Diagnosis December 2019
Treatment: Levothyroxine (currently 75mcg)
TSH level in January 2020 was 14.3, after taking 50mcg Levo I felt great again throughout this summer, had a crash in August and was upped to 75mcg levo.
I'm getting a daily drunken feelng, strange sensations in head, sometimes shortness of breath and brain fog. (similar symptoms to my first diagnosis)
I requested a T3 test (waiting results)
I'm feeling like I'm drunk most of the day, or some kind of hangover, any advice?
Welcome to the forum
75mcg is only one step up from starter dose
When left on too small a dose too long .....vitamin levels can drop dramatically
Low B12 causes “feeling drunk or walking on small boat”
Which brand of levothyroxine are you currently taking
Teva brand upsets many people and Teva is only brand that makes 75mcg
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
And especially if left woefully under medicated for months
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)
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 antibodies and vitamins
medichecks.com/products/adv...
Thriva Thyroid plus antibodies and vitamins By DIY fingerpick 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 down to £26.10 if go on thyroid uk for code
thyroiduk.org/getting-a-dia...
monitormyhealth.org.uk/thyr...
If TPO or TG thyroid antibodies are high this is usually due to Hashimoto’s (commonly known in UK as autoimmune thyroid disease).
About 90% of all primary hypothyroidism in Uk is due to Hashimoto’s. Low vitamin levels are particularly common with Hashimoto’s. Gluten intolerance is often a hidden issue to.
Link about thyroid blood tests
thyroiduk.org/getting-a-dia...
Link about Hashimoto’s
thyroiduk.org/hypothyroid-b...
List of hypothyroid symptoms
thyroiduk.org/signs-symptom...
Funny you should mention B12, my folate came back as very low in september, was prescribed 5mg of folic acid, if anything I'm beginning to feel worse.
My TSH level was last recorded at 0.67 and GP said back in October that they didn't need to give anything higher than 75mcg of Levo.
Also yes I'm on TEVA🙄
I noticed the switch of brand in May this year.
Folic acid to correct low folate can hide symptoms of low B12 and can make B12 symptoms worse
Was B12 tested in September
Or iron, ferritin or vitamin D
Many people find Levothyroxine brands are not interchangeable.
Many patients do NOT get on well with Teva brand of Levothyroxine. Teva contains mannitol as a filler, which seems to be possible cause of problems. Teva is the only brand that makes 75mcg tablet. So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half
List of different brands available in U.K.
dropbox.com/s/6h3h0qi4eqwi6...
Teva poll
healthunlocked.com/thyroidu...
Once you find a brand that suits you, best to make sure to only get that one at each prescription.
Watch out for brand change when dose is increased or at repeat prescription.
academic.oup.com/jcem/artic...
Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).
Levothyroxine is an extremely fussy hormone and should always be taken on an empty stomach and then nothing apart from water for at least an hour after
Many people take Levothyroxine soon after waking, but it may be more convenient and perhaps more effective taken at bedtime
verywellhealth.com/best-tim...
No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.
Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away
(Time gap doesn't apply to Vitamin D mouth spray)
If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test
If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal
To have left you on only 50mcg levothyroxine with TSH of 14 was medically negligent and appalling
But sadly far from rare ....hence over 113,000 members on here
Likely very low vitamin levels as direct result of being left woefully under medicated
When hypothyroid we get low stomach acid. This causes poor nutrient absorption and collapse in vitamin levels
Low vitamin levels lead to poor conversion of Ft4 to Ft3 and TSH drops
Just testing TSH is completely inadequate
NHS England Liothyronine guidelines July 2019 clearly state on page 13 that TSH should be between 0.4-1.5 when treated with just Levothyroxine
Note that it says test should be in morning BEFORE taking Levo thyroxine
Also to test vitamin D, folate, B12 and ferritin
sps.nhs.uk/wp-content/uploa...
gponline.com/endocrinology-...
Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L.
If vitamin levels are very low this tends to lower TSH
Low vitamin levels lead to poor conversion of Ft4 (levothyroxine) to active hormone (Ft3)
Low Ft3 leads to even lower vitamin levels
Frequently all GP looks at is low TSH
guidelines on dose levothyroxine by weight
Even if we frequently 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, or near 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.
Also here
cks.nice.org.uk/topics/hypo...
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
GP should have increased dose of levothyroxine in January to 75mcg
Bloods should have been retested 6-8 weeks later
Dose levothyroxine increased again by further 25mcg ......
Etc
The aim of levothyroxine is to increase dose upwards until TSH is under 2
Ft4 is in top third of range and Ft3 at least half way through range (regardless of how low TSH is)
Frequently when adequately treated TSH will be well under one
EXTREMELY important to have optimal vitamin levels too as this helps reduce symptoms and improve how levothyroxine works
Ask to go back on your old brand of thyroid tablet. I have just found out that the filler in Teva does not agree with me. Feel a lot better since switching, but still not 100% but getting thereI have a 50 and 25 tablet. Which is not teva brand. Take care
When/if test Ft3
Important to test TSH, Ft4 and Ft3 together
Always test as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test
cheapest option for just TSH, FT4 and FT3
£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code
I get that weak and drunk feeling you describe when my T3 levels are too low. It can also occur when my nutrient levels are low, particularly iron and/or ferritin.
I feel like this as well. also my speech is effected I say things back to front it’s embarrassing and I feel defeated I hope you find answers God bless x
My speech is ok, I could say all my times tables from beginning to end and reverse, just difficult thinking.
Just waiting for T3 results and hopefully just a case of needed combination treatment for T3
Have you tried to look at the impact of salicylates in food and medications that you are reacting to. They could contribute to thyroid problems and many other issues. A number of thyroid meds and supplements are high in salicylates even B vitamins
Feeling drunk, been there had to have a couple of beers to sober up lol. It ended up being non diabetic hypoglycemia aka low blood sugar, may want to try some Biotin @10mg a day for a week then 3x a week thereafter worked great for myself if you do it, add in a B complex too as single B's are dependent on one or two other B-Vitamins... Hope that helps...
Have you had your b12 checked?
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