hello, I have recently been diagnosed with Hashimoto’s, although due to a subclinical thyroid I’ve been taking 25mcg levothyroxine for past 4 years or so.
My latest bloods were TSH 4.36 (0.27-4.2)T4 15.8(12-22), T3 3.4(3.1-6.8)
Ferritin 182(30-332), Vit D 82(50-250),B12 active 77.7(>37.5), serum folate 13.2(>7)
The Endo suggested increasing my levothyroxine dose to 50mcg and retesting in 8weeks or so. The aim is to get my TSH <2.
After taking the increased dose for 2 weeks or so I was getting heart fluttering & palpitations. So been advised to alternate 50/25mcg every other day.
Silly Q but do I just cut the 50mcg pill in half on my 25mcg days or get another prescription for a 25mcg dose? If the latter, should I sure they are the same brand? My pharmacy have changed my brand twice in past month!
Any help greatly appreciated
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Myfanwy2022
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However, I have long felt that the same dose every day is the best for me. Therefore, I'd ask for 25 microgram tablets only. And split so as to take one and a half every day. One problem is that prescribers and some pharmacists are sometimes not happy with splitting. They say that you might not get the same dose every day if the split is imperfect. But it must be better than alternating 25 and 50! (Losing crumbs is a possible issue. )
Many find changing makes is a problem - but others seem fairly tolerant.
helvella - Thyroid Hormone Medicines - UK
The UK document contains up-to-date versions of the Summary Matrixes for levothyroxine tablets, oral solutions and also liothyronine available in the UK. Includes injectables and descriptions of tablet markings which allow identification. Latest updates include all declared ingredients for all UK products and links to Patient Information Leaflets, Dictionary of Medicines and Devices (dm+d), British National Formulary, etc. PLUS how to write prescriptions in Appendix F.
Also includes links for anti-thyroid medicines (but not product details).
Hi, it will take the body time to adjust to dosage changes especially when you have been on 25mcg for so long.Yes you can cut the 50mcg pills in half.Try and stick to the brand that suits you best.You can contact your pharmacy and ask that you only receive that brand in future.I did this after receiving diff brands and now I only get Accord.
Can you edit your post to add the ranges for your results (in brackets after readings) as these can vary between laboratories.
As TSH should always be under 2 and many members here reporting they feel best when TSH drops to 1 (or under), you have quite a way to go.
Like you, I experienced adverse (‘hyper’ like) symptoms of fast pulse, palpitations etc when trying to increase Levo. What I’ve found helps is going ‘low and slow’ when making adjustments.
I use a pill cutter to split my tablets. I personally have 2 different brands for the 50mcg and 25mcg tablets which I can tolerate, but many members prefer to stick with just one brand that suits them best. If you find one brand suits you, you can ask your GP to write this on your prescription (eg mine says ‘Almus or Mercury Pharma only’).
I like to make adjustments super slowly… rather than adding the 25mcg in one go, I like to add 12.5mcg to the 50mcg as a first step until well tolerated (ie cutting the 50mcg into quarters- but don’t stress if they are not all equal- if you take over 4 days it will even out!).
It is important to recheck levels 6-8 weeks after being in a consistent dose. Like your endo advised, I actually prefer to wait the full 8 weeks as it can take my body 2 months to ‘feel the benefit’ of the increase.
I will add reference ranges as requested thank you.
So much useful info here too - thanks so much . I must admit it took a good two weeks of being on the 50mcg before the heart palpitations and jitteriness etc started - but I’d had no warning this could happen - scary!!
Could you please advise what you mean by “well tolerated” and roughly how long you would expect to take between 12.5mcg increases pls? although I know this is not an exact science.
I’ve had so many odd symptoms like dry headache and jitteriness since upping dose that I’ve only just connected all the dots. I thought I had a virus!
I hadn’t even realized it would be a gradual further increase of dosage before my TSH finally drops to <2. I think I need to do more research! This forum is so helpful!
‘Well tolerated’ for me means I have no adverse symptoms from an increase in medication (in my case- palpitations, increased anxiety, fast heart rate). It took me many months to reach my optimal dose of Levothyroxine. Some members report achieving this more quickly…. But I’ve personally found I’m better taking things more slowly (ie more tortoise, less hare!)
due to a subclinical thyroid I’ve been taking 25mcg levothyroxine for past 4 years or so.
Levothyroxine doesn’t “top up” failing thyroid, it replaces it
This is because once we start on levothyroxine, pituitary reduces TSH - the message asking your own thyroid to make Ft4 and Ft3
So this is why standard STARTER dose is 50mcg (or 25mcg if over 65 years old) …..but then dose should be increased SLOWLY upwards, usually in 25mcg steps until on approximately full replacement dose. This is typically approximately 1.6mcg per kilo of your weight per day
Having been left incorrectly on extremely low dose for far too long it can be difficult to increase and smaller increase of 12.5mcg daily may be easier to tolerate
Adults usually start with a dose between 50 micrograms and 100 micrograms taken once a day. This may be increased gradually over a few weeks to between 100 micrograms and 200 micrograms taken once a day.
Some people need a bit less than guidelines, some a bit more
TSH should be under 2 as an absolute maximum when on levothyroxine
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).
Many, many patients find it hard to tolerate starting on more than 50mcg. But they still need to increase dose as fast as tolerated
The optimal daily dose in overt hypothyroidism is 1·5–1·8 μg per kg of bodyweight, rounded to the nearest 25 μg. In younger patients with no substantial comorbidities, the full required dose can be given at the start of treatment. Clinicians should consider starting levothyroxine at a dose of 25–50 μg/day, with subsequent titration in adults aged 65 years and older and in those with a history of cardiovascular disease, as excessive doses of levothyroxine might result in worse cardiovascular outcomes, especially in older patients.
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