Sleepy on Levothyroxine Teva

[Hatshepsut59]

I started on Thyroid medication about 7 weeks ago. Initially 25mg , now increased to 50mg as blood results showed thyroid levels still low. Strangely, I am sleeping more deeply than usual at night and have even been sleepy during the day. Has anybody else experienced this??

[Buddy195 Administrator]

Welcome to the forum Hatshepsut59,

So we can offer better advice, can you tell us more about your thyroid condition, ongoing symptoms other than sleepiness, plus blood test results (with ranges in brackets) for:

TSH

FT3

FT4

Plus any antibody and key vitamin tests (ferritin, folate, vitamins D and B12)

If your GP is unable to complete all the above (eg if TSH is within range, some surgeries may not be able to access FT4 and FT3 tests), you could look to do this privately, as many forum members do, for a better picture of your thyroid health:

thyroiduk.org/help-and-supp...

[Hatshepsut59 in reply to Buddy195]

Thanks for your reply. I'm sorry but I don't have those figures. My thyroid tests have been low/borderline normal for many years. It was only recently that a new doctor suggested I should take Levothyroxine. I have been supplementing with solgar b complex , vit c, vit d, zinc and magnesium for years. I also take Lexapro for low mood. I'm perplexed that I'm sleepy on Levothyroxine. Surly it should have the opposite effect.

[helvella Administrator in reply to Hatshepsut59]

Only if you view levothyroxine (and thyroid hormones generally) as some sort of daytime hormone that that wakes you up.

One of the first improvements I got from it was improved sleep. I had been falling asleep, then waking after a short while. Followed by being unable to get back to sleep. Once I was taking it, I was less likely to wake up, and if I did, more likely to get back to sleep.

Thyroid hormones work all day, every day.

But it is good to remember that we are all different. Some people are affected differently. And time and dose are also vitally important.

Non-refreshing sleep is a symptom of hypothyroidism which has been mentioned many times but seems to have fallen out of focus. However many hours you actually sleep, you just don't get that "Good! It's morning and I'm awake" feeling.

You might find this of some interest.

helvella - Bed-time dosing of levothyroxine

Discussion about taking levothyroxine at bed-time. Several linked references to relevant papers.

helvella.blogspot.com/p/hel...

[Hatshepsut59 in reply to helvella]

Thank you very much. That's encouraging 😊

[Buddy195 Administrator]

Do ask your GP for a print out of your blood test results (which you are legally entitled to) and share with us. One thing to remember is when GPs say results are normal/ within range, this may not be the same as ‘optimal’.

[Hatshepsut59]

Many thanks, will do.

[SlowDragon Administrator]

50mcg levothyroxine is only the standard STARTER dose levothyroxine

Bloods should be retested 6-8 weeks after each increase

Levothyroxine doesn’t “top up” failing thyroid, it replaces it

So when only on starter dose you can actually feel more hypothyroid

Likely to need several further increases in dose over coming months

which brand of levothyroxine are you currently taking

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 near full replacement dose

pathlabs.rlbuht.nhs.uk/tft_...

Guiding Treatment with Thyroxine:

In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months.

The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).

The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range.

……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.

The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.

Some people eventually need a bit less than guidelines, some a bit more

TSH should be under 2 as an absolute maximum when 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).

[SlowDragon Administrator]

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

About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high TPO and/or high TG thyroid antibodies

Autoimmune thyroid disease with goitre is Hashimoto’s

Autoimmune thyroid disease without goitre is Ord’s thyroiditis.

Both are autoimmune and generally called Hashimoto’s.

Significant minority of Hashimoto’s patients only have high TG antibodies (thyroglobulin)

20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis

In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)

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

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...

Only do private testing early Monday or Tuesday morning.

Link about thyroid blood tests

thyroiduk.org/testing/thyro...

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

Symptoms of hypothyroidism

thyroiduk.org/signs-and-sym...

Tips on how to do DIY finger prick test

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

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

[Hatshepsut59 in reply to SlowDragon]

Very interesting, thank you. I'm using Levothyroxine Teva as it doesn't contain lactose.

[SlowDragon Administrator in reply to Hatshepsut59]

Ok

So you are lactose intolerant and on lactose free diet?

Lactose intolerance common with autoimmune thyroid disease

Lactose free brands - currently Teva or Vencamil only

Teva makes 25mcg, 50mcg, 75mcg and 100mcg

Many patients do NOT get on well with Teva brand of Levothyroxine.

Teva is lactose free.

But Teva contains mannitol as a filler instead of lactose, which seems to be possible cause of problems. Mannitol seems to upset many people, it changes gut biome 

Teva is the only brand that makes 75mcg tablet.

So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half

But for some people (usually if lactose intolerant, Teva is by far the best option)

Vencamil (currently 100mcg only) is lactose free and mannitol free. 25mcg and 50mcg tablets will be available from summer 2024

March 2023 - Aristo now called Vencamil

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Helpful post about different brands

healthunlocked.com/thyroidu...

List of different brands available in U.K.

thyroiduk.org/if-you-are-hy...

[Hatshepsut59 in reply to SlowDragon]

Thank you very much. Excellent information.