Thyroid UK

Over medicated but hypo symptoms

Hi everyone, today I had a phone call from the doctor wanting to reduce my Levo dose because I am over medicated; t4 26.5 (ref; 11-26) TSH 0.13 (ref;0.27-4.2). I am on 150mcg a day, they want to lower it by 25mcg a day. The problem is I am feeling hyPO rather than hyPER! This is what prompted me to get a blood test done. I have worsening constipation, fatigue, hairloss...no hyPER symptoms at all! I am in the UK so doctors won't prescribe desiccated thyriod - so that is a non starter. Any advice?

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Petunia6, What length of time had elapsed from taking your thyroxine to when the blood was drawn?

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3 months.

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How many hours between your last dose of levo and your blood test! What timne of day was the blood test and was it fasting? Surely you hadn't been off your meds completely for 3 months?

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Oh I see. I take my Meds before bed at 10pm, my blood test was 9.30am the following morning - I had some breakfast in between.

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So your TSH would probably have been higher and your free T4 lower if you had left the recommended 24 hours between levo and blood test, and taken it fasting. I'd try to resist the decrease. You might be able to use the Pulse article for that says that some people need slightly over range FT4 and suppressed TSH to feel well. You can get it from louise.roberts@thyroiduk.org.uk

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Thanks for yr reply Angle of the North, I didn't realise that you had to leave off and fast before testing, I wanted to get an accurate result though. I will have a look at the Pulse article. I think the doctors will get annoyed at me if I don't follow their advice, they look at the numbers over the symptoms😕. Incidentally after I took a lower dose last night I have had a headache all day, something that I only used to get before I was diagnosed! But of course it could be a sign of hyper too this is what makes it all so confusing! Why are these columns getting narrower btw?

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Do you want a happy doctor or to be well? I know it's not easy to argue but show them the Pulse article (Pulse is the doctors' own magazine) and say you'd rather keep the existing dose and test again in 6 weeks.

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I fear I am alreadygett g a name for myself!My doctors have told me they go by the numbers not the symptoms! They have also increase the time from a changein dose to blood test from 6 weeks to 3 months !

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Do you have test results for B12, folate, vitamin D and ferritin. If so post them here. It's common for these to be low and we need good levels to utilise thyroid hormones. If this is happening then you can feel hypo as struggle to use hormones, but blood tests can suggest over medicated

Have you been tested for Hashimoto's- high antibodies, if not ask for this to be done.

You need to know because if you have Hashimoto's you need to consider hidden food intolerances, usually gluten. Leads to leaky gut and low nutrients absorption

amymyersmd.com/2017/02/3-im...

hypothyroidmom.com/92-of-ha...

All thyroid tests should be as early in morning as possible and fasting. Do not take Levo in the 24 hours prior to the test, delay until straight after.

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Yes I have Hashi, vit D 76.1 (ref; >50) B12 529 (191-663) folate 8.3 (2.4-26.8) ferritin 73 (12-233). I once went gluten free for 6 months and didn't feel any different to normal - I don't have any food intolerances that I am aware of. The thyriod blood test done prior to this this one was TSH 0.21 but nobody said anything about that (7 months ago). But now it is 0.13 so it's coming down again. My GP won't test my blood after a change in dose until 3 months - it used to be 6 weeks!

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Your T4 level is high which might indicate over medicated but it would be best to get T3 tested as well to see if this is high or low as might indicate conversion issues. This might also highlight if there is a need for NDT or T3. You can pay for our own tests if necessary, many of us do and they're not hugely expensive.

If I'm only slightly over medicated, I get pretty much the same as under medicated - in fact I probably get more tired and crash easier so it's very hard to tell sometimes. If I'm majorly overmedicated, then it's a bit more obvious but I don't think you'd be that over medicated.

Definitely get your vit levels checked as suggested as many of us deficient in these causing similar symptoms and also consider a gluten free diet if any stomach issues or deficiencies are apparent - completely reversed much of my health issues.

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Thanks for all yr replies so far. I know what you mean about hyper feeling the same as hypo if yr not far over. I did wonder why my hair hadn't stopped fall in out. It's just the constipation that confuses me! I once has a t3 test done about a year ago; t3 4.5 (ref;3.1-6.8) my TSH at the time was 1.23 and t4 19. Was this ok? The doctor said they would re test t3 again😕. Even if I got it privately tested they wouldn't give me t3.

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You need your T3 really because according to the blood results it looks like you are very slightly over medicated but it might be that you're just on the wrong medication and not converting T4 well. Worth checking B12 and vitamin D as well. Have they checked for Hashimotos?

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FT 3 is the most important result and doctors and labs sadly don't realise this. With the results you do have FT3 could be over range so it would be advisable to cut back a little but it could just as easily be very low as you aren't converting the T4 to T3. So two very different scenarios which you need to know where you are.

If it's a conversion issue then you would need to address other issues as mentioned above as Vit D B12, folate and ferritin help the Thyroid to work better and also helps general gealth as well. If you get those tested please post with ranges for comment as GP's think if you are in range you are fine but like thyroid readings it's where in the range that is important.

It's very unlikely a lab would test for T3 unless Endo says so but there are two places to get them done privately. Blue Horizon and MediChecks. They both have offers from time to time, MediChecks on a Thursday.

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Thanks. I was deficient in vid d a couple of years ago (I have had Hashi for 3 years). Is the doctor brought my levels back up with supplements and ever since I have been taking vit d 25ug every day pulse vit k2, selenium also. I am going out today to buy some iron 200mcg (I know I have to take it 4 hrs apart from thyroid Meds), folate and b12 just to raise my levels a bit because I know that they are important for t4 conversion, so I am doing all I can but I am concerned that cutting back my Meds by 25mcg a day might send me hypo again. Fed up with it all😕.

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Unfortunately, you really don't want to supplement Vit D or iron without knowing where your levels actually are. Too much of these is just as bad as not enough. B12 is okay as is water soluble so your body can get rid of the excess easily but not the other two :-)

You could maybe try alternating between the two doses each day?

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My vit Levels are in an above reply. I read that it is very difficult to OD on vit d - you would need a huge amount. Can you tell if my levels need supplementing? They are in range but in the bottom quartile.

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They're not too bad. You can get a little higher on the Vit D and folate needs to be half way through range. I don't like to comment on the iron without a blood count as ferritin can be misleading but going by that range, it could be a little higher.

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Blood count;424

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Sorry I meant the whole panel MCV, MCHC, heamoglobin etc - not so much the white blood cells

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Mcv 0.372 (0.37-0.47), MCHC 349 (300-350), MCHL 29.8 (27-36) HC 130 (115-165) hematocrit 0.372 (0.37-0.47)

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hmm some are a little borderline and only just in range, mcv for example but nothing screaming iron deficiency with the ferritin level. maybe you can try just adding to diet with liver instead or just up a little in case you go too over?

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Ha I just had some liver last night. Ok thanks for all your advice.

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Your T3 conversion doesn't seem that bad either as room for an increase in the test where you had T3 which would have pushed your T£ levels up further although others here can answer that question more precisely.

So I suppose you're left with the constipation issue and tiredness which can be caused by so many things? Just to double check - when you tried gluten free, was it definitely 100% gluten free including cross contamination? 1 tiny crumb of gluten is enough to keep me ill.

Only other thing to try if gluten already ruled this out is a six week elimination diet to see if bothered by other food groups such as dairy.

You could also double check your diet and make sure you are definitely getting everything you need and nothing obvious missing - you can use a site like cronometer which tracks even all micronutrients for a few weeks to double check and you can put any supplements into it to to make sure not getting too much of something accidentally? Also are you eating enough, low calorie intake will stop you having energy although would normally cause low nutritional levels too.

Otherwise NDT self funded could be worth a try as some people just don't get on well with levo.

Sorry not sure what else to suggest, you could check your cortisol and blood glucose levels, many of us have issues in these areas?

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Yes I was 100% gluten free for 6 months - no difference. Thanks for all your help.

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To conclude I am going to reduce dose by 12 mcg per day rather than 25. I don't trust the doctors judgment!

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