Am I on the right dose?

[catpurple7]

I posted my latest test results on here the other day and had some great advice but I wondered if I'm on the right dose of levothyroxine?I'm taking 100mcg daily

TSH 0.01 mU/L 0.30-4.20

T4 17.6 pmol/ L 9.0-19.0

T3 4.5pmol/L 3-5.4

[SlowDragon Ambassador]

Free T4 (fT4) 17.6 pmol/L (9 - 19) 86.0%

Free T3 (fT3) 4.5 pmol/L (3 - 5.4) 62.5%

How do you feel?

Ft4 is nudging a bit high

Do you always get same brand levothyroxine at each prescription

You might consider tiny reduction eg 87.5mcg once a week and 100mcg rest

That might make Ft3 reduce or it might stay as is or possibly even increase

[catpurple7 in reply to SlowDragon]

Yes i always get given Accord.

I'm so tired, doesn't matter how much sleep i have i wake up exhausted, brain fog, words and even sentences are a struggle

[catpurple7 in reply to SlowDragon]

SlowDragon, I've had an email from my Dr and she says she wants me to alternate daily between 100mcg and 75mcg, I haven't changed any dose as yet but you suggested 87.5mcg once a week. I'd really appreciate your advice 🙏 also how do I cut 87.5mcg?

[SlowDragon Ambassador in reply to catpurple7]

Well if you only have 100mcg tablets it would be difficult

You could try 75mcg one day a week initially

Make sure 75mcg GP is prescribing is same brand as your 100mcg

Accord don’t make 25mcg or 75mcg

Request extra 50mcg tablets and cut one in half to get 25mcg

so once a week you would take a 50mcg and half a 50mcg

[catpurple7 in reply to SlowDragon]

Thanks SlowDragon, i picked up the 75mcg today and it was Aristo. i asked what other doses they have of Accord but they only have 100mcg. I wonder whether to try and see if the dr would prescribe extra 100mcg and i can try and chop it up! 😂

[SlowDragon Ambassador in reply to catpurple7]

Aristo - Vencamil

Many members find this is by far the best brand

It’s lactose free and mannitol free

Aristo - Vencamil

Many members find this is by far the best brand

It’s lactose free and mannitol free

Vencamil often very well tolerated/best option for many people

How to get Vencamil stocked at your local pharmacy

healthunlocked.com/thyroidu...

Posts discussing Vencamil

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu....

[catpurple7 in reply to SlowDragon]

I didn't know anything about mannitol, do you know if Accord 100mcg contains it as i've tried to look at the ingredients but it just says lactose

[helvella Administrator in reply to catpurple7]

If it just says lactose, that is because it doesn't contain mannitol.

Not sure where you are looking, but section 6 of the Patient Information Leaflet lists:

Lactose

Magnesium stearate

Maize starch

Pregelatinised maize starch

Stearic acid

The Teva product contains mannitol and a significant number of members have problems tolerating it. But some members find it the best product they have ever taken. The mannitol content is suspected to be why - but that is not proved.

helvella - Thyroid Hormone Medicines - UK

The UK document contains:

Up-to-date versions of the Summary Matrixes for levothyroxine tablets, oral solutions and liothyronine available in the UK. These include declared ingredients for all UK-licensed products.

Details of every dosage of each medicine include PL numbers, PIP numbers, tablet markings, product history and links to:

Patient Information Leaflets

Summary of Product Characteristics

Product Assessment Reports

Dictionary of Medicines and Devices (dm+d) entry and current prices

Document has links to:

British National Formulary

NHS Drug Tariff, etc.

PLUS how to write prescriptions in Appendix F.

Also includes links for anti-thyroid medicines (but not product details).

Direct link to PDF:

📄 dropbox.com/s/bo2jzxucgp9hl...

Blog last updated 02/02/2025 - documents are regularly updated

Link to blog:

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

[catpurple7 in reply to helvella]

Thanks helvella 😊 i just wondered if mannitol could be the reason i have diarrhea most days thats all 😳

[helvella Administrator in reply to catpurple7]

Most pharmacists and doctors would insist the quantities - of lactose or mannitol - are too small to have an appreciable effect.

But I am not convinced.

As Accord does not contain mannitol, that will not be the issue for you while taking Accord.

You could seek to try Teva - and see if mannitol is actually better for you. Or, as already suggested, try Vencamil which contains neither lactose nor mannitol.

[catpurple7 in reply to helvella]

I was on Teva a few years ago but I felt horrendous on it

[SlowDragon Ambassador in reply to catpurple7]

Lots of members find lactose free levothyroxine works well

Suggest you try Vencamil

[DippyDame]

Most important question...."How do you feel?"

[catpurple7 in reply to DippyDame]

Tired 😴

[DippyDame in reply to catpurple7]

Anything else?

Full list of hypothyroid symptoms....

thyroiduk.org/signs-and-sym...

Have you optimised vit D, vit B12, folate and ferritin?

[catpurple7 in reply to DippyDame]

I think i have about 95% of the symptoms 😂

Vit D 108nmol/L 50-250

B12 875ng/L 180-900

Ferritin 77.3microg/L 30-336

Folate 11.4 microg/L 3.0-20.0

[FallingInReverse]

Did you ever sort out your HRT?

[catpurple7 in reply to FallingInReverse]

I did speak to my dr but she said the HRT that i would have to start on would give me periods again (and i don't want that) so to wait until i had gone 12 months without any. I did ask for my hormones to be checked, the results said normal

[FallingInReverse in reply to catpurple7]

You may want to Google the option of bioidentical micronized progesterone.

it’s indicated for its sleep and calming benefits. And I just looked it up and unless you have high enough estrogen level to build the uterine lining, taking it won’t cause withdrawal bleeding.

I’m early in my journey so still learning, but after a moment of feeling like I’d finally optimized my ft4/ft3 it seems my perimenopause wanted to mix everything up again!

I’ll be starting of bioidentical micronized progesterone as my next step, so will see how it goes.

Just sharing - as I’m taking it primarily for an awful fatigue that comes with vengeance the day I ovulate and get less noticeable day 1 of my period.

I guess you’re still peri… do you know if you ovulate at all? Ever track Basel temp or cervical mucous?

Again - just for thought, as I’m tackling similar sounding fatigue. There are lots more people here who know more than I do, but just sharing.

[catpurple7 in reply to FallingInReverse]

Thanks for the info, i'll have a look. I think i'm just in menopause as i've not had a period for a year 🥳

[FancyPants54 in reply to catpurple7]

You can start continuous HRT now then! Why has your silly GP said you have to wait longer. Ridiculous. You can start whenever you like. No need for periods. You need continuous oestrogen and progesterone. No gaps.

Please go and read up, listen to podcasts etc. at balance-menopause.com, it's a mine of up to date information and help. Unlike your GP. Read up and then go back and ask for what you want and ask for it now. There is always a risk of some bleeding in the first 6 months as your body gets used to things. But it soon passes and it's not like a period.