Should I reduce levothyroxine due to palpitations? - Thyroid UK

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Should I reduce levothyroxine due to palpitations?

Petalsoflove profile image
10 Replies

Diagnosed with hashimotos following having a baby. I initially had overactive thyroid then it went under. Started on 50mg when my tsh was around 12. I seemed to not tolerate the medication well like it gave me what seemed like overactive symptoms, so I took 25mg for a couple weeks then went onto 50. I took this ok for a few weeks, albeit still not feeling great. Then as my tsh was around 6 so she upped it to 75mg. I since had a blood test only 3weeks after being on this dose and tsh was 1.4 then after 7 weeks on dose it was 1.5.

So good levels however I had a period of time on and off in last month's of feeling bad heart palpitations, fluttering in stomach, more anxious than ever before. I was sure I was going overactive but tsh says not.

I don't feel too bad today but couple days ago I had the palpitations again and then I was breathless on occasions too. It's all not helped through not sleeping good with a baby.

I also have this little hand twitch which has come back after not having it for some time, don't know if that related to too much thyroxine?

Consultant said I can go back on 50mg and do bloods in 4 weeks. I would of definitely done that a couple weeks ago when I felt worse but now I'm kind of not as bad so I just don't know if should ride it out on 75mg or just trial the 50 given how I've felt.

I also gave an ongoing problem of feeling woozy after bending, when stand back up. I've taken BP and it's ok and doesn't show a drop if anything it goes up. I thought I may have POTS but gp didn't entertain this and I'm sick of testing myself as causes too much anxiety.

Any advice or experience much appreciated.

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Petalsoflove profile image
Petalsoflove
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shaws profile image
shawsAdministrator

Welcome to our forum and I'm sorry you have hypothyroidism.

Quite a number of new mothers seem to develop hypothyroidism.

I'm sorry you are having all these symptoms when you've just had a baby who will be taking up your time, being so young and probably you're not sleeping properly either.

I hope you can find some solace in the following links and members, when they read your post will also respond if they've had the experience similar to you.

thyroiduk.org/?s=pregnancy&...

SlowDragon profile image
SlowDragonAdministrator

Welcome to the forum

Which brand of levothyroxine is your 75mcg?

Are you taking single 75mcg tablet, if so this will be Teva brand. Teva upsets many people

Standard starter dose of levothyroxine is 50mcg. Bloods should be retested 6-8 weeks after each dose or brand change in levothyroxine

Typically dose is increased slowly upwards in 25mcg

The aim of levothyroxine is to increase the dose slowly upwards until TSH is under 2. Many people will have TSH well under one when adequately treated. Most important results are always Ft3, followed by Ft4

Very important to regularly retest vitamin D, folate, ferritin and B12

These are frequently very low when hypothyroid. Improving low vitamin levels by supplementing can significantly reduce symptoms and enable tolerating dose increase in levothyroxine easier

Have you had thyroid antibodies tested?

About 90% of primary hypothyroidism is caused by autoimmune thyroid disease also called Hashimoto’s diagnosed by high thyroid antibodies

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 and thyroid antibodies if not been tested yet

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)

Petalsoflove profile image
Petalsoflove in reply to SlowDragon

Hi thankyou for response, yes I am taking Teva for one tab and accord for the other?Interesting about best to leave the thyroxine on day of blood test I will do that next time

SlowDragon profile image
SlowDragonAdministrator in reply to Petalsoflove

Recommend you ditch the Teva and get increased number of 50mcg tablets prescribed. Accord don’t make 25mcg tablets, so you need to cut an extra one in half

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

Teva, Aristo and Glenmark are the only lactose free tablets

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

tattybogle profile image
tattybogle

Some thoughts....yes , a slight tremor in fingers of outstretched hand is a sign of overmedication.

Palpitations can be sign of too much but also sign of too little, so not much help.

You did seem to be sensitive to increasing Levo dose , judging by your reaction to the 50 initially.

You may be having the same issue on increasing to 75 from 50.

Perhaps it's just going to take time for body to get used to that dose. Dose changes can be done more gradually than 25mcg increments. You could for example try a dose in between 50 and 75.(62.5)

Either by taking 50 one day and 75 the next, or if you prefer to take the same each day so you don't get muddled up you can split a 25mcg tablet in half each day. I do this to get 112.5mcg.

But....

It could also be that you were having a slight temporary increase of your own hormone in the blood which will go down on it's own as it gets used up. This is how the destructive process of Hashimoto's works....The immune system attacks a bit of thyroid gland ,that bit dumps all its hormones into the blood as a result, so you have too much for a while, but as these get used up or excreted you end up with less than before, because that bit of thyroid is now not working anymore. At this point you would need to take slightly more Levo to compensate.

That's all theoretical though.... no one can tell you how long or short this period of 'dumping hormone into blood' last for , or how often it occurs , or how many years it goes on for or how much working thyroid gland you have left each time.

It would be a lot easier to know what was going on if they would at least test your fT4 as well as your TSH (really fT3 is the important one but you won't often get that out of NHS)

TSH (Thyroid Stimulating Hormone) is just a message from the pituitary to the thyroid gland to ask for more thyroid hormone (T4 and T3 )to be made.

T4 is a storage form , and it has to be turned into T3 by the body before it can work.

Levothyroxine is just synthetic T4.

The TSH has a bit of a delayed reaction to hormone levels, it takes about 6 weeks before you can say it has had enough time to get where it's going to be, and it can sometimes take even longer. This is the reason for the long delay between dose change and blood test.

The T4 can be measured much sooner after a dose change, a few days on a new dose would give you an accurate reading for fT4 (Free T4)

I think if i were you , i would try taking 62.5 for a few weeks , so you are only making small changes at a time, (even though you will almost certainly need more than that )

personally i now wait at least 8/10 weeks before i decide how i feel on a new dose , because i find how i feel can seem to change every week initially.

I would also make sure that your blood teats are only done after you have been on the same dose for 6 weeks minimum in future, and try and get GP to do fT4 with the TSH, at least until you feel well. Some areas seem to do TSH and fT4 routinely without much fuss ,and some seem to just do TSH and say they can't get the lab to do fT4 if TSH is in range.

GP's have often been taught TSH tells them everything (in their half an hour thyroid lecture at medical school), but it was only designed as a test to point to a diagnosis , it was never designed as a test to adjust dose by. fT4 (and fT3) are much better tools for this, with TSH being less useful for this.

If you can't persuade GP to do fT4 you can get TSH , fT4 and fT3 for about £ 28 from Monitor My Health , which is an NHS service. If you can afford to do your own it's less hassle and better information than you will get from limited test's GP's can run.

or you can get ones from other places that do cost more , but will also give you B12, Vit D, ferritin and folate, which are equally important for feeling well when taking thyroid hormone, and again are sometimes difficult to get the GP to do without a fight.

Sorry you have got this to deal with as well as a baby, but it is good it's been diagnosed early , I went 4 years after baby before anyone though to check thyroid. So i'm hoping you will start to feel better and enjoy life again sooner rather than later, but thyroid is a slow thing to get right, and after a birth all the hormones are up and down for a few months i think. So be Kind to yourself , and be patient, Only make small changes in dose, and be consistent. You will get there. x

Petalsoflove profile image
Petalsoflove in reply to tattybogle

Thankyou for such an insightful and relevant reply. Yes my consultant will check the tsh, T3,T4 it's just the GP didn't the last 2 times and then stupidly when I asked for it they wrote it on wrong bit of form.I think what you said about the process of hashimotos is right and I think I will try the 62.5 as you say. Explains why some days your better than others. I'll see how evenly the tablets break in half.

I had all my bloods done recently I was initially low on vit D but that was resolved in march time. Think my ferretin and b12 have been checked and fine. Folate was probably checked a few months back.

You would think the consultant would explain things more but she speaks so briefly.

Thank you again

SlowDragon profile image
SlowDragonAdministrator in reply to Petalsoflove

Vitamin levels need to be optimal

Vitamin D at least around 80nmol and around 100nmol maybe better

Serum B12 at least over 500

Folate and ferritin at least half way through range

Petalsoflove profile image
Petalsoflove in reply to SlowDragon

Thankyou for that, I may get a recheck done myself. I will look into the brands as well. Much appreciated

Karen_lee profile image
Karen_lee

I get the palpitations and light head and horrible anxiety but it is usually with my hormones more than my thyroxine dosage I have also cut all coffee out and only drink decaf tea. Also your hormones might be effecting you with having the baby. I try to do a walk outside which helps. Hope you feel better soon

Petalsoflove profile image
Petalsoflove in reply to Karen_lee

Thankyou, yes could possibly be hormones although birth was 9 months ago. Probably just thrown everything out of whack with the thyroid as well. Will get there hopefully ☺️

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