Over medication

[Cecilbenhard]

Can I be over medicated on 25 mg thyroxine?

[SeasideSusie Remembering]

Cecilbenhard

Unlikely. But tell us more.

Do you think you're overmedicated?

Have you got any test results, including reference ranges, on that dose?

Has dose been changed?

Do you have autoimmune thyroid disease (Hashimoto's) confirmed by raised antibodies?

[Lalatoot]

The symptoms of overmedication and under medication can be identical so without blood results it is difficult to know which way your body has gone.

The typical starter dose for levo is 50mcg - 25mcg is usually given to those with underlying health problems.

If you have been misdiagnosed with a thyroid problem and your body was producing enough thyroid hormones and you were taking levo - then I suppose you could be over medicated.

Have you any more information so we can comment? Blood results or background history are a good start. Have you a diagnosis of autoimmune hypo aka hashimoto's?

[Cecilbenhard in reply to Lalatoot]

Thanks for the replies. I have been diagnosed with Hashimotos a couple of years ago after regular monitoring for years. Started on 25 mg of levo but after around 6 weeks felt really unwell. So saw a private doctor who prescribed T3 bio identical in olive oil capsule at 12.5 rising to 25 mgs. Initially felt good but again after around 6 weeks felt really unwell and over medicated symptoms ( according to doctor) and cut back to 12.5 and then reverted to levo but bio identical, as above. Been taking 25 mg of these for a couple of months then started having overmedicated symptoms again. Weight gain, palpitations, very hot and generally unwell so have cut back to 12.5 of those capsules! Can’t seen to get a stable dose. My last blood test on 25 mg of bio identical levo was a few weeks back and shows much improved bloods. My GP said stay on this dose. My private doctor ( a specialist) says the tests showed I’m still under medicated! So really not sure what to do. My latest results were:

TSH 5.5

T4 13

T3 3.8

[Lalatoot in reply to Cecilbenhard]

Your tests do show that you are undermedicated.

For 4 years I was undermedicated . I felt unwell, had palpitations, anxiety , panic attacks, gained weight, hair falling out, dry skin. These were all symptoms I had had when I was hyperthyroid so I was convinced that levothyroxine was causing them.

Eventually I cut back my dose over months from 100mcg per day to 25mcg. Initially I felt great. then 3 months later I was very ill.

Now that I am on 100mcg levo and 15mcg lio I realise that my symptoms were caused bu under medication. My endo did not guide me. They were happy to keep me at TSH 4 and FT4 15 as they were in the normal range.

The problem with a levo dose of 25mcg is that it is not enough. The thyroid which is struggling often shuts off for a rest when we introduce thyroid hormones such as levo. However the small dose we introduce - 25mcg - is not enough to compensate for the thyroid having a rest so we can feel worse.

When on levo our TSH needs to be 1 or lower to feel well. You really need more levo.

I couldn't tolerate levo in one dose so I have always split my dose. I currently take 3 doses of levi in the day along with 3 doses of lio.

[Cecilbenhard in reply to Lalatoot]

What dosage do you take at each time and what times of the day? It’s seems complicated to do that because of the need to leave time either side of eating before taking a dose! I think spilt doses seem like a good idea though.

[Lalatoot in reply to Cecilbenhard]

I take 50mcg levo 5mcg lio between 6am and 7am. 25mcg levo and 5mcg lio 4pm to 5pm. 25mcg levo and 5mcg lio 10pm to 11pm.

When I was on levo only I split it 50mcg 6 to 7 am and 50mcg bedtime. It is whatever fits in with your daily routine.

[Cecilbenhard in reply to Lalatoot]

Thank you so much - these tips are very useful in trying to find the correct dosage and routine.

[Cecilbenhard in reply to Lalatoot]

Do you always leave 4 hours gap after eating before taking your meds? Obviously overnight that works ok.

[Lalatoot in reply to Cecilbenhard]

No. I leave 1 - 2 hours. I don't worry too much about it. Taking several doses a day, if one dose gets absorbed less efficiently for a day or two because of poorer absorption that's ok by my reckoning.

I have friends on levo who don't bother with any of this. They forget doses. They take them at any time of the day when they remember and 1 takes it with her breakfast. It might mean that they are on slightly higher doses than they might otherwise be but they are well and have no problems.

I realise that some of us need to be stricter but I fitted the doses into my routine as effectively as I could and just get on with things.

[Cecilbenhard in reply to Lalatoot]

Thats a relief! thank you

[SlowDragon Administrator]

Do you mean 25mcg levothyroxine

That’s only half the standard starter dose of levothyroxine

Your results show very under medicated

The aim of levothyroxine is to increase dose upwards until Ft4 is in top third of range and Ft3 at least half way through range (regardless of where TSH is) ...important to have optimal vitamin levels too as this helps reduce symptoms and improve how levothyroxine works

guidelines on dose levothyroxine by weight

Even if we don’t start on full replacement dose, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until on full replacement dose

NICE guidelines on full replacement dose

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

gp-update.co.uk/Latest-Upda...

Traditionally we have tended to start patients on a low dose of levothyroxine and titrate it up over a period of months.

RCT evidence suggests that for the majority of patients this is not necessary and may waste resources.

For patients aged >60y or with ischaemic heart disease, start levothyroxine at 25–50μg daily and titrate up every 3 to 6 weeks as tolerated.

For ALL other patients start at full replacement dose. For most this will equate to 1.6 μg/kg/day (approximately 100μg for a 60kg woman and 125μg for a 75kg man).

If you are starting treatment for subclinical hypothyroidism, this article advises starting at a dose close to the full treatment dose on the basis that it is difficult to assess symptom response unless a therapeutic dose has been trialled.

A small Dutch double-blind cross-over study (ArchIntMed 2010;170:1996) demonstrated that night time rather than morning dosing improved TSH suppression and free T4 measurements, but made no difference to subjective wellbeing. It is reasonable to take levothyroxine at night rather than in the morning, especially for individuals who do not eat late at night.

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...

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 you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies

About 90% of primary hypothyroidism is autoimmune thyroid disease

Ask GP to test vitamin levels

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. (Patient to patient tip)

Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins

List of private testing options

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus vitamins including folate (private blood draw required)

medichecks.com/products/thy...

Thriva Thyroid plus antibodies and vitamins By DIY fingerpick test

thriva.co/tests/thyroid-test

Thriva also offer just vitamin testing

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off if go on thyroid uk for code

thyroiduk.org/getting-a-dia...

monitormyhealth.org.uk/thyr...

Getting levothyroxine dose fine tuned and all four vitamins optimal are first steps BEFORE considering other options