New test results: Hi, I began Levothyroxine in... - Thyroid UK

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New test results

Greyhound92 profile image
7 Replies

Hi,

I began Levothyroxine in May 2024 and started on 25mcg. This increased to 50 mcg (June 2024) and then more recently 75mcg (September 2024).

My TSH results are below:

Lab range 0.2-4.0

November 2024 3.9

September 2024 5.3

June 2024 5.1

May 2024 7.2 & 8.1

Note on lab range does say if on levothyroxine adequate replacement therapy indicated by TSH 0.2-2.

My doctor has messaged that my most recent test is normal and to stay on current dose of 75mcg. I think they have just looked at normal no further action on the header of the result and not at the note regarding adequate replacement indicates at 0.2-2.0.

Although my symptoms have improved I'm still not 100%. I still feel occasionally dizzy fatigued and some joint pain. However horrendously heavy periods have improved and can stay awake after work!

Should I be insisting the dose is raised to get TSH closer to 2.0 or is the GP right to be cautious as not to over medicate?

GP surgery previously refused to retest ferritin as was 17 (above the low of 15 on the lab range) and said to try iron supplements if I wanted to after this last blood test. Previous blood tests also showed am borderline perimenopause as FSH was 26. I am 47 years old. Vitamin D test refused also. However, I'm awaiting the results of a coeliac test.

Previous blood tests show high TPO and was started on levothyroxine due to strong family history of autoimmune disease (dad was type 1 diabetic).

Many thanks

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7 Replies
Insomania profile image
Insomania

Like you, I’ve had dreadful support with low iron from GPs. I couldn’t tolerate iron tabs so I was (eventually, encouraged by this forum) referred to nhs haemotology. Yeah they do take it seriously! I’ve had gastro investigations and I just had another nhs iron infusion when ferritin lowered to 46 because it’s impacted my thyroid hormones. You need good iron for thyroid meds to work.

Heavy periods, even if yours are now moderate, Tranexamic acid is a fantastic cheap treatment from GP that helps our iron. I just use it for first 48h. So good.

Greyhound92 profile image
Greyhound92 in reply toInsomania

Hi

Thanks for your reply. I have been prescribed transexamic acid and had helped a little. However, didn't need it at all this month which was great.

Did your GP refer you to haematology?

Insomania profile image
Insomania in reply toGreyhound92

Yes, the GP referred me, because I couldn’t take iron tablets (made gut issues worse).

while I waited for the NHS haemotology appt, i had my first iron infusion privately because I felt so unwell. By the time I saw consultant 3 months later, my ferritin was dropping again. I have iron deficiency anaemia.

SlowDragon profile image
SlowDragonAdministrator

My doctor has messaged that my most recent test is normal and to stay on current dose of 75mcg. I think they have just looked at normal no further action on the header of the result and not at the note regarding adequate replacement indicates at 0.2-2.0.

Yes make an appointment and request next increase

Which brand of levothyroxine is your 75mcg

Do you always get same brand

you MUST test vitamin D

How much vitamin D are you taking

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 with Hashimoto’s, 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...

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

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...

B12, folate and ferritin must be improved to optimal as well

Have you been improving low vitamin levels as detailed in previous post

healthunlocked.com/thyroidu...

SlowDragon profile image
SlowDragonAdministrator

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...

nhs.uk/medicines/levothyrox...

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

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).

sciencedirect.com/science/a...

The optimal daily dose in overt hypothyroidism is 1·5–1·8 μg per kg of bodyweight, rounded to the nearest 25 μg.

Greyhound92 profile image
Greyhound92 in reply toSlowDragon

Hi

Thanks for your reply.

I'm approximately 73kg.

I had stopped any supplements for the latest blood test, but aim to reintroduce the Better You sprays I have for B12 and Vitamin D. I'm also going to start taking Feroglobin liquid again.

I'm going to reply to the GPs message tomorrow and request a further increase.

Last levothyroxine meds were Teva brand and I have been OK with them.

I may look into private testing for ferritin and vitamin d if I don't improve further.

I do feel much better than I did in April/ May but am not yet back to running or going to the gym.

SlowDragon profile image
SlowDragonAdministrator in reply toGreyhound92

aim to reintroduce the Better You sprays I have for B12 and Vitamin D

With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a separate B12 supplement

A week later add a separate 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.

How much vitamin D are you taking

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