coming year

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).

ESSENTIAL to test and maintain optimal vitamin D, folate, ferritin and B12

What are your most recent results

What vitamin supplements are you taking

[annofcloves in reply to SlowDragon]

Vit D- 99.4 50-99999.o

folate- 10.8 3.3-99999.0

ferritin- 59 30-400

b12- 583- 190-910

Since these results on 14 May have been taking 500 B12 and 7 iron supplements.

I weigh 7 and a half stone. Have battled with levo dose for 11 years!!! Large amounts are a no, no and I seem to feel just as well on 12 and a half levo.

[SlowDragon Administrator in reply to annofcloves]

Folate

Suggest you add a daily vitamin B complex

supplementing a good quality daily vitamin B complex, one with folate in (not folic acid)

This can help keep all B vitamins in balance and will help improve B12 levels too

Difference between folate and folic acid

healthline.com/nutrition/fo...

Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid supplements

thyroidpharmacist.com/artic...

B vitamins best taken after breakfast

Igennus B complex popular option. Nice small tablets. Most people only find they need one per day. But a few people find it’s not high enough dose

Post discussing different B complex

healthunlocked.com/thyroidu...

Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule) Thorne can be difficult to find at reasonable price, should be around £20-£25. iherb.com often have in stock. Or try ebay

IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 5-7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate folate supplement (eg Jarrow methyl folate 400mcg)

Other tests that are good indicators of wether you are hypothyroid

Low GFR (kidney function)

High cholesterol

Low heart rate (bradycardia)

High heart in more unusual cases

Plus all the usual symptoms

Cold, heat intolerance, weight gain/loss, gut issues, constipation, anxiety, depression etc etc

[annofcloves in reply to SlowDragon]

Thank you so much for your reply and help.

[Musicfrequency in reply to annofcloves]

It looks like you’ve got a lot of good advice already but I would just add that it’s seldom just one factor. It’s a very fine balancing act to getting it right and we are better judges of our bodies than doctors are. That said I also take Vitamin D supplements as they do such a lot of good as well. I seem to be doing ok on one a day for the B Complex. I’m due a review soon and some more blood tests will show if I’m optimising well. I got side effects from Levothyoxine so have not taken that in years and just stay with taking 2 x Metavive I in the morning an hour before breakfast and the same in the afternoon. It works for me but we’re all very different. Blood testing regularly will keep you on track. I wish you well. 😊

[annofcloves in reply to Musicfrequency]

Thank you so much for your input, I agree it is a balancing act!

[Madge72]

T 3 looks low....mine is 6.4

[annofcloves in reply to Madge72]

I am no better if t3 is higher. It was once 5.1 and I felt dreadful!

[Madge72 in reply to annofcloves]

It needs to be higherOne of the admins will get back to you they have helped me no end

You. need a balance.

[Madge72 in reply to Madge72]

Have you had a full private test thyroid Vitamins and iron

[annofcloves in reply to Madge72]

All these tests are listed above. I would add that I had no vitamins for 6 weeks before the test as I wanted a break before changing from synthetic to natural products. The products I now take are food grown-Wild Nutrition.

[Madge72]

Slow dragon has given her advice she is very goodIf you can follow it and see how you go

[geffers]

Hi

I can’t be of much help to you as all my past experience with Levothyroxine has been based on me applying trial and error based largely on how I feel taking different quantities until I have felt reasonably ok.

I have not particularly followed a scientific root as in my experience GPs appear to have little understanding or knowledge of thyroid problems and don’t want to spend time helping get best results for the patient.

[annofcloves in reply to geffers]

Like you over the years I have trialled and errored with dose. My doctor is quite happy for me to do this!

I have other health issues, mitochondria damage which means very low energy.

Polymorphisms in a gene which means I cannot tolerate most prescription medicines and have to take as little as possible of anything.

When started on levo 11 years ago I tolerated 37 and a half, but now find 12 and a half is all i can mange. This small amount does help and I am guilty of when feeling a little better of overdoing things!