Over medicated

[Elementegirl]

Hi I’ve been on 50 lev four times a week and 75 three times a week , 5 weeks ago I was increased to 75 six days and 50 one day my T4 level is 3 but for the past two weeks I’m suffering terrible insomnia ,legs and arms are crawling , palpitations not an ounce of go in me , sweats then shivers , peeing a lot , my GP is on holiday until after Christmas and I feel my symptoms are over medicated now but is this possible when T4 is at 3 or is it just anxiety? But I’ve been like this before when over medicated plus my thyroid is growing back can anyone advise me please

[SeasideSusie Remembering]

Elementegirl

T4 is at 3

I think it's impossible for your T4 level to be 3 if you are in the UK and that is the Free T4 test. Do you have the reference range?

In the UK ranges vary (different labs have different ranges) and those we often see here are 7-17 or 9-19 or 11-23 or 12-22 and others. So as you are taking Levo your T4 level wouldn't be as low as 3.

Maybe you can check and clarify so that we can offer some help.

[Elementegirl in reply to SeasideSusie]

Thank you for replying and sorry my TSH is 3 I’m feeling really odd at the moment and just checked my blood pressure and it’s higher than yesterday at 160/75 head feels odd and feeling dizzy can over medicated make blood pressure high as I’ve never had high BP ever and I’m cert not myself at all and increased Levo is the only change other than a sinus problem

[SeasideSusie Remembering in reply to Elementegirl]

Elementegirl

With a TSH of 3 you wont be overmedicated, TSH would be very low or suppressed if you were, but just testing TSH alone is inadequate. You need to know your FT4 and, more importantly, your FT3 levels. These two are the thyroid hormones, and it's FT3 level which tells us if we are overmedicated. TSH is not a thyroid hormone, it's a signal from the pituitary to tell the thyroid to make hormone if it detects there's not enough. The higher the TSH the more hypothyroid you are.

Were FT4 and FT3 tested? If so, can you post the results with their ranges.

Symptoms of hypothyroidism can be seen here:

thyroiduk.org/signs-symptom...

Have a look through the list. High blood pressure is a symptom of hypothyroidism so if you are undermedicated then it's possible this could be the cause of your high BP. Dizziness is also a symptom of hypothyroidism so again it could be caused by undermedication.

[Elementegirl in reply to SeasideSusie]

I’ve just spoken with GP and I’m having a blood test tmrw also picking up my print off results but she’s just told me my Tsh was 3 and my T4 was 27 does this make sense until I get my print off ? So hypo is more likely as that makes more sense as I’m so lethargic and BP is even higher now at 167/72

[SeasideSusie Remembering in reply to Elementegirl]

elementgirl

she’s just told me my Tsh was 3 and my T4 was 27 does this make sense until I get my print off ?

Not really without the ranges. From the ranges we normally see here your FT4 would appear to be over range which doesn't make sense with that TSH level.

[Elementegirl in reply to SeasideSusie]

Can you explain what doesn’t make sense ? As that’s what she told me ?

[SeasideSusie Remembering in reply to Elementegirl]

Elementegirl

As mentioned in my previous replies:

In the UK ranges vary (different labs have different ranges) and those we often see here are 7-17 or 9-19 or 11-23 or 12-22 and others

Were FT4 and FT3 tested? If so, can you post the results with their ranges.

As reference ranges vary from lab to lab it's essential that we have the range as well as the result in order to interpret your results.

You have given your FT4 result as 27 without a range. With the ranges we normally see here your result of 27 would be way over range, I have never seen a range go higher than 24. So I'm assuming that your FT4 result is high and over range.

With a high FT4 one would expect to see a low TSH - as FT4 increases then TSH generally decreases. So with a high, over range FT4 one would expect to see a bottom of range TSH.

An over range FT4 suggests overmedication but you'd need FT3 tested to confirm that. A TSH of 3, when the patient is taking Levo, suggests undermedication. That's why your results, as you've given them (without ranges) doesn't make sense.

We always advise that members ask the reception for a print out of results, that way nobody can make a mistake and the correct result and reference range will be on the print out.

[Elementegirl in reply to SeasideSusie]

I’ve just returned from GP and was given a print out with no T4 results at all so I asked for the nurse to write everything down from the beginning of the year but don’t understand why it wasn’t on print out so here they are 5-2-2020–Tsh 0.24 ,T4 23.1

29-72020 Tsh-0.16-T4 27

5-12 2020 Tsh-3.0- T4 23.1

I was increased to 75 Levo six days a week and 50 one day a week from the 12 November and started feeling not myself around the 1st Dec . Hope you can make sense of all this and really do appreciate your time to look into and advise xx

[SeasideSusie Remembering in reply to Elementegirl]

Elementegirl

There are still no reference ranges so your results can't be interpreted. The ranges will be on the print out, usually at the side of the result and may be in brackets, eg (made up numbers)

TSH: 2.5 (0.27-4.2)

However, from what you have written, you don't have a result of TSH: 3 when FT4 is 27 as you were apparently told and mentioned above :

she’s just told me my Tsh was 3 and my T4 was 27

[Elementegirl in reply to SeasideSusie]

There’s nothing on the print out and will have to set this after Christmas as the Nurse didn’t even know what I was talking about she just wrote the numbers down so will try and sort out post Christmas and really sorry about this 😢

[Elementegirl in reply to SeasideSusie]

Hi I’ve just rang Receptioist and now she’s found this 29 7 2020

Tsh 0.16

T4 27 ( 10 -20

5 -12 2020 Tsh 3.0 (05-4.4 )

And no T4 testing in Dec

I cannot believe all this tbh and I’m definitely going to have a serious conversation with my GP when she’s back because it’s utterly ridiculous

Does this help ? Susie

[SeasideSusie Remembering in reply to Elementegirl]

Elementegirl

29 7 2020

Tsh 0.16

T4 27 ( 10 -20

OK, well that makes more sense - a low (probably below range) TSH with an over range FT4. Those results would suggest overmedication. What were you taking when this test was done and was your dose of Levo reduced based on this result?

You said above:

"I was increased to 75 Levo six days a week and 50 one day a week from the 12 November and started feeling not myself around the 1st Dec"

Why the increase at that time, did you have another test, you haven't given any results for November.

5 -12 2020

Tsh 3.0 (05-4.4 )

And no T4 testing in Dec

So your TSH is now higher than in July suggesting undermedication.

I see that you've had a thyroidectomy but say that your thyroid is growing back. Was it a total or partial thyroidectomy and what was the reason?

Have you seen an endo or had a scan to confirm that your thyroid is growing back?

A few things come to mind.

1. Do you have Hashimoto's (usually confirmed by raised TPO and/or TG antibodies)?

2. Do you take Biotin or a B Complex supplement and if so, did you leave it off for 7 days before the test?

3. Do you always do your test under the exact same conditions every time to ensure that you can accurately compare results, ie

* test no later than 9am (this is because TSH is highest early morning and lowers throughout the day),

* with nothing to eat or drink except water before the test (this is because eating can lower TSH and coffee affects TSH),

* last dose of Levo 24 hours before the test (this is because taking your Levo before the test gives a false high FT4)

Testing just TSH is inadequate because it is not a thyroid hormone, it's a signal from the pituitary. The thyroid hormones are FT4 and FT3 and these tell us our thyroid status, with FT3 being more important as it tells us if we are overmedicated. Unfortunately most doctors don't know this.

We advise members to always get a print out of their results after every blood test, keep a record of results, ranges, dose of meds, how you feel, whether dose is changed based on result. This is an important resource for us so that we know where we feel best, where we don't feel so well, and we can refer to this if a GP wants to change our dose.

If GP only tests TSH then we advise getting private tests to include THS, FT4 and FT3.

It's also important to know our nutrient levels (Vit D, B12, Folate and Ferritin) as these need to be optimal for thyroid hormone to work properly. Have these been tested?

[Elementegirl in reply to SeasideSusie]

Hi I’ve just been given my results from Christmas Tsh 2.9 (0.5.4

Ft4 15.9( 10.20

T3 3.4. (3.5.6.5

Dr says to increase my Levo to 75 and get another test in six weeks as these are best results this year

Can you advise me please

[SeasideSusie Remembering in reply to Elementegirl]

Elementegirl

Your results do show the need for an increase in dose so GP has done the right thing. Follow our advice on how to do the test (see points 2 and 3 in my reply above) and post new results when you have them.

[Elementegirl in reply to SeasideSusie]

Really? Thank goodness for this reply as I’ve been told by country health in Norwich that my results are clearly not optimal saying T4 is just a transporter which has totally confused me as my GP is excellent but that doubt had been put in my mind as it’s a company that provides alternative medicine I was thinking of I may have to change but what you have confirmed has eased my mind considerably but I’ve still got terrible anxiety and BP is high and I do my testing exactly as you recommend and my husband is getting the print off Did you need ferritin etc as I’m not sure if they have printed that off but I can get that but just to clarify that you think my dose advice has been correct ?

Many many thanks S susie xx

[SeasideSusie Remembering in reply to Elementegirl]

Elementegirl

The aim of a treated Hypo patient on Levo only, generally, is for TSH to be 1 or below with FT4 and FT3 in the upper part of their reference ranges, if that is where you feel well.

Your TSH is clearly too high, your FT4 is only 39% through it's range and FT3 is below range.

saying T4 is just a transporter

T4 is basically a storage hormone which has to convert to T3, maybe that's what they mean. T3 is the active hormone which every cell in our bodies need so out of all the thyroid tests it's the FT3 which is the most important.

Did you need ferritin etc as I’m not sure if they have printed that off but I can get that

A good level of ferritin is needed for thyroid hormone to work properly and good conversion to take place, so if ferritin has been tested then yes, post the result and range. Also important are Vit D, B12 and Folate.

but just to clarify that you think my dose advice has been correct ?

Yes it was correct to increase your dose based on these new results, but what were you taking before because on 23rd December you wrote above

I was increased to 75 Levo six days a week and 50 one day a week from the 12 November

[Elementegirl in reply to SeasideSusie]

Yes all correct it was an increase in December and I will get the ferritin etc as soon as I get them and now I need to look at the reason for my high BP as never in my life have I ever had this along with a lot of the symptoms of over medicated so I’m not too sure what to do Would you think that it could be Levo just getting more into my system as this is the only thing that has changed

Many thanks one else more and I certainly feel better reading your reply 😊

[SeasideSusie Remembering in reply to Elementegirl]

Elementegirl

Would you think that it could be Levo just getting more into my system as this is the only thing that has changed

To be honest, I have no idea what's going on.

On 29.7.20 your results were:

Tsh 0.16

T4 27 ( 10 -20

and on 5 -12 2020

Tsh 3.0 (05-4.4 )

And no T4 testing in Dec

I did ask you if you had Hashi's or took B Complex and not leave it off for 7 days before the test but you never responded to those questions. So I have absolutely no idea why you should have had such a high over range FT4 in July and now it's down to 39% through range. So all I can do is base my current comments on your new results.

High blood pressure and anxiety are both listed as symptoms of hypOthyroidism and with your current results showing undermedication one would expect some symptoms.

[Elementegirl in reply to SeasideSusie]

Hi SSusie my Ferritin level is 85 ugl(12.0- 300.0) Folate says above range 22.4 ug/L ( 3.0-17.0)

Above high reference limit

Is what is said

And something I don’t understand at all

Would you know please

[SeasideSusie Remembering in reply to Elementegirl]

Elementegirl

Ferritin is recommended to be half way through range. Ranges vary from lab to lab, from male to female and apparently from pre to post menopausal so it can be confusing. I've also seen it said that a good level for females is 100-130.

So yuor ferritin level isn't dire, but it might be beneficial if it's nearer to the half way point, I think I'd be aiming for the 100-130 .

As for folate level - do you take a B Complex? Or maybe you eat lots of folate rich foods? List of foods high in folate/folic acid in this article:

bda.uk.com/resource/folic-a...

[Elementegirl in reply to SeasideSusie]

Hi I have stopped my supplements in Dec and was only taking a week possibly as I started with lots of symptoms I thought were the supplements however looking up over medicated for Levo I assumed it was that , terrible sweats in the night , insomnia (2-3hrssleep) legs and arms tingling , palpitations, high BP , no energy -all started 8 days after increasing my Levo to 75 which my GO said at the time that she didn’t want me to be over medicated and I had none of those symptoms prior but I did have anxiety symptoms earlier in the year , The blood results came back yesterday saying that I needed to be increased to 75 every day which after what she had said previously warning me about going over , I was taking 75 up to July and tbh

I hadn’t felt better but she said I was then over medicated and reduced me and I’ve not been ok since the dropping my dose and then increasing in Dec

I just have been thinking why would she change her mind ? And her diagnosis was I’ve anxiety ( Christmas etc) and it possibly could be can I ask you opinion please as I’ve never ever once had high blood pressure and I wasn’t aware that I had anxiety as it felt like over medicated but on saying this I’m on 75 and symptoms today don’t seem to be as bad just slightly

I’m sorry for the long message but you said exactly what she did which made me think could it be Anxiety?

Would you be able to make any sense in this please as I’ve certainly had nothing over Christmas to cause any anxiety but who knows in this climate we are in as I am worrying about covid etc

Thank you for your help I do honestly appreciate everything you have said 😊

[SeasideSusie Remembering in reply to Elementegirl]

Elementegirl

I hadn’t felt better but she said I was then over medicated and reduced me and I’ve not been ok since the dropping my dose and then increasing in Dec

I just have been thinking why would she change her mind ?

Because your latest results are showing undermedication. Look at your results

On 29.7.20 your results were:

Tsh 0.16

T4 27 ( 10 -20

and on 5 -12 2020

Tsh 3.0 (05-4.4 )

And no T4 testing in Dec

So in July your had over range FT4 which suggests overmedication. Your TSH is also below range (but we should not alter dose by just looking at TSH). In December your TSH has risen suggesting undermedication and now your Christmas results:

Tsh 2.9 (0.5.4

Ft4 15.9( 10.20

T3 3.4. (3.5.6.5

Show the same increased TSH, a very much lower FT4 than July and a below range FT3 which all suggest undermedication, this is why your GP has increased your dose of Levo.

I can't explain why you've had such a swing with your results but I have asked you more than once if you have Hashimoto's which would be confirmed by raised thyroid antibodies and you haven't answered the question. If you do have Hashi's that would explain the swing.

I can't comment on anxiety as it's not something I suffer from, but it is a symptom of hypothyroidisim, as is high blood pressure, as I mentioned above. But high blood pressure can come with age as well, you are the same age as me and I developed high blood pressure about 2-3 years ago and have had to go on a BP medication.

Looking at your previous post from the beginning of December:

healthunlocked.com/thyroidu...

your low Vit D and low B12 were discussed along with what you should take to improve these, yet you're now saying that you stopped your supplements in December. You need to get your nutrient levels optimal, thyroid hormone can't work properly unless they are.

[Elementegirl in reply to SeasideSusie]

Many thanks for your reply and I have asked more than one else if I’m Hashi and there’s no evidence to that , would that be on my blood tests? But I’ve never been told that I am but I will double check once my GP is back or I can ring and speak to the receptionist and will let you know as soon as they reply .

[SlowDragon Administrator in reply to Elementegirl]

You need to get FULL thyroid testing 6 weeks after each dose increase in levothyroxine (or brand change in levothyroxine)

Do you always get same brand of levothyroxine?

Bloods should be retested as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

Essential to regularly retest vitamin D and B12 as well

When were these last tested

What vitamin supplements are you currently taking

Important to maintain optimal vitamin levels, this frequently means taking vitamin supplements virtually continuously

[SeasideSusie Remembering in reply to Elementegirl]

Elementegirl

Doctor's call it autoimmune thyroid disease, patients know it as Hashimoto's (it was discovered by a Dr Hashimoto).

To know if you have it you need thyroid antibodies testing.

Thyroid Peroxidase (TPO) antibodies and Thyroglobulin (Tg) antibodies.

TPO antibodies can be done by a GP but Tg antibodies generally only done when an endo requests it.

If TPO antibodies are negative it often means that Tg antibodies aren't tested but one can have negative TPO antibodies but positive Tg antibodies.

Hashi's can also be diagnosed by ultrasound.

I was diagnosed Hypo back in 1975 and I've never had an antibody test carried out on the NHS.

[Lotika]

I certainly felt sick and dizzy when I first started levo and when I moved the dosages upwards to get towards optimal medication. I also felt as it my heart was beating too fast occasionally as well, whilst my body adjusted. In my case, it all sorted itself out in the end! I remember being quite surprised that nobody warned me... the doctor had said “take this forever and you will be fine”, not “start taking this, you will struggle a bit, and over the coming months we will slowly see some improvements”, which of course, would have been more accurate! Are you able to speak to a different GP to put your mind at ease?

[Elementegirl in reply to Lotika]

Thank you for your reply but my increase was 5 weeks ago but do you think I would be getting symptoms five week later but I must say that I did notice things not ok 3 weeks ago and it’s gotten progressively worse

[Lotika in reply to Elementegirl]

Hmm, not the same as my experience in that case... as I recall, I had those symptoms maybe for a week or so following each increase... I’m afraid I am at the limit of my ability to make any helpful suggestion aside from seeing whether there is a different GP you can speak to whilst yours is on holiday...