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Original poster

Levothyroxine starting dose

21 replies

ReverseFerret · 14/02/2023 17:08

I have been feeling really really unwell for months with the usual symptoms of hypothyroidism... crashing fatigue, 0 energy etc etc ..

Dr has referred me to endocrinologist which is good but was very very reluctant to prescribe levothyroxine until she saw how distraught I was.

However, prescription is for 25mgs but all paperwork in the box suggests a normal starting dose of 50mgs.

My levels are:
Serum TSH 4.69
Serum Free Thyroxine 14.3
Serum thyroid peroxidase ab 235

Has anyone experience improvements in symptoms on such a low dose ??

OP posts:

Fridaysgirl17 · 14/02/2023 17:29

This might be different as my son was only a newborn when diagnosed but he was started on 25 mgs as his starting dose almost 6 years ago,& has only recently been upped to 50mg in the last few months,he was upped to 37.5 mg about 2 years ago. I know his meds are decided by his numbers when he has his blood work done twice yearly,his doctor suggested a few different changes first but then the increase was necessary as they made no change

DrEllie · 14/02/2023 17:30

Too much is really dangerous sonic is common to start on quite a low dosage to see what effect it has

Original poster

ReverseFerret · 14/02/2023 17:31

Thanks... i wonder if size matters... I'm a bit bigger than a new born

OP posts:

Unicornsandgriffins · 14/02/2023 17:34

My hypothyroidism started when i was pregnant, they started me on 25mgs, then increased it to 50mgs and then 75. After giving birth, following further blood tests, it was reduced to 50mgs. I've been on 50mgs for a few years now x

LondonLovie · 14/02/2023 17:39

Started on 25mg and went up in increments of 25mg until I'm now on 125. Been on a range between 100-150 over the 8 years I've had it. I believe it's very common to start on 25mg. I feel your pain, my under active thyroid was crippling and I had it post-partum and throughout may leave. I wish my doctor would refer me to an encrinologist! I have never felt right and my levels are raised again.

Thingsthatgo · 14/02/2023 17:43

I started on 50 and very quickly was over medicated. I nearly lost my mind; it made me feel so weird. I would definitely recommend starting at 25 and work your way up.

KangarooKenny · 14/02/2023 17:56

I started on 25

CrescentMoons · 14/02/2023 18:04

Start on 25

NoMoneyForEducation · 14/02/2023 19:27

My 10 year old son (he was about the size of a 7 year old) and I (about a size 14/16 5'5" woman) started on 50mg so I would say 25 is low....but I think our bloods were way worse (for my son THS was 150 and free T4 was less than 4.)

So potentially starting you low as you may not need much to top you up. And being on too high a dose is horrid!

PrincessHoneysuckle · 14/02/2023 19:39

I started on 75mcg 15 yrs ago.Im.now.on 125mcg

Natsku · 14/02/2023 19:41

I started on 25 (and stayed on it for several years until 2nd pregnancy when needed to up to 75 which I'm still on)

HufflepuffRavenclaw · 14/02/2023 19:47

I have been on levothyroxine for about 8 years. I started on 25 mcgs, blood tests every 8 weeks and my dose was incrementally raised by 25 mcgs each time until 125 mcgs which is where I am now, and stable.

Xmasbaby11 · 14/02/2023 19:50

I started on 100 about 15 years ago, now on 175. I don’t know what my levels are though. I had no symptoms before I was diagnosed!

sunnydayys · 14/02/2023 19:56

Those TSH and T4 levels would be normal at my local lab.
I appreciate your thyroid peroxidase is positive and you are symptomatic but based on your results I'd say your current diagnosis is sub clinical hypothyroidism

cravingtoblerone · 14/02/2023 20:11

I started on 25mcgs. The first 18 months on levothyroxine can be a bit of a balancing act as your body finds its natural level. You should be having blood tests every 3 months to measure and you may find your prescription increases slightly later on.

I went up to 50mcg within 9 months and stayed on that for about 15 years. Have increased again recently to 75mcg as perimenopause has slowed everything down a bit.

longcoffeebreak · 14/02/2023 20:16

I started in 25 years ago and that made me feel pretty odd - dizzy and heart palpitations whilst I got used to it. Also uour free thyroxine is higher than mine and i'm on 125 of thyroxine and 20 liothyronine a day so it doesn't look like you might need much.

Procrastatron · 15/02/2023 09:01

Hi, I started on that dose a couple of years ago with similar lab results. NICE guidance is to treat the person not the numbers so even if you numbers are borderline it’s good that you are being treated. For me it did make a difference but the symptoms did creep up on me again recently and it was only when I had a routine blood test that I realised that on reflection. I’m now on 50 and the doctor was nervous about the increase and told me what to look out for re being over medicated. Maybe it’s psychological, 25 felt like a token dose, the extra 25 now feels like a bold move.

CrunchyCarrot · 15/02/2023 09:17

25 mcg is barely anything. I was started on that and it did nothing. 50 mcg should be the bare minimum, then likely it will need to be increased after the next blood test, at around 5-6 weeks.

Original poster

ReverseFerret · 15/02/2023 12:52

Thanks everyone.
I'm going to keep an open mind about the 25mcg dose but i feel so unwell I just want my life back.. I'm worried I might lose my job if I have to wait months to get levels right

OP posts:

TheOtherHotstepper · 15/02/2023 13:21

25mcgs is too low to do anything really. It's a starting dose for the elderly or those with heart problems.

I50mcgs with blood tests and increases at six week intervals until you feel well would the standard way to go, although one school of thought says you should start at 100mcgs as most people end up taking between 125 and 200.

Lots of info and support on the ThyroidUK forum.

Bloop123 · 16/10/2025 19:26

Hi @ReverseFerret i realise this is a very old post but wondering if the 25mcg made any difference for you?

I’ve also been put on 25mcg with a tsh of 6.9 and trying to stay positive that it will help but not feeling hopeful! I am awaiting ivf, so for me I really dont want to wait too long..

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