Why do you need less thyroxine replacement as you get older?

[Helenfeb]

Thyroxine replacement medications

I had thyroid cancer when I was 18 40 years ago and had a total thyroidectomy

As I’ve got older the amount of replacement thyroxine has been reduced

Can anyone explain why? I’ve never really found out

[SlowDragon Administrator]

It may not need reducing

There’s current obsession by medics to reduce levothyroxine, sometimes inappropriately

In past most patients were prescribed between 200-400mcg levothyroxine. With the invention of a TSH test, levothyroxine doses have been reduced over the years

How much levothyroxine are you currently taking?

When were levels last tested?

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...or if under medicated

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, best not mentioned to GP or phlebotomist)

Is this how you do your tests?

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 ultra vitamin (doesn’t include folate)

medichecks.com/products/thy...

Thyroid plus vitamins including folate (private blood draw required)

medichecks.com/products/thy...

Medichecks - JUST vitamin testing including folate - DIY finger prick test

medichecks.com/products/nut...

Medichecks often have special offers, if order on Thursdays

Thriva Thyroid plus vitamins

thriva.co/tests/thyroid-test

Blue Horizon Thyroid Premium Gold includes vitamins

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...

[pennyannie]

Hello Helenfeb and welcome to the forum :

Your dose of thyroid hormone replacement is likely to change over a time, but should only be adjusted by the reading of your blood test results and checking your levels of T3 and T4 against the relevant range.

Do you have any blood test results to share with us, what is your dose of thyroid hormone replacement and how are you currently feeling, and presume to be asking this question guess your suffering symptoms of hypothyroidism ?

[shaws Administrator]

Considering that the majority of UK GPs are poorly trained in dealing with patients who have a dysfunctional thyroid gland I think they only look at a TSH result and if it is in range, they think patient is on a sufficient dose. Whereas we, the patients, need a TSH of 1 or lower (not somewhere in the range) and we need FT4 and FT3 to be in the upper part of the ranges. The latter two are rarely tested and I think it is ridiculous that 'modern' day doctors seem to think that to treat a patient who's hypo is easy-peasy, i.e. get TSH somewhere in the range and never check the Frees and prescribe other medications for the symptoms they have.

Also ask to have B12, Vit D, iron, ferritin and folate tested.

Always get thyroid hormones tested as early as possible - even if you have to make the appointment weeks ahead. It should be a fasting blood draw (you can drink water) and allow a gap of 24 hours between last dose of levo and the test and take it afterwards. This helps keep the TSH at its highest as that seems to be all most doctors look at. Always get a print-out of your results, with the ranges, for your own records and post if you have a query.

[Helenfeb in reply to shaws]

Thanks for your advice

Need to speak to my doc tomorrow so will ask if T3 etc levels checked

[shaws Administrator in reply to Helenfeb]

Don't be surprised if he refuses and it is a Free T3 test (and Free T4 too) which will be more informative. Also remember to get the earliest appointment for the blood draw, fasting and allow a gap of 24 hours between last dose of thyroid hormones and test and take afterwrds.

[Lora7again]

I have just found out my Dad who was on 100mcg of Levothyroxine has had his dose reduced to 50mcg. I have asked him to request his blood results because I think he needs more than that even though he is 78 and classed as *elderly*. He does have COPD but otherwise he has fairly good health and I don't know why his GP has done this. He thinks his GP is wonderful but I think he is incompetent.

[shaws Administrator in reply to Lora7again]

You're right - you do need to clarify why a reduction in your father's dose is required. Doesn't sound right to me unless his TSH is 1 or lower (which we want but that doctor's don't). Many doctors would think your father has taken too much thyroid hormones. I think many doctors are satisfied if TSH is in range .

[Lora7again in reply to shaws]

His TSH jumped up to 20 so his GP did a retest after 4 weeks and then it had gone down to 5 so his GP was satisfied with that. I think 5 is too high but my Dad says he feels ok but I think he would feel better on a higher dose. Both him and his wife are on 50mcg and are both very tired all the time which they put down to be being in their 70s.

[shaws Administrator]

Probably your doctor, instead of listening to you about your clinical symptoms, is ignoring them altogether and may be reducing your dose according to your TSH alone.

[bantam12]

I used to be on 150mcg but now only need 125mcg, I have no thyroid, my tsh is 0.02 which my GP is absolutely fine with and I'm well, I just don't need as much Levo as in the past 🤷‍♀️

[Hidden]

I have been reading a lot about this lately.

It seems common to need less thyroid hormone once post-menopause or once off HRT as estrogen increases TBG (thyroid binding globulin). With much less estrogen around, you probably need less thyroid hormone.

i am not sure how much a decrease in basal metabolic rate would affect your thyroid hormone needs.

But I think others are right that too many doctors just assume you are optimally treated with a TSH anywhere in range...unfortunately, many doctors don´t test free Ts and ignore symptoms, claiming they are not thyroid-related because your TSH is "normal"...I think that thyroid dysfunction is one of the diseases doctors don´t know enough about, yet consider very easy to treat...they think it´s a "one size fits all" solution.