Over replaced thyroxine- how to reduce?

[msmono]

Hi,

I reduced my levo from 100 to 75 mcg following symptoms of over-replacement and had around 4 weeks of feeling really really well (just normal actually) until the last few days when the symptoms have returned: feeling like i have flu, very hot (though i don't sweat any more for some reason), sleepless, anxious, aching all over, brain fog. A G.P. rang me Friday and suggested reducing as my test last week continued to show possible over-replacement. He didn't pressure me (results TSH level (XaELV) 0.01 miu/L [0.35 - 5) free T4 level (XaERr) 21.8 pmol/L [7 - 20])

Is it unusual to go back down to the dose i started on? Whats the best way to reduce? I just want to feel well again. The other thing is that since starting treatment in june I've lost about 10% of my body weight which could explain a need to reduce?

Im taking loads of vitamins but haven't got the money till after xmas to get these retested.

Thanks in advance for any advice

[SlowDragon Administrator]

These are the last results?

healthunlocked.com/thyroidu...

They didn't really suggest over replacement

[msmono in reply to SlowDragon]

I had another test just after that (an nhs one which they asked for). Its included in that or another post). I feel over medicated as stated and when i reduced from 100 to 75 i felt better after a few days and then for a month.

[SlowDragon Administrator in reply to msmono]

Recommend getting full Thyroid and vitamin testing 6-8 weeks after dose reduction

Vitamin levels often drop when dose is reduced

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .

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

This gives highest TSH, lowest FT4 and most consistent results.

[msmono in reply to SlowDragon]

I missed two doses to be sure and it was a fasting test. Unfortunately i cant afford any more private tests for a while so thats me (like a lot of people) up the creek. It was great to have 4 good weeks though- and this time i didn't make the mistake of believing it would last so i enjoyed it while it did 😋

[msmono in reply to SlowDragon]

What kind of levels would suggest over-replacement if symptoms were present?

[greygoose in reply to msmono]

If you were really over-replaced, you would have a very high FT3. As you haven't even had the FT3 tested, you can't really know if you've been over-replaced. You cannot go by symptoms alone because so many symptoms are both over- and under-. Just because you have over-range does not mean you are converting all that T4 to T3. You could be a poor converter and your symptoms are actually hypo symptoms.

[msmono in reply to greygoose]

Hi and thanks, these feel like different symptoms to when I'm ‘under’. The over- heating for a start- so unusual for me. But i hear you on the free t3 - the endo asked for it but of course they wouldn't do it. It was 75% through the range though when it was (privately) tested two months ago.

[Aurealis]

You could make a smaller reduction and take different doses on alternate days 75/100

[msmono in reply to Aurealis]

Im on 75 at the moment Down from 100 a month ago) and just had the above blood result despite missing two doses before test. Im not going on that though but on how ill I feel. I could do 75/50 though? Ive lost quite a lot of weight (and im only 5ft) so maybe i just need a lower dose now. Thanks for posting.

[greygoose in reply to msmono]

Weight-loss can also be a hypo symptom. And could be due to many other things.

[msmono in reply to greygoose]

Its due to having less appetite and eating really really healthily since june. Its one very good thing thats come out of this and I'm not worried about it but i just thought if i weighed less then maybe (according to the formula) i need less.

[greygoose in reply to msmono]

There isn't a formula that I know of. Losing weight has never meant that I've needed less hormone.

[Aurealis in reply to msmono]

1.6mcg/per kg of body weight is sometimes quoted but no-one seems to use it as even if you know how much your body needs, you don’t know how much is absorbed, or converted. If only life were so simple. In my experience loss of weight can cause you to need to reduce the dose, but weight loss is a non-specific symptom as greygoose says. More often, in me, it happens with over- replacement rather than under but I unfortunately seem to usually put on weight if not optimal whichever way it’s out. You could be opposite to me. Be careful with the feeling hot symptom too, if you can compare your skin temperature by touch with those around you that may be a better guide, as subjective feelings on temperature can be wildly out. Your other symptoms suggest undertreatment to me.

[greygoose in reply to Aurealis]

1.6mcg/per kg of body weight is sometimes quoted

Yes, but that's for people who are about to have their thyroids removed, as a starting dose for afterwards. It is then adjusted up or down according to their needs. It's not intended to be a goal to work towards for other types of hypo.

[msmono in reply to greygoose]

Point taken on that. 🙂

[msmono in reply to Aurealis]

Thanks, i just feel a bit crazy (hyper-active and buzzy but not in a nice way) but also ill like i have flu, and very hot (the latter being very unusual for me as I’ve been pretty much frozen and low temperature readings for years and years until starting treatment in june) Also when I'm ‘under’ i pretty much sleep all the time. Think I'm going to try a slight reduction and see what happens.

[Aurealis in reply to msmono]

Just be careful, in case you do have flu!

[msmono in reply to Aurealis]

Thanks, im pretty sure I haven't but who knows its too easy to blame everything on hashis! At least i had 4 good weeks this time.thanks again for your input. Much appreciated 🙂

[Nanaedake in reply to msmono]

You can't rely on how you feel. It's an indication that something is out of balance but only blood tests will tell you what. Symptoms are unreliable with thyroid as over and under medication can have similar symptoms.

Overheating might be due to B12 supplements, too much iron, menopause, and any number of other things.

[Aurealis in reply to Nanaedake]

I’ve adjusted according to how I feel for many years quite successfully, but I have avoided supplements. As you say, it’s hard to tell once you’re taking more than one drug or supplement. Tests can be unhelpful

[msmono in reply to Aurealis]

How long did it take you to reach a level? How do you adjust if you don't mind me asking? Im still quite new to this so not always sure how I feel when sometimes its just feeling either very or slightly ill. I think i needed the supplements (i tested as low-normal on the usual suspects) but maybe I've over done it. Ill probably have to bite the bullet and find some money for more private tests.

[msmono in reply to Nanaedake]

Hi, thanks for your input. re supplements thats really interesting - do you mean potential over-supplementing? Ive been maxing the b12 and iron as they were low. I hear what you're saying re tests but g.p. wont do them so I’m working in the dark a bit. (Its almost definitely not meno). Over- heating is so, so unusual for me. I’m usually freezing!

[Nanaedake in reply to msmono]

You can have private blood tests with online labs such as Medichecks or Blue Horizon. Check out Thyroid UKs website. Blood tests might not be perfect but they're the best guide we have. Most people who have hypothyroidism and are vitamin deficient,have to supplement some vitamins for life to retain good levels. You simply can't adjust by symptoms. If you do then you risk running into problems.

[msmono in reply to Nanaedake]

Hi, yeah i had lots of private blood tests and a private endo hence supplements but i (like many) have a limited budget and its going to be a long time before i can raise a spare £150 odd for the well woman ultra vit which will allow me to review everything. Anyway, Im going to take a supplement break in case anything there is causing problems. Thank you for the advice.

[Nanaedake in reply to msmono]

A lot of people just do the thyroid ultra vit which is currently £70 approx with the discount I think from Medichecks.

Some vits are water soluble like vitamin C and your body will excrete what you don't need but iron and vitamin D are stored so they are more critical to check and make sure you don't go over range with them.

What vitamins are you actually taking?

[msmono in reply to Nanaedake]

I was low/normal on b12, iron (but didnt have a full panel) and vit d. Im was taking a high dose of b12 and d and normal dose liquid iron, vitk and magnesium. I did see that test but i think i need a full iron panel and would like to see where my oestrogen is at so I can rule it out (i use it transdermally and 12 hours away from levothyroxine just in case).

[Nanaedake in reply to msmono]

Is it K2-MK7? It's a shame you can't at least test D and iron as you might be at a good level and just need a maintenance dose now.

[msmono in reply to Nanaedake]

Yes - i think its that k2. Thanks again for your advice. 🙂