Dosage change

[Pixipot]

Was on 75micro grams of levothyroxine but I had constipation again, lethargy and terrible sugar cravings so I decided to go up to 100 mgs but my poop went pale coloured and I felt on edge so I went back to 75mgs again but my weight hasn't changed as I put on a stone and a half also my periods suddenly stopped. Went down to 50mg as I got fed up cutting the pill in half, (I may be a bit down) started feeling strong sugar cravings and I've put on 3 pounds...I just can't find the right strength for me without some side effect at every dossage, so I'm on 50mg no period, I'm constantly fighting the urge to consume chocolate but bowel movements back to normal...any ideas guys?

[SlowDragon Administrator]

Recommend you go back to 75mcg.

Stick on whichever brand suits you best

Get FULL thyroid and vitamins tested 6-8 weeks after being on constant unchanging dose levothyroxine

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

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.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 down to £26.10 if go on thyroid uk for code

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

monitormyhealth.org.uk/thyr...

[SlowDragon Administrator]

75mcg is only one step up from starter dose

Unless very petite, likely to need higher dose

But get tested after 6-8 weeks on 75mcg and see what results suggest

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, 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

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...

Essential to regularly retest vitamin levels and common to need to supplement regularly to maintain optimal vitamin levels

What vitamin supplements are you currently taking

[Wired123]

I’ve got the maddest sugar cravings, although adding T3 has finally reduced them.

Not sure if my cravings for chocolates and cakes is caused by thyroid issues or if it’s just some kind of addiction to chocolates and cakes.

Cravings can be linked to many things, whether thyroid or nutrient deficiencies. Did you experience such cravings before you became hypothyroid?

[tattybogle]

I'd advise that you don't make such large changes to dose so frequently as you have been doing, and leave it much longer before deciding if a new dose feels better or worse.After a few experiences of changing Levo dose last year i would say;

a) Only increase by 12.5 mcg/day at a time.

b) Stay on that dose for at least 8 weeks before deciding hoe you feel , accept that symptoms may change every week during this time.

c ) Consider a brand change in the same way as a dose change , ie, don't change dose at same time as brand, that way you can tell which is causing any difference in how you feel. And accept that it may take several weeks to get used to a different brand. So don't be too quick to decide it doesn't suit you.

It's really unhelpful that so often prescriptions are now 2 months apart ,and that often we just get given a different brand and told it makes no difference. I find it does, and even if a new brand doesn't cause specific problems, i still find that i feel better overall if i'm not having to 'adjust' to a new brand every couple of months.

Of course, the chemist will probably still say "Levo brand change makes no difference" and roll their eyes.....

[Wired123]

You raise a great point Tattybogle, I’m on a trial of T3 and 3 weeks in, each week is different - week 3 hasn’t been as good as week 1 and 2, but I’m carrying on.

You’re right that we should stick it out for 6-8 weeks and then determine if the dose is right.

It’s important to ride out temporary side effects (and benefits), to see what the treatment does more long term.

[SlowDragon Administrator in reply to Wired123]

Personally I find it takes 10-16 weeks for any dose change to settle in.

[fuchsia-pink]

If you find splitting tablets a faff, it's ok with levo to alternate doses - ie 50 mcg one day and 100 mcg the next, as it's got a long half-life. Agree with SlowDragon that you probably need to go back to 75 mcg - on average - a day at least, as 50 mcg is a very low dose ... Do you have any recent blood results on 75 mcg?

[SlowDragon Administrator in reply to fuchsia-pink]

TSH Value = 3.18 Range = 0.35 - 5.00 Unit = mU/L

FREE T4 Value = 11.3 Range = 9.0 - 21.0 Unit = pmol/L

Pixipot results from 5 months ago after 6 weeks on 75mcg

Clearly in need of dose increase way back then

[fuchsia-pink in reply to SlowDragon]

Agree