Am i over medicated?: Hello,i am new to the site... - Thyroid UK

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Am i over medicated?

4 years ago•7 Replies

Hello,i am new to the site and hope i can get some advice on Levothyroxine over medication please.I have had bloods done in the last few days and they have been marked as abnormal,as yet i have been unable to speak to a GP as they are fully booked and i am waiting for a telephone appointment,on posts i have read on site i think it is possibly over medication and if so i do not want to carry on with my current dose as it could be a few weeks till i speak to a Doctor,they are obviously unconcerned even though it is an abnormal result.They are aware of my symptoms as i have felt really unwell for about 3 months.The only results i have is for TSH as this is the only blood test done for patients taking Levothyroxine.I would really appreciate any advice.My TSH results are 0.16 (range 0.2-4).Thank you.

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Mastiff

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SeasideSusieRemembering4 years ago

Mastiff

Just testing TSH alone is not an indicator of thyroid status once we are diagnosed and on Levo. TSH is not a thyroid hormone, it's a signal from the pituitary. The thyroid hormones are FT4 and FT3 and these tell us whether we are overmedicated - the most important one being FT3.

A TSH of 0.16 with a range of 0.2-4 is a tiny fraction under range and I certainly wouldn't be worried about it. I'm not worried about my suppressed TSH of <0.005 because I know my FT4 and FT3 are comfortably within range.

Also, what time of day was your test done, and was it done fasting? TSH is highest early morning and lowers throughout the day, so we always advise getting a test no later than 9am, and because eating can lower TSH we advise waiting until after the test to have breakfast, and because coffee can affect TSH we advise drinking water only until after the test. So if your had your test later than 9am then your TSH is going to be lower than if you had it before 9am.

* How do you feel? What symptoms do you have?

If your GP wants to lower your dose of Levo on the strength of that TSH alone, then I would refuse until FT4 and FT3 have been tested. If your GP wont do them then we have private labs which hundreds of members here use.

Mastiff in reply to SeasideSusie4 years ago

Thanks for your reply,i appreciate it.The test was done at 3.30 in the afternoon as i was put in on a cancellation after reporting my symptoms so the wrong time really.I thought i was hypo as i have felt ill for several months with symptoms of fatigue,pins and needles,carpal tunnel,gained 1 stone in 4 weeks,no appetite,dizziness,waking up regularly during the night but also surprisingly feeling hot all the time but no temperature,recently palpitations and heart rate fluctuating which coincide with being hyper.I have been on 125mc levo for about 20 years with the odd glitch where i have been on 150mc but always end up back at 125mc and that is my current dose.My history is i was diagnosed thyrotoxic about 21 years ago,went on block and replace but was unsuccessful so had 2 doses of radio iodine that resulted in being hypothyroid,have been on levothyroxine ever since mainly at the 125mc dose.I do have a few more results re vitamins etc that i notice other members have posted that may help

VIT B12-417 range 211-911

FERRITIN-54 range 10-322

FOLATE-7.5 range 5.4-24

I do not have a Vit D level but i was given a high loading dose about 10 years ago and when normal levels were reached placed on 1000iu a day as a maintenance dose which i have taken ever since.

Unfortunately at the moment getting to speak to GP is really difficult but hope i can get to speak within the next week to see what needs doing to alleviate symptoms.

I would really like to thank you for your time and hope i have given you enough info.

I have just been looking at my results over the past 12 months and there seems to be a steady decline in TSH level,up until this year T4 was checked so it looks like they have only recently stopped testing this,never had T3 checked though.

17/08/2020 TSH 0.16

12/03/2020 TSH 0.33

18/12/2019 TSH 1.6

FT4 19.8 range 10-20

13/09/2019 TSH 0.47

FT4 18.3 range 10-20

SeasideSusieRemembering in reply to Mastiff4 years ago

Mastiff

My history is i was diagnosed thyrotoxic about 21 years ago,went on block and replace but was unsuccessful so had 2 doses of radio iodine

Did you ever have thyroid antibodies tested back then? Or since?

The antibodies are:

Thyroid-Stimulating Immunoglobulin (TSI) and TSH receptor antibodies (TRAb). These are the antibodies for overactive thyroid (Graves disease) and if positive then Carbimazole, Block and Replace, RAI or maybe eventually Thyroidectomy would be the treatment.

Thyroid Peroxidase (TPO) and Thyroglobulin (Tg) antibod8ies. These are the antibodies for autoimmune thyroiditis (patients call it Hashimoto's) which tends to start off with a "hyper" episode but is actually underactive thyroid. The immune system attacks and gradually destroys the thyroid, in the process the antibodies can fluctuate and symptoms can swing between "hyper" (it's a false hyper not true hyperthyroidism) and hypothyroidism. The treatment for this is Levothyroxine.

It might be an idea for you to have TPO and Tg antibodies tested. If GP wont do these then I'd consider doing a private test with one of our recommended labs to include the full thyroid panel, i.e. TSH, FT3, TPO and Tg antibodies. Please ask for recommendations of which test/lab if you are interested.

VIT B12-417 range 211-911

Is the unit of measurement pmol/L or ng/L or pg/ml (the latter two are the same).

If it's ng/L or pg/ml then this result is low. According to an extract from the book, "Could it be B12?" by Sally M. Pacholok:

"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".

"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."

If it's pmol/L then the equivalent is 565pg/ml so could still do with improving.

I would suggest taking a good quality, bioavailable B Comples such as Thorne Basic B or Igennus Super B. If you take a B Complex it will contain Biotin (or a separate Biotin supplement) then this needs to be left off for 7 days before any blood test as this can give false results when Biotin is used in the testing procedure (which most labs use).

FOLATE-7.5 range 5.4-24

B12 and Folate work together. Folate should be at least half way through range so that would be 15+ with that range so yours is low. The folate contained in the B Complex will help, as will eating folate rich foods.

FERRITIN-54 range 10-322

This is too low. Ferritin is recommended to be half way through range. You can help raise your level by eating liver regularly, maximum 200g per week due to it's high Vit A content, also liver pate, black pudding, and including lots of iron rich foods in your diet

apjcn.nhri.org.tw/server/in...

Don't consider taking an iron supplement unless you do an iron panel, if you already have a decent level of serum iron and a good saturation percentage then taking iron tablets can push your iron level even higher, too much iron is as bad as too little.

I do not have a Vit D level but i was given a high loading dose about 10 years ago and when normal levels were reached placed on 1000iu a day as a maintenance dose which i have taken ever since.

So you had Vit D deficiency back then and supplementation is therefore for life. Has your Vit D been tested recently? When taking D3 we should retest twice a year to ensure our levels are within the range recommended by the Vit D Council/Vit D Society which is 100-150nmol/L. If GP wont do it then you can do a bloodspot fingerprick test with an NHS lab who offer this test to the general public for £29:

vitamindtest.org.uk/

We need to ensure that the maintenance dose we take keeps us within that range. I had severe Vit D deficiency and my maintenance dose is 5,000iu D3 daily although many people take less.

Doctors don't know, because they're not taught much about nutrients, but there are important cofactors needed when taking D3 as recommended by the Vit D Council.

D3 aids absorption of calcium from food and Vit K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems such as hardening of the arteries, kidney stones, etc.

D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds if taking D3 as tablets/capsules/softgels, no necessity if using an oral spray.

Magnesium helps D3 to work. We need Magnesium so that the body utilises D3, it's required to convert Vit D into it's active form. So it's important we ensure we take magnesium when supplementing with D3.

Magnesium comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds if taking magnesium as tablets/capsules, no necessity if using topical forms of magnesium.

naturalnews.com/046401_magn...

drjockers.com/best-magnesiu...

afibbers.org/magnesium.html

Don't start all supplements at once. Start with one, give it a week or two and if no adverse reaction then add the next one. Again, wait a week or two and if no adverse reaction add the next one. Continue like this. If you do have any adverse reaction then you will know what caused it.

Mastiff in reply to SeasideSusie4 years ago

I think i must have had antibodies tested at the time as i was diagnosed with Graves Disease at the time,i was then treated in the order you stated,Carbimazole,then block and replace then RAI which i had to do twice,it was approx 6 months after RAI that i went hypo and was then placed on lifetime levo.I was then discharged back to gp from endocrinology and have been under GP ever since.Only ever had usual TSH tests.

Only been retested for Vit D twice in about 10 years so need to look into that,i remember i was over minimum limit but nowhere near the limits you state,i seem to remember it was about 69.I will check into supplements to make sure safe to take as i am on other medications,indapamide and candesartan for hypertension and lansoprazole for silent reflux,it does look like i am in need of supplements and need to consider your advice on getting tests done privately,in the meantime i am hoping i will get feedback from my GP soon as at present i just feel absolutely awful all the time which then causes anxiousness that makes things feel even worse,thank you so much for your advice ,i am really glad i found this forum and i am sure it will be a great help to me as i can see it has helped many others,i never realised that Thyroid disease could be so complicated and it does seem GPs are sometimes oblivious to facts surrounding it.

SeasideSusieRemembering in reply to Mastiff4 years ago

Mastiff

i am on other medications,indapamide and candesartan for hypertension and lansoprazole for silent reflux,

Are you taking these well away from your Levo? Levo has to be taken on it's own, one hour before or two hours after food, with a glass of water only and water only for one hour either side, two hours away from any other medication and supplements (some need 4 hours).

I am on BP tablets which I take at bedtime, my Levo I take in the early hours of the morning when I need a bathroom trip so that could be around 4am-7am.

Low stomach acid is often a problem for Hypo patients, and is often mistaken for high stomach acid. I wonder if your Lansoprazole for silent reflux is actually a case of you have low stomach acid rather than high - a mistake many doctors make. As PPIs suppress gastric acid secretion this can affect absorption of levothyroxine

Mastiff in reply to SeasideSusie4 years ago

I,like you take my levo anytime between about 5am and 7am,usually getting up for a bathroom trip and this seems to have become habit or me,i always take a bottle of water to bed and keep my levo upstairs,i take lansoprazole about 10 am and blood pressure meds at lunchtime,i always take vit D3 with my evening meal.I have wondered myself if the PPI could be causing a problem,i think i may try to wean off for a while and try just using Gaviscon to see if it helps.Also after taking levo i tend to leave about 2 hours before eating or drinking anything but water,i am sure with the advice given there is a lot i can do to improve my thyroid health it is just until i hear what the GP says i am stuck in limbo,hopefully it will be sooner rather than later.Thank your replies,i have already learnt a lot from them.

SlowDragonAdministrator in reply to Mastiff4 years ago

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also EXTREMELY important to regularly 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

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 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

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

bluehorizonbloodtests.co.uk...