Dosage

[Bridkid67]

Iam currently on 75mcg of levothyroxine and had all brands ie teva crescent and wockhartd etc excuse if I seem a bit thick lol why can I not take one 75mcg like crescent pharma do instead of taking one 25mcg and one 50mcg?

[SlowDragon Administrator]

Up until recently only Teva made 75mcg tablets

Now Vencamil also do 75mcg

75mcg tablets are not cheaper for NHS

what were your last thyroid and vitamin results and ranges

75mcg is very low dose, especially for a bloke

How long have you been on 75mcg

Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine

For full Thyroid evaluation you need TSH, FT4 and FT3 tested

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

What vitamin supplements are you taking

Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

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 always be below 2 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.

[Bridkid67 in reply to SlowDragon]

Been on 75mcg for a while now maybe 6 months plus last TSH level was 1.9 Dr Said it was in range all the usual speel etc as for vitamins I just take a fish oil 1000mg and vitamin B12 spary and vitamins C 500mg iam waiting to see liver specialist because last 2 blood tests showed abnormal liver enzymes but God knows when that is they said anything up to a year so don't know wether to wait or go back and see Dr and insist on a increase by the way weighed myself yesterday 16.5 stone so 75mcg is not near enough?

[Tina_Maria in reply to Bridkid67]

As slowdragon has pointed out, 75mcg is a small dose of levothyroxine - it is basically just a small bit up from a starter dose! A general replacement dose for levothyroxine is 1.6 mcg per kg of body weight, so if you weigh 75kg, you should roughly be on 125mcg levothyroxine. It is stated here in the prescribing information:

cks.nice.org.uk/topics/hypo...

Has your GP ever tested your T4 and T3? Your T3 is the active hormone and the driver of your metabolism. If your T3 levels are too low, you can have high cholesterol levels, which can lead to increased liver enzymes, as your body has not got sufficient thyroid hormones to deal with dietary components such as cholesterol and glucose, therefore levels as well as liver enzymes can rise.

If you can, you could do a private thyroid function test, checking TSH, T4 and T3. You should also check your Vitamin D, folate and iron levels, as optimal levels are needed to support your body to make the most of your levothyroxine, and it helps with the conversion of T4 to T3.

Fish oil may improve your lipid profile and increase HDL and pro-inflammatory markers, but it will not help with high cholesterol - only sufficient amounts of T3 can help with that, as it is a metabolic problem (too little thyroid hormones), not a dietary one.

[Bridkid67 in reply to Tina_Maria]

I'll have to have private blood test because we know the NHS only test TSH and go on that for treatment any suggestions to the best one please?

[SlowDragon Administrator in reply to Bridkid67]

Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Post all about what time of day to test

healthunlocked.com/thyroidu...

Testing options and includes money off codes for private testing

thyroiduk.org/testing/

Medichecks Thyroid plus BOTH TPO and TG antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes BOTH TPO and TG antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

Medichecks and BH also offer private blood draw at clinic near you, or private nurse to your own home…..for an extra fee

Only do private testing early Monday or Tuesday morning.

Tips on how to do DIY finger prick test

support.medichecks.com/hc/e...

If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal

Monitor My Health (NHS private test service) offer thyroid and vitamin testing, plus cholesterol and HBA1C for £65

(Doesn’t include thyroid antibodies)

monitormyhealth.org.uk/full...

10% off code here

thyroiduk.org/testing/priva...

IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 3-5 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endocrinenews.endocrine.org...

In days before blood test, when you stop vitamin B complex, you might want to consider taking a separate folate supplement (eg Jarrow methyl folate 400mcg) and continue separate B12 if last test result serum B12 was below 500 or active B12 (private test) under 70

[SlowDragon Administrator in reply to Bridkid67]

Get FULL thyroid and vitamin testing done

Highly likely you are ready to increase to 100mcg

Blood test should be done every 3 months until stable over at least 3 tests

[SlowDragon Administrator in reply to Bridkid67]

Being on inadequate dose levothyroxine will affect liver results

Low thyroid levels also raise cholesterol

Both should normalise once your thyroid is correctly treated

palomahealth.com/learn/fatt...

nhs.uk/conditions/statins/c...

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.