Levothyroxin reduction and Painful Backache.

[RattyPatty]

My GP has been reducing my Levothyroxin from 175mcg down to 75 mcgs over the last two years as she said I was hyperthyroid having been hypothyroid for many years. Didn't feel too bad after the last reduction but have put on a stone.

I had a full Medicheck in September but just showing the thyroid result here. The comments said I was still over medicated so without going to the GP I reduced dose to 50 mcgs. (She had frightened the life out of me by saying I would have all sort of health problems if I was overmedicated).

About 8 weeks after reduction I woke up with extremely painful backache right across my waistline. I thought I had maybe slept badly and it would clear up. Three weeks later it was getting worse and I was so tired some nights I was eating my dinner with my eyes closed.

I discovered muscle cramps in the centre of the body is a symptom of hypothyroid so I went back to 75 mcgs 9 days ago and my back pain and stiffness has been improving daily. (I am not prone to back problems).

I am assuming from this that it was the reduction in Levothyroxin that caused the pain.

From what I have learnt my high T4 and very low T3 means the T4 is not converting well to T3 and T3 is what my body needs if I am to be able to reduce my Levothyroxin.

Am I correct? Any advice please on how to discuss this with my GP. I am 72.

Thank you.

Thyroid Hormones

TSH X 0.152 mIU/L (Range: 0.27 - 4.2)

Free T3 3.5 pmol/L (Range: 3.1 - 6.8)

Free Thyroxine X 23.900 pmol/L (Range: 12 - 22)

[SeasideSusie Remembering]

RattyPatty

Yes, your FT4 being high and FT3 being low suggest that you aren't converting T4 to T3 very well. However, we need optimal nutrient levels for thyroid hormone to work properly. Did you have the full thyroid/vitamin package, i.e the Thyroid Check ULTRAVIT test?

If not then I would do so as this includes thyroid antibodies (worth checking if you haven't had them done) and Vit D, B12, Folate, Ferritin.

[RattyPatty in reply to SeasideSusie]

Have posted results under Marz's reply. Thank you.

[Marz]

Am wondering if you took your Levo/T4 before your test which is suggested by your high FT4.

You are only over- medicated if your FT3 is over range and yours does suggest a conversion issue.

Have you had B12 - Folate - Ferritin - VitD tested ? Optimal levels needed for good conversion ...

[RattyPatty in reply to Marz]

Yes I took the Levothyroxin about 6.00am and had the test at 11.30 am. Had two mugs of tea with semi skimmed milk about 3 hours before but no food.

Red Blood Cells

Haemoglobin 144 g/L (Range: 120 - 160)

Haematocrit 0.427 L/L (Range: 0.35 - 0.47)

Red Cell Count 4.22 x10^12/L (Range: 3.8 - 5.8)

MCV X 101.2 fl (Range: 81 - 98)

MCH X 34.1 pg (Range: 27 - 33)

MCHC 337 g/L (Range: 300 - 350)

RDW 13.6 % (Range: 11.5 - 14.4)

White Blood Cells

White Cell Count 5.64 x10^9/L (Range: 3 - 10)

Neutrophils 2.9 x10^9/L (Range: 2 - 7.5)

Lymphocytes 2.19 x10^9/L (Range: 1.2 - 3.65)

Monocytes 0.36 x10^9/L (Range: 0.2 - 1)

Eosinophils 0.07 x10^9/L (Range: 0 - 0.4)

Basophils 0.07 x10^9/L (Range: 0 - 0.1)

Clotting Status

Platelet Count 323 x10^9/L (Range: 150 - 400)

MPV 9.6 fl (Range: 7 - 13)

Kidney Health

Urea 5.5 mmol/L (Range: 2.5 - 7.8)

Creatinine 80 umol/L (Range: 45 - 84)

eGFR 61.17 ml/min/1.73m2 (Range: ? 60)

Liver Health

Bilirubin 12.9 umol/L (Range: < 21)

ALP 75 IU/L (Range: < 130)

ALT 20.8 IU/L (Range: < 35)

GGT 21 IU/L (Range: 6 - 42)

Proteins

Total Protein 78.3 g/L (Range: 60 - 80)

Albumin 40.8 g/L (Range: 35 - 50)

Globulin X 37.5 g/L (Range: 19 - 35)

Diabetes

HbA1c 37.28 mmol/mol (Range: 20 - 42)

Cholesterol Status

Total Cholesterol X 5.54 mmol/L (Range: 0 - 5)

LDL Cholesterol X 3.4 mmol/L (Range: < 3)

Non HDL Cholesterol X 4.02 mmol/L (Range: < 4)

HDL Cholesterol 1.52 mmol/L (Range: > 1.3)

Total Cholesterol : HDL 3.64 ratio (Range: < 4)

Triglycerides 1.37 mmol/L (Range: < 1.7)

Inflammation

CRP HS 2.48 mg/L (Range: < 5)

Gout Risk

Uric Acid 342 umol/L (Range: 140 - 360)

Muscle Health

Creatine Kinase 75 IU/L (Range: 26 - 192)

Iron Status

Iron 19.25 umol/L (Range: 5.8 - 34.5)

TIBC 60.45 umol/L (Range: 45 - 72)

UIBC 41.2 umol/L (Range: 24.2 - 70.1)

Transferrin Saturation 31.84 % (Range: 20 - 50)

Ferritin 86 ug/L (Range: 13 - 150)

Minerals

Magnesium - Serum 0.86 mmol/L (Range: 0.66 - 0.99)

Vitamins

Folate - Serum 8.14 ug/L (Range: > 3.89)

Vitamin B12 - Active 119.000 pmol/L (Range: 37.5 - 188)

Vitamin D 64.5 nmol/L (Range: 50 - 175)

Thyroid Hormones

TSH X 0.152 mIU/L (Range: 0.27 - 4.2)

Free T3 3.5 pmol/L (Range: 3.1 - 6.8)

Free Thyroxine X 23.900 pmol/L (Range: 12 - 22)

Hormones

Hormone Phase Postmenopause Phase

FSH 34.7 IU/L (Range: 25.8 - 134.8)

LH 24 IU/L (Range: 7.7 - 58.5)

Oestradiol 49.2 pmol/L (Range: < 100)

[Marz in reply to RattyPatty]

It is suggested here that it is best to stop your Levo 24 hours before testing - so as you took it in the morning it would explain the level being over range. Your VitD would be better around 100 - are you supplementing ? Are you on any other medications ? Supplements?

[RattyPatty in reply to Marz]

I don't take any other medication or supplements.

If I don't take my Levothyroxin before a blood test and it results in a lower T4 level wouldn't that prove that the doctor was right about over medication?

[Marz in reply to RattyPatty]

You are only over medicated if your FT3 is over range - yours is low in range and you need to supplement VitD ...

[SeasideSusie Remembering in reply to RattyPatty]

Yes I took the Levothyroxin about 6.00am and had the test at 11.30 am

That has given you a false high FT4. The last dose of Levo should be 24 hours before test.

Your iron panel seems to be OK.

Magnesium - Serum 0.86 mmol/L (Range: 0.66 - 0.99)

Magnesium is an unreliable test and most of us are low in magnesium anyway.

Folate - Serum 8.14 ug/L (Range: > 3.89)

In double figures would be better, you can improve this by eating lots of folate rich foods.

Vitamin B12 - Active 119.000 pmol/L (Range: 37.5 - 188)

This is OK.

Vitamin D 64.5 nmol/L (Range: 50 - 175)

This is too low. The Vit D Council recommends a level of 125nmol/L and the Vit D Society recommends a level of 100-150nmol/L. My suggestion, based on Vit D Council's recommendation, is to take 4,000iu D3 daily along with it's important cofactors - magnesium and Vit K2-MK7. Retest after 3 months.

When you've reached the recommended level then you'll need a maintenance dose to keep it there, which may be 2000iu daily, maybe more or less, maybe less in summer than winter, 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 an NHS lab which offers this test to the general public:

vitamindtest.org.uk/

MCH X 34.1 pg (Range: 27 - 33)

This is slightly over range, your GP might want to keep an eye on it.

[SlowDragon Administrator]

Reading previous posts....you definitely look like you had a hyperthyroid phase

healthunlocked.com/user/rat...

Stress of moving house perhaps?

[RattyPatty in reply to SlowDragon]

It is exactly two years since I packed up and moved house so I don't think that could be the reason for my backache and lethargy now.

However you have reminded me that I did have backache at the time, and felt very tired of course, but I put it down to all the heavy work I was doing at 70. I was on my normal for then dose of 150 mcgs. It wasn't as bad as the backache I am experiencing now.

As the T4 is only a little above the range at 23.900 (12-22)

I think I may just carry on at 75 mcgs. I have now been back on this dose for 10 days and feel that my back is improving.

I will get another test done in March, before taking the morning dose, as this will give time for the increase to show and be six months from the full test shown above.

I can't be sure that reducing my Levothyroxin caused the backache or that increasing it is helping it go away but I do feel strongly that the reduction was the cause.

Thank you for your reply.

[SlowDragon Administrator in reply to RattyPatty]

Your vitamin D is too low, this can give bone pain

GP will only prescribe to bring vitamin D up to 50nmol. Aiming to improve by self supplementing to at least 80nmol and around 100nmol may be better .

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

etesting twice yearly via vitamindtest.org.uk

Vitamin D mouth spray by Better You is good as avoids poor gut function.

It's trial and error what dose each person needs. Frequently with Hashimoto's we need higher dose than average

Local CCG guidelines

clinox.info/clinical-suppor...

Government recommends everyone supplement October to April

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

Magnesium

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Vitamin K2 mk7

betterbones.com/bone-nutrit...