Increasing Levothyroxine

Thank you for the responses to my last weeks posts. I'm sorry to bother you with a few more. I asked my gp to increase my levothyroxine 50 mcg to 75mcg because my BP was high, 2.2 TSH at that time. She finally agreed to the increase and after 7 days I am seeing an improvement in my blood pressure. However, during the past few evenings, starting about 9 pm I have been having some "skipped beats" in my heart rhythm. Perhaps one skipped beat every 5 to 15 minutes....... otherwise my heart rhythm is normal. All day I am feeling much better, more like my old self, and no skipped beats. Are these skipped beats something that might pass as my heart gets used to the increased hormone? Why do they only happen at night? When I go to bed they go away. I should mention I am a 58 yr old female in good health and I exercise at least 3-4 times a week. I have an appt with an endocrinologist in June. Im afraid if i tell my GP she will tell me to go back to 50 mcg and take an antihypertensive. Therefore, treating the symptoms but not the cause. Thank you so much for reading and any advice.

[shaws Administrator]

Even though your dose has been increased, it might still not be high enough yet as doses are increased by 25mcg until the TSH is low.

The aim is a TSH of 1 or below with a Free T4 and Free T3 in the upper part of the ranges. T4 (levothyroxine) is the inactive hormone and it has to convert to T3 (active hormone). It is T3 which is needed in our millions of T3 receptor cells *brain and heart contain the most) so if we're good at converting T4 into T3 - optimally - you should not have clinical symptoms.

[Hidden in reply to shaws]

Thank you for all of this important information. I never paid attention to my thyroid or the condition before because I was always doing fine, until I decreased the amount. It is amazing how important the thyroid is.

[Aurealis]

Possibly you only notice it in the evenings or it only occurs when you’re tired. Perhaps the increase you’ve had in dose allows you to do more but your heart isn’t used to it yet. It does sound like you may be doing a bit too much if it goes when you go to bed. That would seem to be a good sign I think (but I’m not medically qualified of course)

[Hidden in reply to Aurealis]

Thank you. Perhaps that is why!

[NWA6]

Or another way to think about it is that the 25mcg per day is too much atm. When my TSH was 2.5 -2.9 I only added in another 25mcg for the week and after 3wks TSH was down to 0.33. So you could play with your dose. 50 x5 and 75 x 2 or 50 x 4 and 75 x 3 or 50/75 on alternate days.

[Hidden in reply to NWA6]

That is a great idea. Thank you! I asked my GP if i could start going up slowly, by increasing by 12.5 extra per day instead of the 25. She said no, it will take too long to fix my bp. I think I need a new GP! I am so happy that I have found an endocrinologist. Only problem is the wait until June. Thank you so much.

[NWA6 in reply to Hidden]

Youre welcome dogluva. June is probably great timing to see an Endo because you have to find the right dose for you and that takes time as you don’t want to play about with your dose too quickly or too much. It can take 5-7 days for Levo to react/change your levels. For me persoanllly If I’m going to feel a change in dose it’ll happen within 2wks. Just remember that we’re all different and as you said if your other reply you have to become your own advocate and so that means really becoming sensitive to your body and listening to all the changes so that you can find what works for you.

[SlowDragon Administrator]

Essential to test vitamin levels and antibodies

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also extremely important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially if Thyroid antibodies are raised

Low vitamin levels can affect heart rate and cause skipping bears

Has GP tested Thyroid antibodies or vitamins? If not, request that she does so ASAP BEFORE you see Endocrinologist

Getting vitamin levels optimal by supplementing can help Thyroid hormones work better

Bloods should be retested 6-8 weeks after each dose increase

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and fasting. Last Levothyroxine dose should be 24 hours prior to test,(taking delayed dose immediately after blood draw). This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

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

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 special offers, Medichecks usually have offers on Thursdays, Blue Horizon its more random

If antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).

About 90% of all hypothyroidism in Uk is due to Hashimoto's.

Low vitamins are especially common with Hashimoto's. Food intolerances are very common too, especially gluten. So it's important to get TPO and TG thyroid antibodies tested at least once .

Link about thyroid blood tests

thyroiduk.org/tuk/testing/t...

Link about antibodies and Hashimoto's

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

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

List of hypothyroid symptoms

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

[Hidden in reply to SlowDragon]

Thank you for all of the advice and information! So important to be informed. I feel like I have to advocate for myself. Why do the GPs have to make it so difficult?

[SlowDragon Administrator in reply to Hidden]

Medics cover learning about thyroid and all its complexity in about a single day at medical school..... that it's a simple disease to treat......it can be anything but simple ....there are so many variables......

It can take many years to get diagnosed. Every single cell in the body needs Thyroid hormones

Autoimmune thyroid disease (Hashimoto's) can be even more complex. Levels jumping around, upsets other endocrine systems.

Low vitamins are extremely common

Many medics just don't seem to see the link between poor gut function, low vitamins and hypothyroidism

[MissGrace]

Whatever the reason may be - get it checked out. You may be able to get an ECG at your GP’s. Best to get things checked - it’s probably nothing to worry about if it isn’t accompanied by breathlessness or dizziness but for your own peace of mind get someone to have a listen. When I saw a cardiologist and told him I tended to have palpitations when tired - sitting on the settee in the evening or when in bed - he said that was because it was more noticeable if I was sitting quietly and not busy - we are more aware of our heart then. Hope you feel better soon. 🤸🏿‍♀️🥛

[Hidden in reply to MissGrace]

Yes, so true. Thank you!