Thyroid UK

Hi, I have been diagnosed hypothyroid for about 4 months now, given 25mg levothyroxine first, then 50mg after a scan revealed my thyroid is really quite fibrous and knackered!

At my last consultation my tsh was 3.5, but my doctor won't give me more levothyroxine until I am over 5. Although I do feel a lot better than I did before treatment, I am starting to get little niggles of how I was - wrist pain/sight problems/tiredness etc. I am due another blood test in July - if it's still under 5, is there a bargaining chip I could use to trial a higher dose of meds? Any advice greatfully accepted!

2 Replies

Mandy, if your symptoms are returning or getting worse why not return to your GP earlier armed with the Thyroid book that we have mentioned on other posts from good Chemists around £4.99 written by Dr Toft as in there (although I don't agree with several other things he says) he says that often patients are not well until their TSH is under 1 and their Free T4 at the top or even above of the lab range before they feel well.

Also you could quote the above that Dr Toft has recently written in a GP journal called The Pulse. This is written for GP guidance so your GP could not argue with it. Good luck!

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Hi Mandy,

The article that Suze mentions is a good one, it came out in February of last year and has just been adapted to use as part of GPs CPD on Thyroid Disease last month on 26th May. I'll put a link to it and an extract below at the end for you. You need to register to read this online but it is free and easy to do.

When you go back for your next test go as early as possible in the morning as your TSH is highest then. Preferably as soon as the surgery opens if you can. TSH is highest in the early hours of the morning and reduces through the day & is lowest in the afternoon, but it is quite a bit lower even by 11am so enough to make a difference between getting an increase or not.

It’s also best to take your thyroxine immediately after the test that day if you normally take it in the morning. Thyroxine peaks in the blood for a few hours after taking it so if you always have an early morning test and take it afterwards it makes it easier to monitor your progress.

You should still be getting your T4 tested as well as the TSH as your treatment is still being optimised so do ask your GP to test this. See UK Guidelines for the Use of Thyroid Function

“Key questions on thyroid disease (1.5 CPD hours) 26 May 10

Endocrinologist Dr Anthony Toft answers GP Dr Pam Brown’s questions on thyroiditis, thyroid eye disease and thyroxine dosing

6 What is the correct dose of thyroxine and is there any rationale for adding in tri-iodothyronine?

The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range – 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance.

But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

This ‘exogenous subclinical hyperthyroidism’ is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l).

Even while taking the slightly higher dose of levothyroxine a handful of patients continue to complain that a sense of wellbeing has not been restored. A trial of levothyroxine and tri-iodothyronine is not unreasonable. The dose of levothyroxine should be reduced by 50µg daily and tri iodothyronine in a dose of 10µg (half a tablet) daily added.”


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