Help please ... : Hi, need some advice about my... - Thyroid UK

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Help please ...

Clementik profile image
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Hi, need some advice about my Levo dose ... I started Levo in 4/2024 due to my TSH almost 8 and many weird symptoms ... I been on 50mcg and after first 4 weeks I checked my keys vitamin levels and seen my TSH went down to 3,45 in short time ... after another 4 weeks my GP retested and my TSH was 3,31, I increase my dose to 62,5mcg as I wanted to have my TSH in lower half of the range due to high positive antibodies but my GP was against any increment as my TSH was in normal range but i still increased ... now i retested after another 8 weeks and my TSH is 5,13 ... see results attached. I already increased to 75mcg and will let know about it my new GP, also my endo is due in 12/2024 as I also got low testosterone level, still feeling bad my worst symptoms are bad heart function, irregular heartbeats - my heart skipping beats or adding extra beats, huge anxiety etc. but i may need to change my life style too ... my folate, B12 and ferritin increase a but vitamin D not, already changed vitamin D and dose too, I checked my cortisol multiple times always been ok

 SlowDragon

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Clementik
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SlowDragon profile image
SlowDragonAdministrator

Hardly surprising

Levothyroxine doesn’t “top up” your own thyroid….it replaces it

Likely to need further increases in dose over coming months

Retest 6-10 weeks after being on 75mcg Levo

Which brand of levothyroxine are you taking

Do you always get same brand

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 somewhere near full replacement dose (typically 1.6mcg levothyroxine per kilo of your weight per day)

cks.nice.org.uk/topics/hypo...

bnf.nice.org.uk/drugs/levot...

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).

low vitamin levels directly linked to still being hypo because of being on inadequate dose levothyroxine

Clementik profile image
Clementik in reply to SlowDragon

Will retest in 8 weeks then and I'm already on 75mcg for almost week, I taking Accord levo only as i don't want to mixed but i'm tired of cutting this meds it's crumble a lot i got 25mcg tablets from MercuryPharma but never mixed them, I'm currently 106kg but it's rollercoaster with my weight so what you saying is I have to increase slowly to 170mcg ?

SlowDragon profile image
SlowDragonAdministrator in reply to Clementik

so what you saying is I have to increase slowly to 170mcg ?

Well not necessarily…..but highly likely to eventually be on at least 125mcg or 150mcg daily

As dose levothyroxine slowly increases you may see weight begin to slowly decrease

Clementik profile image
Clementik in reply to SlowDragon

so I added another 12,5mcg and will retest in 8 weeks see where my TSH is and then add another 12,5mcg

SlowDragon profile image
SlowDragonAdministrator in reply to Clementik

Come back with new post with results after next test

You may need to wait and retest again in a further 8-10 weeks if results show not ready to increase yet

SlowDragon profile image
SlowDragonAdministrator

How much vitamin D are you taking

Are you taking any magnesium supplements

Aim to improve vitamin D to at least 80nmol

GP should prescribe 1600iu everyday for 6 months

NHS Guidelines on dose vitamin D required

panmerseyapc.nhs.uk/media/2...

But with thyroid issues we frequently need significantly higher dose vitamin D, especially if still on inadequate dose levothyroxine

GP will often only prescribe to bring vitamin D levels to 50nmol.

Some areas will prescribe to bring levels to 75nmol or even 80nmol

leedsformulary.nhs.uk/docs/...

GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)

mm.wirral.nhs.uk/document_u...

improving to around 80nmol or 100nmol by self supplementing may be better

pubmed.ncbi.nlm.nih.gov/218...

vitamindsociety.org/pdf/Vit...

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

Test twice yearly when supplementing

Can test via NHS private testing service

vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function.

There’s a version made that also contains vitamin K2 Mk7.

One spray = 1000iu

amazon.co.uk/BetterYou-Dlux...

Web links about taking important cofactors - magnesium and Vit K2-MK7

Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Recipe ideas

bbc.co.uk/food/articles/mag...

Interesting article by Dr Malcolm Kendrick on magnesium

drmalcolmkendrick.org/categ...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

Clementik profile image
Clementik in reply to SlowDragon

2000ui vitamin D at the moment and yes i do take magnesium too, GP do not prescribed anything she just told me to buy over the counter Vitamin D and take daily dose as my level is not bellow 25, I got those better you sprays

SlowDragon profile image
SlowDragonAdministrator in reply to Clementik

2000ui vitamin D at the moment and yes i do take magnesium too,

Suggest you increase vitamin D to at least 4000iu per day

Retest again in 2-3 months

You may need higher dose

Clementik profile image
Clementik in reply to SlowDragon

Ok thanx, will do that

SlowDragon profile image
SlowDragonAdministrator

anxiety and irregular heartbeat often result of being hypo

Folate on low side

B12 only just adequate

Exactly what B vitamins are you taking

Clementik profile image
Clementik in reply to SlowDragon

taking just B12 now, folate, Iron, D3+K2 and magnesium and selenium

SlowDragon profile image
SlowDragonAdministrator in reply to Clementik

rather than just folate try a vitamin B Complex 

Then once your serum B12 is over 500 (or Active B12 level has reached 70), you may be able to reduce then stop the B12 and just carry on with the B Complex.

If Vegetarian or vegan likely to need ongoing separate B12 few times a week

Highly effective B12 drops

natureprovides.com/products...

Or

B12 sublingual lozenges

uk.iherb.com/pr/jarrow-form...

cytoplan.co.uk/shop-by-prod...

In-depth article on different forms of B12

perniciousanemia.org/b12/fo...

B12 range in U.K. is too wide

Interesting that in this research B12 below 400 is considered inadequate

healthunlocked.com/thyroidu...

perniciousanemia.org/b12/le...

And why aiming to keep B12 over 500 recommended

perniciousanemia.org/b12/le...

Low folate

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/maintain B12 levels too

Difference between folate and folic acid

healthline.com/nutrition/fo...

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) and continue separate B12 until over 500

Post discussing how biotin can affect test results

healthunlocked.com/thyroidu...

helvella.blogspot.com/p/hel...

Clementik profile image
Clementik in reply to SlowDragon

thanx for all that, when I get back home end of the month will try to get good b-complex and start taking it now i got cheap one at home from H&B and there is folic acid in that one, for now i taking separate B12, Foloc acid, Iron, D3+K2, Magnesium, Zinc

SlowDragon profile image
SlowDragonAdministrator

also got low testosterone level,

This should improve as dose levo increases

Also low vitamin D and low testosterone are linked

frontiersin.org/journals/en...

Low testosterone when hypothyroid

thyroidpharmacist.com/artic...

goodrx.com/conditions/hypot...

You may eventually need to get testosterone treatment if remains low

Retest in few months once all vitamins are optimal and on roughly final dose of levothyroxine

Clementik profile image
Clementik in reply to SlowDragon

I'm going to endo in december so will see then where my Testosterone is and if will need therapy for it

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