Overmedicated?

[Tara1718]

Hi I am new I have symptoms of sweating and anxiety and weight loss, also increased heart rate am I likely overmedicated on 150mcg levothyroxine? Diagnosed 2012 thanks

TSH 8.3 (0.2 - 4.2)

Free T4 13.8 (12 - 22)

Free T3 3.6 (3.1 - 6.8)

[Clutter]

Tara1718,

Symptoms could be due to overmedication. You should ask your GP to do a thyroid function test to check.

[Tara1718 in reply to Clutter]

TSH 8.3 (0.2 - 4.2)

Free T4 13.8 (12 - 22)

Free T3 3.6 (3.1 - 6.8)

[Clutter in reply to Tara1718]

Tara1718,

You are undermedicated. Ask your GP to increase dose. The goal of Levothyroxine is to restore the patient to euthyroid status. For most patients that will be when TSH is 0.2 - 1.0 with FT4 in the upper range. FT4 needs to be in the upper range in order that sufficient T3 is converted. Read Treatment Options in thyroiduk.org.uk/tuk/about_... Email dionne.fulcher @thyroiduk.org if you would like a copy of the Pulse article to show your GP.

[SeasideSusie Remembering]

Tara

Have you had thyroid antibodies tested - were they high - Hashimoto's?

Have you had vitamins and minerals tested - Vit D, B12, Folate, Ferritin?

On 150mcg Levo and those results something isn't right, Hashi's and low nutrient levels spring to mind.

[Tara1718 in reply to SeasideSusie]

Hi antibodies were high 5 times out of 6 most recent results below

Thyroid peroxidase antibodies 740.5 (<34)

Thyroglobulin antibodies 375 (<115)

Will post vitamins and minerals in a few minutes

[SeasideSusie Remembering in reply to Tara1718]

Tara

You only need antibodies to show high once to confirm autoimmune thyroiditis aka Hashimoto's. This is where antibodies attack the thyroid and gradually destroy it. The antibody attacks cause fluctuations in symptoms and test results.

Doctors attach little or no importance to antibodies and don't seem to understand what Hashi's does. You'll need to read, learn and understand so that you can help yourself.

You can help reduce the antibodies by adopting a strict gluten free diet which has helped many members here. Gluten contains gliadin (a protein) which is thought to trigger autoimmune attacks so eliminating gluten can help reduce these attacks. You don't need to be gluten sensitive or have Coeliac disease for a gluten free diet to help.

Supplementing with selenium l-selenomethionine 200mcg daily can also help reduce the antibodies, as can keeping TSH suppressed.

Gluten/thyroid connection: chriskresser.com/the-gluten...

stopthethyroidmadness.com/h...

stopthethyroidmadness.com/h...

hypothyroidmom.com/hashimot...

thyroiduk.org.uk/tuk/about_...

Hashi's and gut/absorption problems tend to go hand in hand and very often low nutrient levels are the result. I expect that yours will be low and I'll comment further when you've posted them.

[Tara1718 in reply to SeasideSusie]

Thanks is adopting a gluten free diet affordable? I am on minimum wage

[SeasideSusie Remembering in reply to Tara1718]

You don't have to buy special 'gluten free' foods. Easiest way is to buy fresh, prepare from scratch.

If you make a new thread asking for help to start a gluten free diet then I'm sure those members who follow it will be happy to reply. You could also use the search facility, also look through posts under the topic "Gluten Free Chat" healthunlocked.com/thyroidu...

[Tara1718 in reply to SeasideSusie]

Thank you Susie

[SeasideSusie Remembering in reply to Tara1718]

You're very welcome

[Baobabs in reply to SeasideSusie]

SS did anyone tell you lately, or at all, that you are doing a fantastic job helping people !!!!!!!!!!

[SeasideSusie Remembering in reply to Baobabs]

Ah, bless you Baobabs thank you for your kind words, much appreciated

[Tara1718 in reply to SeasideSusie]

Ferritin 41 (30 - 400)

Folate 2.2 (2.5 - 19.5)

Vitamin B12 197 (190 - 900)

Vitamin D total 25.5

(<25 severe vitamin D deficiency. Patient may need pharmacological preparations

25 - 50 vitamin D deficiency. Supplementation is indicated

50 - 75 vitamin D may be suboptimal and long term may lead to clinical effects

>75 adequate vitamin D)

Taking 210mg ferrous fumarate 3 times a day and 800iu vitamin D once a day since 2013

Thanks

[SeasideSusie Remembering in reply to Tara1718]

Tara

Just what I was expecting to see!

Ferritin 41 (30 - 400) Taking 210mg ferrous fumarate 3 times a day

For thyroid hormone to work (that's our own as well as replacement hormone) ferritin needs to be at least 70, preferably half way through range. You can help raise your level by eating liver regularly, maximum 200g per week due to it's high Vit A content, and including lots of iron rich foods in your diet apjcn.nhri.org.tw/server/in...

I imagine that you have a diagnosis of iron deficiency anaemia as you are taking 3 x ferrous fumarate daily. Take each iron tablet with 1000mg Vitamin C to aid absorption and help prevent constipaton. Always take iron 4 hours away from thyroid meds and two hours away from other medication and supplements as it will affect absorption.

**

Folate 2.2 (2.5 - 19.5)

Vitamin B12 197 (190 - 900)

What is your GP doing about your folate deficiency?

Have you been checked for B12 deficiency? You can check here b12deficiency.info/signs-an...

You should post on the Pernicious Anaemia Society forum for further advice healthunlocked.com/pasoc quoting your B12/Folate/Ferritin results, your iron deficiency anaemia information and any signs of B12 deficiency you might be experiencing. You may need further investigations and may need B12 injections.

I have read (but not researched so don't have links) that BCSH, UKNEQAS and NICE guidelines recommend:

"In the presence of discordance between test results and strong clinical features of deficiency, treatment should not be delayed to avoid neurological impairment."

And an extract from the book, "Could it be B12?" by Sally M. Pacholok:

"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".

"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."

**

Vitamin D total 25.5 800iu vitamin D once a day since 2013

You are 0.5 away from severe Vit Deficiency.

Ask your Gp this question:

"Considering I've been taking Vit D for 4 years, why am I still just 0.5 away from severe deficiency?"

The reason is (and yourGP probably wont admit this) is because he has prescribed the wrong dose of D3. You need loading doses so ask for them, and personally I would refuse to leave the surgery without a prescription for loading doses - see NICE treatment summary for Vit D deficiency:

cks.nice.org.uk/vitamin-d-d...

"Treat for Vitamin D deficiency if serum 25-hydroxyvitamin D (25[OH]D) levels are less than 30 nmol/L.

For the treatment of vitamin D deficiency, the recommended treatment is based on fixed loading doses of vitamin D (up to a total of about 300,000 international units [IU] given either as weekly or daily split doses, followed by lifelong maintenace treatment of about 800 IU a day. Higher doses of up to 2000IU a day, occasionally up to 4000 IU a day, may be used for certain groups of people, for example those with malabsorption disorders. Several treatment regims are available, including 50,000 IU once a week for 6 weeks (300,000 IU in total), 20,000 IU twice a week for 7 weeks (280,000 IU in total), or 4000 IU daily for 10 weeks (280,000 IU in total)."

Each Health Authority has their own guidelines but they will be very similar. Go and see your GP and ask that he treats you according to the guidelines and prescribes the loading doses. Once these have been completed you will need a reduced amount (more than 800iu so post your new result as the time for members to suggest a dose) to bring your level up to what's recommended by the Vit D Council - which is 100-150nmol/L - and then you'll need a maintenance dose which may be 2000iu daily, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. You can do this with a private fingerprick blood spot test with City Assays vitamindtest.org.uk/

There are important cofactors needed when taking D3

vitamindcouncil.org/about-v...

D3 aids absorption of calcium from food and K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems.

D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds.

Magnesium helps D3 to work and comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds

naturalnews.com/046401_magn...

Check out the other cofactors too

When you come to buy your own maintenance dose eventually, as you are Hashi's for better absorption you will be best buying an oral spray eg BetterYou.

**

As mentioned, gut/absorption problems are often present when Hashi's and this causes the low nutrient levels. Unless nutrients are optimal then thyroid hormone can't work. So you need to address the absorption problem as well as the Hashi's. Check out SlowDragon 's reply to this post on ways to tackle the absorption issue healthunlocked.com/thyroidu...

**

Your original question was whether you were overmedicated due to your symptoms. With Hashi's you can have hyper-type symptoms as well as hypo symptoms.

[Tara1718 in reply to SeasideSusie]

Thanks again. Yes I was given a diagnosis of iron deficiency anaemia. I was taking folic acid very briefly but when my B12 was shown to be low I was tested for intrinsic factor antibodies which were negative. I still need to add folic acid back in but I am due a second B12 injection next month and I am worried the folic acid will interfere with the B12 injection? There was something about not taking folic acid with possible B12 deficiency?

[SeasideSusie Remembering in reply to Tara1718]

It would be best to get advice from the PA forum about that.

[Suzi24]

Sweating and fast heartbeat are usually symptoms of over medication. Talk to your doctor to have your dose adjusted

[Tara1718 in reply to Suzi24]

Sorry but have you seen my current results? They are not overmedicated ones. Thank you

[Tara1718 in reply to Suzi24]

The sweating and increased heart rate happens with exertion only

[Angel_of_the_North]

You are very underdosed if those are your current bloods. Often when there is not enough thyroid hormone your body pumps out adrenaline to keep you going and so you get sweating and tremors and anxiety. When optimally dosed and feeeling well, most people have free t4 and free t3 in the top quarter of the range and TSH under 1 or even suppressed. If those are not your current bloods, you need to post them so people can advise as you might be overmedicated.

[Tara1718 in reply to Angel_of_the_North]

They are my current bloods, the sweating and increased heart rate happens with exertion only

[Angel_of_the_North in reply to Tara1718]

So it looks as though you need a dose increase and possibly need to investigate whether you have issues with absorbtion.

[eeng]

While most people gain weight when they are undermedicated some people do lose it. Your fast pulse rate is probably down to the iron deficiency. Your blood can't carry enough oxygen because there isn't enough iron, so the heart has to pump faster to get the oxygen to your cells. Does it get worse with any kind of exertion?

[Tara1718 in reply to eeng]

It happens with exertion only

[eeng in reply to Tara1718]

well that's pretty conclusive. If you were overmedicated you would probably have a fast pulse all the time, not just after exercise. One of my daughters was anaemic for a while and had a very fast pulse and felt breathless whenever she exercised. She's fine now though.