Just started block and replace after just being a blocker and I am having trouble sleeping . I am on 40 carbimazole and 100microgram of levo

[Silverlion]

I am starting block and replace after being on a blocker for a while and I am finding it so hard to sleep. Will this pass or I am on too higher a dose? I thought B/R would be better but feel dreadful.

[bantam12]

It can be difficult to get the doses right, for me it didn't work as I was always on to much or to little but some people get on very well.

[Silverlion in reply to bantam12]

Yeah I was fine on it a few years ago but dont know whether I should be on propranolol to help with feeling anxious and trouble sleeping?

[Lora7again in reply to Silverlion]

I never took Propranolol because I was worried it would slow down my heart too much. I just took Carbimazole and then PTU.

ebmconsult.com/articles/pro...

Just to add I always have trouble sleeping because my goiter makes me snore.

[pennyannie]

Hey there Silverlion

I was never given the opportunity to try Block and Replace but I would think it's a fine balance and adjustments maybe needed, but you 'll need to start listening to your body as you're the one with the symptoms.

If your AT drug level is to remain static, just adjust the T4 to bring you up a little and to ease some of the hypothyroid symptoms you are suffering, and since T4 is a storage hormone you'll probably have to wait a couple of weeks before you see any benefits.

My insomnia resolved as soon as I went on the AT drugs and I was able to continue to work.

It's so difficult, as there are no definitive answers, you just need to try, give it some time, and see how you go.

[asiatic]

I have been on BR for 4 years . Changing from titration made me feel worse instead of better and it took many adjustments to find the right balance. I am now on 10mg Carbimazole and 50mcg. Levo and feel well and happy to stay on this dose until hopefully I go into remission. I had a good endo who was happy to keep testing and adjusting until I reached the lowest effective dose. This was important to me. I would have felt uneasy being on 40mg. Carbimazole. That is a high dose. What doses were you on before ? Most Graves patients need to be titrated down as they start going hypo and at that point BandR becomes a good option.

[jimh111]

I've never been on block and replace. I would have thought 100 mcg levothyroxine is too little if your thyroid is fully supressed. Also, propranolol is used in hyperthryodism to reduce T4 to T3 conversion since the thyroid releases much more T3 in hyperthyroidism. If you are on block and replace I would have thought propranolol might be discontinued as on levothyroxine monotherapy you would already be missing the T3 from your thyroid. if you need to have a beta blocker maybe your doctor could consider one that doesn't affect thyroid hormones.

[ali56]

Hi Silverlion

I was put on block and replace when first diagnosed with graves 40mg carbimazole and 100mcg levothyroxine. Have never felt so ill in all my life

thought I was going mad. I think 100 mcg levothyroxine was too high for me

As soon as I stopped taking it felt much better. Changed my consultant to one who didn’t do block and replace.

Ali56