How soon can levothyroxine be increased?

[Conkerlover]

I'm hoping someone can help me, my husband was diagnosed with hypothyroidism aprox 2 months ago and has been on 100mg of levothyroxine per day since. So far it appears that he still has loads of symptoms and from looking back at his blood tests he is anemic, has kidney issues, liver issues and super high cholesterol - we have private medical insurance so would the treatment be any different than nhs? He's basically been given pills and told to crack on for 3 months then go back for further blood tests. The GP won't treat anything else yet as thinks it's probably all linked to the thyroid. He's always been as strong as an ox and really healthy so it's come as a bit of surprise

Any help much appreciated

[Buddy195 Administrator]

Welcome to the forum Conkerlover

So we can offer better advice, can you share your husband’s blood test results (with ranges in brackets) for:

TSH

FT3

FT4

Plus any antibody and key vitamin tests (ferritin, folate, vitamins D and B12)

If your GP is unable to complete all the above (eg if TSH is within range, some surgeries may not be able to access FT4 and FT3 tests), you could look to do this privately, as many forum members do, for a better picture of your thyroid health:

thyroiduk.org/help-and-supp...

I would certainly get all the above tested before considering private options. By doing this, you will have all the important tests prior to seeking an endo consultation. Before considering a private endo, also share all test results with us and ask members for a recommendation in your area.

Your GP should be retesting thyroid levels 8 weeks after starting treatment, as this is the time dosages can be adjusted. Remember you are legally entitled to copies of all tests, so do ask for a print out if you can’t access these on line. We also need to see ranges- as these can vary between laboratories.

[Conkerlover in reply to Buddy195]

Thank you for your response - I tried to upload screenshots but had issues so hopefully below makes sense - it's the tests that were out of range

Tsh - >100 mu/l (0.35 - 4.94)

T4 - 5.4 pmol/l (9 - 19.1)

Red blood cell - 4.17 (4.5 - 5.5)

Haematocrit- 0.389 (0.4 - 0.5)

Basophil count - 0.12 (0.0 - 0.1)

Serum cholesterol - 9.4 mmol/l (3.6 - 5)

Serum creatinine - 115 (59.0 - 104.0)

Serum alanine aminotransferase 60 u/l (<45)

[greygoose in reply to Conkerlover]

Are those his results at diagnosis? Or on 100 mcg levo? Not surprising he has lots of symptoms. And he's been on that dose for two months? He needs to go back to his doctor and either get a retest (if he hasn't had one) or an increase in his dose of levo. His TSH and FT4 really are bad on that test.

Levo can be increased by 25 mcg every six weeks to begin with. But as he gets nearer his sweet-spot, it's wise to make smaller increases and wait longer so as not to over-shoot it. But your husband is a long way off that! Poor man, he must feel dreadful.

[Conkerlover in reply to greygoose]

Thank you. It's the test results at diagnosis and they put him on a starting dose of 100 mcg and told him to come back in 3 months to be retested and dose adjusted, 3 months just seems so long when living with feeling awful- he works a manual job and he's a hands on dad too. So the first step should be retest and see where everything is now?

Thanks for all your help

[RedApple Administrator in reply to Conkerlover]

Typical starting dose of levothyroxine is lower (50mcg) with a retest in 6 weeks or so and subsequent dose increase, usually in 25mcg increments. The GP has fast forwarded the dose by starting with 100mcg, so the three months wait for retest isn't that unreasonable. But no harm in asking for a test sooner, if only to put your minds at rest. Starting replacement hormone isn't a quick fix. It takes time for the body to adjust to getting it's thyroid hormone through the digestive system in big dollops, rather than naturally trickling out from the thyroid.

[greygoose in reply to Conkerlover]

I expect they put him on such a high starter dose because his FT4 was so very low. But they don't really understand how to treat hypo. And three months is far too long for a retest! But, knowing how their minds 'work' I imagine they thought a high dose needs longer to settle. That's their type of 'logical' thinking but they really don't understand how it all works.

So, as he feels so terrible - which is not unexpected! - and he's been on that dose for two months, I think he should contact his doctor and insist on a retest and increase now. As he's a man, they might listen to him!

[Buddy195 Administrator]

I would ask GP for a retest after 6-8 weeks of commencing Levo (in first instance). Also ask for FT3, plus ferritin, folate, B12 and vit D. As my previous reply, your surgery (like many) may not be able to access FT3.

We advise an early morning test (as TSH highest at this point) and to leave the daily Levo dose until after the blood draw.

[JoBarr31]

Has your husband experienced any stressful events preceding his diagnosis? In my experience (of being diagnosed with ulcerative colitis and hashimoto’s) both were brought on by emotional trauma. Might be worth exploring if this resonates.

[Conkerlover in reply to JoBarr31]

Yes!!! This sounds ridiculous but he fell into a ditch at home and landed backwards on a piece of wood jutting out and stabbed himself in the lower back, luckily missing major organs. We had initially put the thyroid symptoms down to that as the hospital (despite many scans) left debris in the wound so it didn't heal properly and he had to have lots of antibiotics. Following this he then had a severe case of shingles - for a man that hasn't been to the doctors in 20 years then he's barely left in the past 5 months or so!

[pennyannie in reply to Conkerlover]

It is not ridiculous at all - it sounds silly, especially considering who and what he is and did.

That was a massive shock to his symptom -

Do you have an inflammation blood test marker there as well ?

He needs to rest up - and try and turn off the ' what if ' in his head :

[JoBarr31 in reply to Conkerlover]

Oh my goodness - that is SO traumatic and not at all ridiculous.

If he has been on lots of anti-biotics it may be worth visiting a nutritionist or homeopath to help his gut lining heal. If the gut lining is impaired this has a MAJOR knock on effect to all systems.

I bet he’s feeling low too so some lovely natural healing practices may be a great addition - think yoga nidra, nature walks if he’s up to it, breath work to help balance the fight/flight response, nervous system etc.

There is so much we can do to heal ourselves, as well as taking prescription medication.

Good luck to you both ☺️

[Conkerlover in reply to JoBarr31]

Ah thank you for your message - I'm a big believer of gut health and have him on pre and pro biotics as well as home made yogurt, sourdough bread and fermented foods. Unfortunately it just takes so long to see a difference

[JoBarr31 in reply to Conkerlover]

That sounds amazing but, yes, the dietary route can take time - there are very good gut healing supplements to speed up the process but that is best left to a qualified nutritionist to advise you on.

What I would say, through personal experience and after extensive research into auto-immune disease, is focus on getting his nervous system in check. If he is calm and emotionally balanced (as much as any of us can be!) and gets good quality sleep/rest, his body will know how to heal.... with the help of nutrition, which you're across, and medication to support.

Don't forget to take care of yourself too ConkerLover - this must be a stressful time for you as well.

[Conkerlover]

Hi all, I managed to get the doctor to retest but unfortunately they only did tsh and t4 which have improved, but tsh is still 25.38 (0.35 - 4.94), t4 is now within range. I'm going to get a medichecks full blood work done as he still has so many symptoms, primarily aching all over and painful feet? They've upped the thyroxine to 125 from 100

Any ideas on anything to improve the aching? Is there any vitamins / amino acids which help?

Thanks for all your help

[Lulu2607 in reply to Conkerlover]

Hi Conkerlover . Vit D might be low, it's worth checking, and low vit D causes all sorts of issues. Don't accept a result of 'normal' as thyroid patients need it to be high in range The Better you vit D +K2 spray (try Boots) is recommended on here a lot. It will take a while to feel better. My TSH of 160 and T4 too low to measure took 6 months to come into range and my symptoms bounced all over the place in that time . It took another 6 months to feel a lot better. It could take many months for your husband to recover and it will always be an ongoing project. Lots of trial and error with diet and he will need to prioritise his health.

[SlowDragon Administrator in reply to Conkerlover]

Get his vitamin D, folate, ferritin and B12 levels tested

Then supplement if necessary

Test vitamin D via NHS private testing service

vitamindtest.org.uk

Request folate, B12 and ferritin included at next test

Vitamin D

NHS Guidelines on dose vitamin D required

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

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...

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

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

vitamindsociety.org/pdf/Vit...

Once Improve level, very likely 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...

It’s trial and error what dose we need, with thyroid issues we frequently need higher dose than average

Vitamin D may prevent Autoimmune disease

newscientist.com/article/23...

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...

[wilson123456]

Maybe add selenium to the list .. helps synthesize thyroid hormones, maintains thyroid tissue, and protects the thyroid from oxidative stress. I've been diagnosed with hashimoto's for over 10 years , my GP has no clue whatsoever , he said of your Tsh doesn't improve we will take the thyroid out like mine , I literally ran out the door and changed , 1. Get a full thyroid panel done with genova diagnostic and check all thyroid markers not just TSH. Then a heavy metal test and check too see if there is any heavy metals present. Selenium is vital for thyroid function.I've done literally 100s of test on my blood markers and Vit d , magnesium was very low .

Then I supplemented on T3 which was the game changer , my tsh went from 15 to 3 in range , I had to micro dose this as t3 increases metabolic rate but this is all self funded so GP won't prescribed this. The thyroid is such a complex organ and so many factors can contribute to its downfall.

It's stressful and a lot of chasing around to see what is effecting the thyroid, and expensive ! Started to add Lugols iodine to my diet and will wait to see my private blood results soon with a full nutreval test also added to the list.

Unfortunately you will have to be your own doctor on this subject as the GP won't ask you any another questions on your lifestyle etc etc it's just take thyroxine for the rest of your life start at 125 then come back and see me in 3 months - clueless so clueless I get so upset with the people suffering from this condition and the GP just say take thyroxine where this is much more complex .

Good luck