Reduced Levo dose and symptomatic in three days!!

[Lizs1212]

Hello, I went to the doctors on Wednesday about some epic hot flushes since my dose was increased from 125 to 150. On this dose I didn’t have any symptoms apart from the hot flushes. Long story short he tested my thyroid (and full blood count and some other stuff I have no idea what it means) and from the results advised me to reduce my dose to 125 again. Today I’ve woken up dizzy, feeling sick, very tired and I have palpitations. I’d prefer just the hot flushes than how I feel today!! Posted my blood for info. Any advice?

[SlowDragon Administrator]

All thyroid tests should ideally be done as early as possible in morning and fasting. When on Levothyroxine, don't take in the 24 hours prior to test, delay and take straight afterL This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, GP will be unaware)

Is this how you did the test?

Your TSH is still within range.

Have you had vitamin D, folate, ferritin and B12 tested recently? These need to be at good levels to help thyroid hormones work well.

For full Thyroid testing it's important to test FT3 as well

Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies

thyroiduk.org.uk/tuk/testin...

Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have money off offers.

[Lizs1212 in reply to SlowDragon]

Thank you for your reply. The test was done at 3.30pm, doctor didn’t mention fasting or a morning check.

I haven’t had any of the additional tests you mention although I did start taking Vit D and Magnesuim recently but not religiously!

I think I may have to pay to have the full thyroid testing.

[SlowDragon Administrator in reply to Lizs1212]

If you want to do tests it needs to be 6-8 weeks minimum on constant dose

If you stay on reduced dose, possibly waiting even longer. Reductions seem to take longer to rebalance

Personally I would retest at higher dose.

[shaws Administrator in reply to SlowDragon]

This is from the following link:-

Worth Considering a Bedtime Switch?

Typically, patients are advised to take their levothyroxine first thing in the morning, at least 30 minutes but preferably an hour before eating, on an empty stomach and with only water.5 The goal is to achieve consistency in taking the medication to avoid fluctuations in thyroid levels and variable control of symptoms.

But for patients who may want to add milk to their morning coffee or cereal, there are alternative dosing strategies, including taking levothyroxine at night.

While not all patients may be candidates for bedtime administration, those who have a consistent sleep routine and don’t take other medications before bed might consider making this switch.

endocrineweb.com/conditions...

[jimh111 in reply to SlowDragon]

Fasting makes no difference to thyroid blood tests. Early morning blood draw will give a higher TSH, a higher fT3 and possibly a marginally higher fT4 depending on the individual academic.oup.com/jcem/artic... .

Mid afternoon blood draw gives more consistent results because the TSH curve has levelled out. Evening and early morning blood draws are least consistent as the curve is on a steep slope and each blood draw will occur on a different part of the slope as the timing and our body clock varies academic.oup.com/view-large... .

It's best not to take levothyroxine up to four hours before the blood is taken.

[NickP1 in reply to jimh111]

Thats interesting...

[mrsm49 in reply to jimh111]

Hi jimh111, what about t3, how long should you leave between taking that and blood test (am on combo 100levo 20t3 taken as 10/5/5) Thanks x

[SlowDragon Administrator in reply to mrsm49]

No T4, 24 hours before and 12 hours for T3 is the recommended gap

[jimh111 in reply to mrsm49]

mrsm49, ideally you will have the blood taken about half-way between two doses of hormone be it L-T3, L-T4 or NDT. This will give you a rough idea of your average hormone levels.

You should not have the blood taken within a few hours of taking thyroid hormone because the blood levels are unusually high for a few hours until they get absorbed into tissues and bound to proteins.

[Sus64 in reply to jimh111]

How far ahead not to take NDT before the blood test do you recommend?

[Sus64 in reply to jimh111]

Oh, sorry, I see you addressed that further down.

[marsaday]

The TSH is in a good place. The Ft4 is higher, but the range is often up to 22 and used to be maybe 24. I assume this is on 150 T4 ?

Some people need to have the tank really full, so to speak to feel well. Having a Ft4 of 23 is not such a bad thing, plus many people would have a suppressed TSH with a higher FT4, so your body is still saying please make some more T4 (although it is whispering this instead of shouting).

The fact you have lowered and gotten some bad signs is a good thing as it confirms you do need a higher level to feel good.

It is always a good idea to sometimes drop the T4 dose to just check you are at the correct level for yourself. Sometimes we can be over medicated, but not realise it. So don't be to worried you now feel worse. I would go back up and see how things work out. Will the flushing return ? Could this be down to another issue ?

Have you been taking other supplements or dropped taking something apart from the T4?

[eeng]

Maybe you need to take something between 125 and 150 mcg. You could try taking 125 and 150 on alternate days. Just because those are the doses the pharmaceutical industry provides doesn't mean they are the perfect dose for anybody! Your body will average the doses out over a few days.