Levothyroxine

[Monique66]

This is probably a silly question but here goes, what is the difference between T3 and levothyroxine. My GP said my T3 is about low so upped my thyroxin dosage from 125mg to 150mg which I take in the mornings. I went back yesterday as I felt my heart was racing and was told to take 125mg one day and 150mg the next. I took 125mg this morning g but feel really tired, nauseous and a bit dizzy. GP did say levels could take a few days to even out . Has anyone else had this and did it get better soon?

[cjrsquared]

Levothyroxine is t4 an inactive form of the hormone which the body then converts to t3 the active hormone. In health the thyroid produces about 20% of required t3 and the rest as t4 which is converted to t3 throughout the body. The conversion requires a particular enzyme plus optimal levels of iron and vitamins, hence the need to monitor vit b12, ferritin, folate and vit d to promote good conversion.

Hope that helps.

[Monique66 in reply to cjrsquared]

Cjrsquared you have helped a lot. I have had this condition for almost eight years but much to my shame I really didn't understand, though my GP did explain, the various connections.

[greygoose]

Did you get a copy of those results? If so, post them here, with the ranges, and let's have a look.

Did your increase in dose require a change in brand of Levo? It's rather unlikely that the hormone content would have those effects in such a short time. So, it could be the fillers you're reacting to.

Telling you it would take a 'few days' to even out, is a standard reply to any reaction to a pill, and not necessarily applicable for any of them.

[Monique66 in reply to greygoose]

Hi, no brand is still the same. I didn't get a printout although GP told me verbally. I didn't think of the fillers.

[Monique66 in reply to greygoose]

Could it be my blood pressure dropping due to lower doseage?

[SlowDragon Administrator in reply to Monique66]

You are legally entitled to printed copies of your blood test results and ranges.

UK GP practices are supposed to offer online access for blood test results. Ring and ask if this is available and apply to do so if possible, if it is you may need "enhanced access" to see blood results.

In reality many GP surgeries do not have blood test results online yet

Alternatively ring receptionist and request printed copies of results. Allow couple of days and then go and pick up.

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

Important to see exactly what has been tested and equally important what hasn't been tested yet

Ask GP to test vitamins and thyroid antibodies if not been done

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and fasting. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

Last Levothyroxine dose should be 24 hours prior to test, (taking delayed dose immediately after blood draw).

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

Medichecks currently have an offer on until end of May - 20% off

thyroiduk.org.uk/index.html

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_...

Many people need to fine tune the doseage

It can make you feel rather unwell, with even a small dose reduction.

Bloods should be retested 6-8 weeks after any dose change (or change in brand of Levothyroxine too)

[Monique66 in reply to SlowDragon]

My GP did tell me I'm sensitive to thyroxine.

[SlowDragon Administrator in reply to Monique66]

It can be because you have low vitamin levels

Extremely common, and especially if you have Hashimoto's

Regular testing of vitamin D, folate, ferritin and B12 annually recommended

More frequently if supplementing to improve any that are too low

These all need to be at good levels, not just within range

Eg B12 range is typically 210-750

GP would say result is fine if it was 230 or 680. But on Levothyroxine we often need B12 at least over 500, if not higher

Folate similar, nearer top of range likely better

Vitamin D at least over 80nmol. Anything over 50nmol is fine by GP standards

Ferritin at least half way in range

[Monique66 in reply to SlowDragon]

I take two adcal d3 caplets everyday and have a vitamin b12 injection every eight weeks, increased from every 12 weeks approximately 4 months ago. I've already learnt so much on this site and everyone has been so supportive and helpful!

[SlowDragon Administrator in reply to Monique66]

So if you already have been diagnosed as low vitamin D and low B12 it's likely you have Hashimoto's

You need to make sure you take your vitamin D four hours away from Levo

Vitamin D needs retesting, folate and ferritin too

With Hashimoto's Vitamin D mouth spray by Better You is good as avoids poor gut function. Can lead shorter time between Levothyroxine and mouth spray too - about an hour




It's trial and error what dose each person needs.

Frequently with Hashimoto's we need higher dose than average

Local CCG guidelines on vitamin D doseage

clinox.info/clinical-suppor...

Government recommends everyone supplement vitamin D October to April

gov.uk/government/news/phe-...




Also read up on importance of magnesium and vitamin K2 Mk7 supplements when taking vitamin D

betterbones.com/bone-nutrit...

articles.mercola.com/sites/...

healthy-holistic-living.com...

sciencedaily.com/releases/2...

articles.mercola.com/sites/...


betterbones.com/bone-nutrit...

This article explains should discuss with specialists before taking any vitamin K if you take any blood thinning medication

drsinatra.com/vitamin-k2-su...

[Monique66 in reply to SlowDragon]

I started off with Graves Disease and had RAI almost eight years ago, since then it's been under active. I've got pernicious anemia as well.

[SlowDragon Administrator in reply to Monique66]

Two problems after Graves

First TSH is often stuck on suppressed levels after periods of being hyperthyroid. Medics frequently keep reducing Levo in attempting to get TSH to rise

Gluten intolerance and low vitamins often remain after RAI

Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse

chriskresser.com/the-gluten...

amymyersmd.com/2018/04/3-re...

thyroidpharmacist.com/artic...

scdlifestyle.com/2014/08/th...

[Angel_of_the_North in reply to Monique66]

Do you actually need the calcium in adcal? Most people don't and it will interfere will the absorption of thyroxine - need to leave 4 hours between adcal and levo. I also suspect the dose of D3 in adcal is too low to do much good if you were actually deficient. I'd get a retest to see how you are now doing. You also need to take vitamin K2 and magnesium with vit D to make sure that the calcium goes into your bones, not your arteries

[Monique66 in reply to Angel_of_the_North]

Ah I didn't know that, I'm so glad I came across this site as I've already learnt so much.

[greygoose in reply to Monique66]

Do you suffer from low blood pressure? Did your blood pressure drop? Blood pressure doesn't normally react that fast, either. And, I don't think falling blood pressure make you nauseous. Could you have some kind of infection?

[Monique66 in reply to greygoose]

Hi Greygoose, yes my blood pressure can go low, it can make me feel nauseous.Funnily enough the first day I took the higher dose (150mg) I felt dizzy and nauseous but not tired.

[greygoose in reply to Monique66]

Low blood pressure is a hypo symptoms, and would really suggest you need that increase. But, as I said, that's too fast acting for it to be the actual hormone causing the problem, far more likely to be the fillers.

[Monique66 in reply to greygoose]

I wondered if the increase was a bit too high, as I could feel my heart starting to race and my body revving up. Mx

[greygoose in reply to Monique66]

Well, in time it might prove to be. But you wouldn't know that the first day you take it. It takes at least a week to feel any effects from a dose change, and 6 weeks to feel the full effects.

[Monique66 in reply to greygoose]

I took increased dose for a week but heart racing and body revving up, went back to GP on Friday and was told to try 125mg one day and 150mg the next, yesterday I took the 125mg. I've had this happen to me before when my dose was lowered too much felt it first day however I gave it a week before returning to my GP who said my blood pressure had gone too low.

[greygoose in reply to Monique66]

OK, but there's not very much anyone can say about this. You haven't posted any blood test results (with ranges) and you haven't said if you've had your nutrients tested. This obviously isn't a common problem, because no-one else has responded. So, I really think we need more detail.

[Monique66 in reply to greygoose]

Yeah had nutrients tested. Need to get a printout of blood tests from my GP. My GP did say I'm sensitive to levothyroxine, last time my dose needed changed ( almost a year ago) they had to adjust it a few times along with a beta blocker I take, but once they got it right I felt better than I had done for a few years!

[greygoose in reply to Monique66]

I'm not sure that even means anything, sensitive to levothyroxine. It's just one of those things doctors say to cover up the fact that they have no idea what's wrong.

So, if you're taking a beta blocker, does that mean that you already had a heart problem of some kind before you started taking levo? Which one is it?

[Monique66 in reply to greygoose]

Hi, no I don't have a heart problem, was prescribed beta blocker to counteract a side effect of levothyroxine, it was causing a tremor.

[greygoose in reply to Monique66]

Beta Blockers don't agree with everyone - they make me quite ill. So, have you never considered that it might be the Beta Blocker causing the problems?

[Monique66 in reply to greygoose]

I started off on propranolol, was on it for around 5.5 years, not a large dose, then needed my levothyroxine dose lowered GP didn't change my beta blocker dose, blood pressure became too low, GP told me not to take beta blocker and raised slightly my levo dose which was fine for a few weeks but tremor returned so GP gave me a very low dose of different beta blocker and I was fine for almost a year.

[greygoose in reply to Monique66]

Do you know what your readings were when your doctor thought your dose needed lowering? Now it needs raising, I'm wondering if your doctor is dosing by the TSH.

[Monique66 in reply to greygoose]

Unfortunately I don't but do know this time Ts3 and Ts4 test was done.

[greygoose in reply to Monique66]

OK, well, post the results here, when you get them, and tell us what the doctor says.

[Monique66 in reply to greygoose]

I definitely will, everyone has been so helpful and supportive.

[Angel_of_the_North in reply to Monique66]

Beta blockers interfere with thyroid function and makes some things, like breathlessness, worse. So I'd try to get off them if you can. Then you might find that you don't need as much levo.

[Monique66 in reply to Angel_of_the_North]

Hi angel of the north, I don't suffer from breathlessness thankfully, a tremor and get anxious.

[pennyannie in reply to Monique66]

Hi Monique66

I think some of your current symptoms could be related to your Graves Disease.

I understand that you have had treatment for this disease, probably with anti thyroid medications and then the RAI which basically "burnt out " your thyroid rendering you hypothyroid.

I understand being hyperthyroid can be considered life threatening and the NHS believe that hypothyroidism is a better option than hyperthyroidism since they believe they can manage an underactive thyroid better than they can manage an overactive thyroid.

Simply swopping one set of symptoms for another is a little bit simplistic and simply removing or destroying the major gland under attack, the thyroid, doesn't actually solve the underlying problems that may still be lingering of Graves Disease.

Graves is an auto immune disease and as such it's for life, it's in your blood / DNA.

There is probably some genetic predisposition, maybe a generation away from you.

I read Graves can be triggered by a sudden shock to the system like a car crash or an unexpected death and Graves is said to thrive on stress and anxiety.

I too have Graves and received RAI in 2005 becoming unwell some 5 years ago.

Through this website I have been able to help myself back to better health and am now self medicating with Natural Desiccated Thyroid.

Graves patients can have a very low, or suppressed TSH after treatment and RAI.

Our own thyroid feedback loop has been broken through the treatment we have received and a TSH blood test doesn't go far enough for our future health needs.

it is imperative that you are dosed and monitored to T3 and T4 bloods levels and not to a TSH read which maybe giving you a false low read - a bit like knowing your car needs petrol but having a fuel gauge stuck on full.

I hope that makes some sense, along with the answers I gave you yesterday on your other post.

[Monique66 in reply to pennyannie]

Yeah it does thanks. Being monitored on T3 and T4 tests. There is thyroid disease on both sides of my family. I remember being told an under active thyroid is easier to control than an over active but yes all it does is swap one thing for another. Some of these symptoms I feel do remind me of Graves Disease like you say, as if it's still in the back ground.

[pennyannie in reply to Monique66]

Well I'm very pleased to read that you haven't become a victim of being treated with only a TSH blood test for reference.

Ideally T3 and T4 should be balanced and in upper quadrants of their relevant ranges. T3 is roughly 4 times stronger than T4 and a ratio of 1/4 is considered about right.

As previously mentioned Graves patients, especially after RAI may find a T3/T4 combo or NDT better options of thyroid hormone replacement.

It might be worth considering your work / life balance, along with diet, and maybe try to develop some relaxation and meditation techniques and hobbies that you actually enjoy.

Do you have any blood tests to share with us ?

[Monique66 in reply to pennyannie]

I need to get a copy of my latest blood test results. I try to relax and eat a healthy diet, get enough sleep, in general have a balance to life as stress is our enemy.