Overmedicated but underactive symptoms

[MandShef]

Hello, I've just had my latest blood test results, and am seeking advice. Back in March I was taking 50mcg of Levo & my TSH was at 3.5 (0.27 - 4.2). I was hoping to get it down to the lower half of reference range (as advised), so Levo was increased to 75mcg. I felt much better, BUT, my heart was racing, and my next blood results showed I'd gone over-medicated - TSH 0.02, T4 30 (12 - 22). My Levo was reduced to alternate days 75/50, but it made absolutely no difference, so it was reduced again to 50mcg 5 x p/wk, 75mcg 2 x p/wk. This has resulted in my latest results where my TSH has remained at 0.02, my T4 lowered into range at 21.3. I have my Dr appt on Friday, and I'm fully expecting him to reduce me back down to 50mcg. However, I was completely surprised by the results, as I had started to experience underactive symptoms again - tiredness, weight gain, achy joints. Can over-medication do this? What if I go down to 50mcg and my results go back to 3.5 - will I have a case for trying again to get it down to lower half of ref range, or will I be stuck because my previous attempt resulted in over-medication? Any advice before I go to the docs would be most appreciated.

[shaws Administrator]

When you had the blood test which showed you were 'overactive' did you allow a 24 hour gap between your last dose of levothyroxine and the test?

[MandShef in reply to shaws]

Hi, no I didn't. Basically up until recently my GP only tested TSH not T4, and whereas I know T4 can spike after taking medication, I understand TSH isn't affected, so I hadn't thought it was an issue. When I went over-medicated & he started to include T4 in the tests it put me in a pickle, because I didn't know whether if I suddenly stopped taking levo before blood tests it would be inconsistent with all my other tests ... *gulp*

[Hidden]

There is the possibility that you simply aren't converting the Levo into active T3 that your body needs. This could be for a variety of reasons, you could have the homozygous form of the DIO2 gene, which would reduce your capacity to convert, or probably more likely, you could be deficient in one or more of folate, ferritin, B12 or Vit D. Have you ever had any of those tested?

[MandShef in reply to Hidden]

Hi, frustratingly my GP doesn't test for T3, so I have no way of checking that. I had shown up previously as Vit D deficient, but I'm now supplementing. My iron levels had also been consistently low, but again, I'm supplementing. My GP doesn't test for vitamins/minerals as standard (in fact, he refused to re-test Vit D on the assumption that if I'm supplementing I'll be fine!).

[Hidden in reply to MandShef]

It's fairly usual for GPs not to test for T3, and sometimes if they DO request it, the lab they send blood to may still not test if TSH and T4 are 'in range'.

If you are only on a low dose of Vit D supplementation (800 i.u. daily is often prescribed) then it's really not high enough to get your levels raised. You may need to take a much higher dose for a short period for a boost. How much iron are you supplementing with?

[MandShef in reply to Hidden]

Just checked the packet and it says Iron 14mg, and D3 is 1000iu, but I must admit, I sometimes forget to take them (my estimate would be I take them 4/5 days out of a 7 day week).

[Hidden in reply to MandShef]

Oh dear, well that level of iron isn't going to help much at all. Usually if one is very deficient, 3 x 200 mg tablets are used (Ferrous Fumarate, although there are other types that may be more readily tolerated).

Vit D, 1000 i.u. is likely not high enough to make much of a dent.

Really you need to get those levels tested otherwise you're just shooting into the dark, and you don't want to end up with too high levels either, as both can be toxic. Medichecks and Blue Horizon both offer tests (you can get B12, folate, ferritin and Vit D all in one package, if memory serves). You'd need to stop taking any iron or Vit D for at least a week before such a test, though, but well worth knowing what you are working with.

[MandShef in reply to Hidden]

Thanks, think I'll 'treat' myself to some private tests soon (next pay day!), as another poster has suggested I also get T3 etc tested too.

[greygoose]

Have you had your antibodies tested?

[MandShef in reply to greygoose]

Yes, as part of my original diagnosis, but not since. It was 106 (<34).

[greygoose in reply to MandShef]

OK, so you have Hashi's. So, on that test where the FT4 was 30, you weren't over-medicated, you'd just had a Hashi's flare. The level will go down again by itself.

But, there's nothing wrong with a TSH of 0.02 - that's where you want it, when you have Hashi's. To minimise the flares. As long as your FT3 is in-range, you are not over-medicated, and the TSH is irrelevant, it can go as low as it likes.

What I would advise you to do is get your FT4 and FT3 tested privately, so that you know how well you are converting. If you don't know that, and rely on the TSH, then you will never get your dose sorted.

[MandShef]

Hello, I just thought I'd update as I've had my Dr appointment now. I'm pleased to say that he said much the same as Greygoose - that a suppressed TSH of 0.02 was fine, as long as I'm not experiencing any hyper symptoms and my T4 is in range. He said I can stay on my dose, and he'll re-test in 6 months just to check it's settled. I'm really pleased as I was convinced I'd be forced to reduce dose. Now I can concentrate on improving my health - arranging some vit tests as Jadzhia suggested, and improving my diet and exercise regime.