My 92-year-old mum was only diagnosed as hypothyroid 6 years ago (a TSH of 7) and was put on 25 mcg of levothyroxine ever since, which brought the TSH into range, but only just. she has never had an increase in dose. Her last blood test showed a TSH of 5.67 (in a range up to 5) which her GP seems to think is fine, saying "It's just a tiny bit over" (!). So, why not just get it into range ?!? (T4 is low in the range and T3 not tested).
Although she is generally fit and well (always has been), she is falling asleep in the early evening and I feel that she should have an increase in levo (even alternating 25/50 to start with), and wonder if others feel the same. Also - should she push for a T3 test to back this up? She actually has a face to face appointment on Monday - first in many years!
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Kacey12
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Having a range does not mean that a result is fine if it's anywhere withing it it. A range is just a collection of results found in the general population - some of whom will probably have undiagnosed thyroid problems. Nobody suggests that the people at the tops and bottoms of these results are well, just that they have these results.
What you should be looking at is euthyroid (normal) levels. And a euthyroid TSH is around one - perhaps a tad higher at that age, but not over 2. So a TSH of 5.67 may be only slightly over-range, but is a lot higher than euthyroid.
So, yes, she very much needs an increase in dose, and her GP has been very negligent in not increasing it a long time ago, in accordance with the protocol of retesting six weeks after starting levo, and increasing dose by 25 mcg, and continuing like that until the patient is well.
Here is an article about ranges that you might find interesting. You could pass it on to your GP.
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 olderand 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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Levothyroxine absorption is enhanced during fasting and is reduced by many foods and beverages, particularly caffeine and milk. Patients should therefore be given clear advice that levothyroxine should ideally be taken on an empty stomach, with water, at least an hour before a meal.
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Although this approach promotes levothyroxine absorption, it might be too inconvenient for some patients to maintain compliance. Alternative strategies include taking levothyroxine at bedtime or taking levothyroxine consistently 30 min before breakfast.
If you have an underactive thyroid (hypothyroidism), treatment may be delayed until this problem is treated. This is because having an underactive thyroid can lead to an increased cholesterol level, and treating hypothyroidism may cause your cholesterol level to decrease, without the need for statins. Statins are also more likely to cause muscle damage in people with an underactive thyroid.
poor kidney function with low GFR and high creatine also linked to inadequate dose levothyroxine
i agree with you Kacey.... at least get it in range for heavens sake. I can't see any harm in pushing for her to try a small increase to 25/ 50 alternate (37.5mcg / day).
info in these 2 posts may come in useful for conversation with GP :
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