I have been on levothyroxine since August 2024, started at 50 but then moving to 75mg. I have recently begun to feel very sluggish again and have burning in my toes and lack energy to do anything beyond essentials. Drs are testing my TSH levels rather than T3 and T4. My TSH levels had gone down to normal range when tested at the end of January, so all fine there, but I don’t know what my actual thyroid results are as they don’t test them.
Is is reasonable to ask for an increase in my levothyroxine based on my symptoms? I have gained some weight and have my round face back again -which had previously settled. My Dr did previously say they would increase according to my symptoms, and I feel that they have come back. TIA
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Cavalierloversam
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It would be perfectly reasonable. 75 mcg is not much more than a starter dose, and if symptoms are returning it means that you're ready for the next increase.
The TSH now being in-range doesn't mean anything - unless it's 1 or below. But even then TSH is very unreliable. Your TSH can look good - or even be suppressed - but your thyroid hormone levels still be too low. Unfortunately doctors don't understand that and rarely test for FT3 - they don't even always do FT4 which is totally illogical given that it's T4 you're taking, not TSH! But they think they know it all and you can't tell them anything!
And of course we are now in March so it may well have fluctuated again. I think I will do an e consult for my Drs tomorrow and ask if it could be increased.
For full Thyroid evaluation you need TSH, FT4 and FT3 tested
Also both TPO and TG thyroid antibodies tested at least once to see if your hypothyroidism is autoimmune
Very important to test vitamin D, folate, ferritin and B12 at least once year minimum
Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease
Reading your previous posts you need testing for pernicious anaemia
Burning toes suggests low B vitamins
Request GP test vitamin levels if not tested recently
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)
Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins
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
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
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
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Too much levothyroxine? 
How long does it take for TSH levels to rise or fall following an increase or decrease in levothyroxine?
:)
Levothyroxine concerns. 
