How to reduce dose?

[mpond]

I am going to ask my GP to lower my dose of Levothyroxine from 100 to 75 mcg. If I still have 100mcg left when he does how can I take them so they don’t go to waste and I do take 75mcg? Do I skip a tablet every certain number of days maybe?

[SeasideSusie Remembering]

mpond

I would be wary of asking for your prescription to be reduced, it may be difficult to get it raised again if you feel the need. If you want to reduce it yourself the just cut a 100mcg tablet in half. Take 100mcg on one day then 50mcg the next day, just repeat alternating the dose.

But why do you want to reduce? Two weeks ago your results were:

TSH 0.04

FT4 16.4

FT3 5.3

Even though you haven't given ranges then it's unlikely your FT4 or FT3 are over range based on all the ranges we see here. My surgery's FT4 range is the lowest I've seen at 7-17 and most FT3 ranges tend to have an upper limit in the 6s, eg 6.5 or 6.8

[jimh111 in reply to SeasideSusie]

I would follow this advice. Generally 25 - 5- mcg more levothyroxine is needed during pregnancy so you can just trial the lower dose and if after a month or so you are better on it you can get your prescription changed. Also, after birth many women have 'post-partum thyroiditis' which settles down after a while. This could be happening to you. See how things go on 75 mcg and if they don't improve in a month or two see your doctor.

[mpond in reply to SeasideSusie]

I recently read an article saying it’s risky to have such a low TSH for prolonged periods of time. That’s partly why I want to see if with 75mcg I feel better

[SeasideSusie Remembering in reply to mpond]

Well all I can say is that my TSH has been mostly suppressed since at least 1997, it's only just scraped into the very bottom of the range on 4 occasions out of 57 tests and depending on how low the different machines measure to it's often been <0.005

Don't forget that TSH is not a thyroid hormone, it's from the pituitary, the thyroid hormones are FT4 and FT3 and it's that which determines how we feel.

[tattybogle in reply to mpond]

Prolonged periods (in relation to very low tsh ) means years, rather than months . I wouldn't let that concern you for a while yet. You've got enough else to deal with for now, without worrying about statistical risks. Obviously if your FT3/ FT4 results are over-range then its different (lower your dose a bit ), but Tsh on its own shouldn't be worrying you at the mo. Mine's been 0.05 ish for about 15 years, so i've researched the 'risks'. I'm not a poster child for good health outcomes on Levo , ... but i have no heart or bone problems either.

[jimh111 in reply to mpond]

This is true in most cases. In your case your fT3 and fT4 are not high, it is more likely your pituitary is underperforming rather than being suppressed by too much hormone. It's also possible you have thyroiditis (inflammation of the thyroid) and your thyroidal secretion is erratic, this may settle down. Trying a reduced dose is a sensible move, try it and resume 100 mcg if you feel worse.

[tattybogle]

Assuming this is because you now feel overmedicated since the birth ? Be cautious of getting your prescription lowered, they may not put it up again later, ( when you will probably need it again once you have settled down after this birth)

I'd want a blood test to see where my levels were just for the record before changing dose.

(but i can understand why you might not want to go in at the moment)

You can lower it yourself anyway, ask for prescription to be altered to 2x50 a day , then cut one in half to get 75 a day (less chance of getting confused if you take the same everyday)

Avoiding changing brand is more important, if you want to be sure if you feel better with a reduction, you wont be able to tell ,if you get a different brand of Levo (which often happens if you change dose. Check it's the brand you want before you leave the chemist.

[tattybogle in reply to tattybogle]

Or do what SeasideSusie suggests , which is better actually (i didnt think of that !)

[mpond in reply to tattybogle]

This is good advice too as I may forget if the day before I took 50 or 100. To get the prescription changed would I have to ask the GP or my pharmacy? I think the GP might refuse if he suspects I intend to alter my dose though

[tattybogle in reply to mpond]

I asked mine to give me 50's because i had been trying a split dose am/pm and had found it helped with fatigue in the late afternoon. I'm sure he thought i was an idiot ! but he did it.

[SeasideSusie Remembering in reply to mpond]

It's more expensive to prescribe 2 x 50mcg than 1 x 100mcg, so yes, he might get suspicious. If you cut a 100mcg tablet into two, put the spare one in a small lidded container, make a spreadsheet and mark off what you take each day, or marke it in a notebook and keep it with your tablets (that's what I did when I was alternating doses).

[mpond]

They are doing my TFTs again tomorrow. I do feet I am overmedicated. I hadn’t considered PP thyroiditis. I will look into it. My pharmacy changed the brand of Levothyroxine just before lockdown. I assumed it was due to Brexit. I haven’t noticed any difference between since I started talking the nee brand ones.

One of my symptoms is difficulty sleeping (when I get the chance). I feel I don’t go into a deep enough sleep when I manage it. The other symptoms are fatigue and weight loss. I am eating well but had to cut down on sugar as it makes it harder to sleep.

I will take your advice and reduce the dose myself to try and see if I feel better.

[humanbean in reply to mpond]

My pharmacy changed the brand of Levothyroxine just before lockdown. I assumed it was due to Brexit.

I doubt the change in brand of Levo is due to Brexit. Much more likely to be due to cost or they may have changed their supplier.

[SlowDragon Administrator in reply to mpond]

Which brand of levothyroxine are you now on

Teva brand upsets many people

[mpond in reply to SlowDragon]

It’s called “accord”

[mpond in reply to SlowDragon]

How does it upset them? What can I do if they do give me the Teva one?

[SlowDragon Administrator]

Get yourself a weekly pill dispenser and fill it up.....that way you never forget dose and especially if taking different dose alternate days

Important to get vitamin D, folate, B12 and ferritin tested

[mpond in reply to SlowDragon]

My GP is usually reluctant to test them. And he usually doesn’t check FT3 and FT4. Only TSH. I’ll see tomorrow if I can get the nurse to test those vitamins but I doubt it.

[SlowDragon Administrator in reply to mpond]

Did you loose lot of blood during delivery?

Can cause low ferritin

Recommend Testing full thyroid and vitamins privately If necessary before reducing dose

[mpond in reply to SlowDragon]

No, I lost what is considered normal. Might have to try doing it privately I think.

[SlowDragon Administrator]

Never reduce dose based just on TSH and Ft4...

Low vitamin levels tends to lower TSH

[mpond]

Forgot to say that part of the reason I wanted to reduce my dose was because for a few days I had breakfast almost straight after taking the Levothyroxine and I felt a lot better those days. Then once I managed to get an appointment for new TFTs tomorrow I made sure I waited an hour to eat breakfast and I started feeling unwell again

[greygoose in reply to mpond]

That's probably more to do with low blood sugar than your dose of levo. You can have no idea how much you absorb when you do that. It might be exactly the same, depending on what you eat for breakfast. So, I really don't think that's a good basis for reducing your dose.

When you get your new results, do post them on here, and let's have a look. But, please don't forget the ranges. Ranges vary from lab to lab so we absolutely need the ranges that went with your results to be able to interpret your results.

I recently read an article saying it’s risky to have such a low TSH for prolonged periods of time. That’s partly why I want to see if with 75mcg I feel better

Just so you know, having a low TSH will not make you feel bad. TSH doesn't make you feel anything, whether it's high or low. It's just a chemical messenger from the pituitary to the thyroid to tel it to make more hormone. If it's low, it's because the pituitary considers you have enough thyroid hormone in the blood (which doesn't always mean you do, but that's another story). It's T3 that causes symptoms when it's too high or too low.

[mpond in reply to greygoose]

Ok, I will post the results. The receptionist are not always happy to tell me the results in great detail. Before the current crisis I would just ask them to print them. So will try to get the ranges by phone 🤞

[greygoose in reply to mpond]

The law in the UK says that you are entitled to a print-out of your results - they are YOUR results. So, if they get difficult, just remind them that they're breaking the law and there are steps you can take to force them to give you the results - AND, the ranges are part of the results. You can't have one without the other.

[mpond in reply to greygoose]

Thanks! I will do

[Batty1]

I have never read a post here in 3 yrs that someone wanted a reduction....Wow!

[mpond in reply to Batty1]

Well I have am very concerned that I’m not able to function properly. I eat as much as my husband who is taller and larger than me. He has put on weight and I’m the thinnest I’ve been in decades. I get exhausted to the point of finding it difficult to speak. I struggle to sleep when I get an opportunity to nap. I know it’s hard to function when having a small baby but none of the mothers I know who gave birth around the time I did are struggling as much as I am. I’m just trying to find the cause. It seemed to me that the days I felt a bit better recently were the days I did not take my meds correctly so I thought it may be I am getting hyperthyroid. Over the years my body has responded differently to the same dose of Levothyroxine. Hence why I wanted to try and see how I feel with a lower dose.

[mpond]

My results

TSH 0.09 (0.4-4.9)

FT4 17.7 (9.0-19.0)

FT3 4.0 (2.9-4.9)

B12 411 (187-883)

Folate 13 (3.1-20.5)

Vitamin D 66 (>49.9)

Ferritin 12 (15-204)

Platelet distribution 13% (9-12)

Monocyte count 0.50 (0.0-0.39)

Everything else is normal