Levothyroxine after Total Thyroid Surgery

Introduction

This leaflet has been designed to provide advice as you have been prescribed Levothyroxine after your Total Thyroid Surgery (removal of your Thyroid Gland).

Thyroid Hormones

Your Thyroid Gland produces a hormone called Thyroxine (T4), which is involved in metabolism, energy levels and growth.

Another hormone called Thyroid Stimulating Hormone (TSH) helps your Thyroid Gland produce T4.

After your Thyroid Gland has been removed, without replacing your T4 Hormone, your body’s ability to control metabolism and energy is reduced.

Levothyroxine

Levothyroxine is the name of a man-made version of T4 hormone. It is used to replace T4 hormone after your Thyroid Gland is removed.

Levothyroxine will need to be taken for the rest of your life. It can take several months to find the correct dose of Levothyroxine for you.

This will be done by checking your blood and assessing the levels of T4 and TSH in your body and then adjusting the dosage of Levothyroxine in response to your blood results.

If you are prescribed levothyroxine you will be entitled to a medical exemption certificate. This means that you will not have to pay for your prescriptions.

*Ask your GP for an FP92A form*

Aim of treatment

The aim of Levothyroxine treatment depends on the reason you have had your Thyroid Gland removed.

Levothyroxine will replace the T4 hormone that your body is now unable to produce. It will also reduce TSH levels in your body, which can be a target for some Thyroid conditions.

Before your treatment starts, your specialist will discuss the aims of your treatment with you.

Dosage

The dose of Levothyroxine, you will begin taking, will depend on your weight. This can be changed depending on the results of regular blood tests (measuring both T4 and TSH levels).

Levothyroxine tablets come in the following strengths (each in separate boxes).

• 25 micrograms
• 50 micrograms
• 75 micrograms
• 100 micrograms

You may take a number of these strengths to make up your individual dose. This may include taking different doses on alternate days to give you an average dose over the week.

You should not change your dose without talking to your medical professional.

How to take Levothyroxine

Levothyroxine should be taken at the same time every day, ideally first thing on a morning. It should be taken with water, 30-60 minutes before breakfast.

You should leave a gap of 4 hours between taking Levothyroxine and having drinks that contain caffeine (e.g. tea and coffee) or taking medication which include Calcium, Iron or antacids as they can disturb the absorption of Levothyroxine.

Grapefruit is known to increase the absorption of Levothyroxine as it increases the acidity of the stomach.

If you are unable to take Levothyroxine in the morning, you should still ensure you take it at the same time every day.

Most people find that Levothyroxine tablets are easily swallowed. If you have swallowing difficulties, some brands of tablets can be added to a little water and allowed to dissolve or be crushed before swallowing.

Ask your Pharmacist to check if your brand of tablets will dissolve in water. If this is not possible, your doctor may be able to prescribe Levothyroxine in a liquid form for you.

Missed dosed

It is important to take Levothyroxine tablets at the same time every day as this can affect your blood test results and your health.

If you forget to take your Levothyroxine, take it as soon as you remember. If it is almost time for your next dose, just skip the forgotten dose.

Do not take 2 doses together to make up for a missed dose.

Overdose

Taking 1 extra dose of your Levothyroxine by accident is unlikely to cause harm.

Please speak to your Doctor if you accidently take more than 1 extra dose or you get side effects such as a racing heart beat or chest pain.

These effects could take a couple of days to appear.

Blood tests

You will need regular blood tests to check levels of TSH and T4 in your body after starting Levothyroxine treatment. This will allow your dose to be changed according to your own circumstances.

At the start of treatment, you will have blood tests more regularly, once your hormone levels are stable you will then need them once a year.

You may need blood tests more often if you are:

• Pregnant or planning to become pregnant.
•   Start or stop a medicine that can interfere with your Levothyroxine.
•   Have any symptoms that could mean your dose is not right.

Side effects

Generally, Levothyroxine has minimal side effects when taken in the correct dose and according to your blood tests. However, like all medications, it can sometimes cause side effects.

The most common side effects are due to taking a bigger dose than your body needs. They usually go once your dosage is reduced by your doctor.

Talk to your medical professional if these effects bother you or do not go away:

• Feeling sick.
• Being sick.
• Diarrhoea.
• Headaches.
• Feeling restless or excitable.
• Having problems sleeping.
• Flushing or sweating.
• Muscle cramps.
• Shaking, usually of the hands.

For a full list of all possible side effects, see the leaflet inside your medication box. If you are unsure, ask your Medical Professional.

Interaction with other medications.

Your Doctor and Pharmacist will review your other medications before starting Levothyroxine to check for any medication interactions.

If any of your regular medications change, you should speak to your Medical Professional.

Always check with the Pharmacist before buying any medication at a pharmacy or health store.

Brand of tablet

Several manufacturers produce Levothyroxine and your pharmacy may not always give you the same brand.

Most people will not be aware of any differences between brands, very rarely you may feel less well with certain brands of Levothyroxine.

The reason for this is not clear but might relate to differences in fillers and bulking agents between the various brands of tablets.

If this is the case, you should discuss this with your Doctor, as some may agree to prescribe a consistent brand of Levothyroxine.

Storage

You should keep Levothyroxine tablets out of the sight and reach of children.

You should keep Levothyroxine tablets at room temperature, away from moisture and strong light.

Pregnancy and breasfeeding

If you are pregnant or become pregnant, you should inform your Doctor as soon as possible. Closer monitoring of your dosage will be required. 

Contact numbers

University Hospital of North Tees

Thyroid Nurse Specialist Telephone: 01642 624627
Please leave a voicemail and you will receive a reply, although this might not be on the same day due to availability.

Surgical Secretaries Telephone: 01642 383292
Monday to Friday, 09:00 a.m. to 04:00 p.m.

Targeted Lung Health Check Navigator Telephone: 01642 624963
Monday to Friday, 08:00 a.m. to 04:00 p.m.

References

• Levothyroxine: new prescribing advice for patients who experience symptoms on switching between different levothyroxine products – GOV.UK (www.gov.uk)

• The British Thyroid Foundation (BTF) (btf-thyroid.org) – The British Thyroid Foundation works with patients and medical professionals to inform and support people of all ages living with thyroid disorders

• Levothyroxine sodium | Drugs | BNF | NICE

• https://www.baets.org.uk/ British Association of Endocrine and Thyroid Surgeons (BAETS) – BAETS is the representative body of British Surgeons who have a specialist interest in surgery of the endocrine glands (thyroid, parathyroid and adrenal).

Comments, concerns, compliments or complaints

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