I've realised that my hormonal problems, and variable levothyroxine dose for the last few years may have been the main contributing factor for my rapid decline in kidney function 120-80 GFR in 3-4 years.
Some studies I have only just come across say overmedicaiton accelerates the disease.
Has anyone been overmedicated for a long time?
I'm also wondering, that say if you don't have thyroid issues, and you took 50mcg levothyroxine, would your body adapt to this, and produce lower thyroid hormones. ie can you only be overmedicated in the long term if you are taking more than your body would naturally produce if healthy?
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biowarrior
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Looking at previous posts you are male age 25 and only taking 75mcg levothyroxine
Is that correct
How long have you been on just 75mcg levothyroxine
Bloods should be retested 6-8 weeks after each dose increase
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
The aim of levothyroxine is to increase dose upwards until Ft4 is in top third of range and Ft3 at least half way through range (regardless of how low TSH is) ...
Extremely important to have optimal vitamin levels too as this helps reduce symptoms and improve how levothyroxine works
Yes. I have all my vitamins and I feel pretty perfect. I have absolutely no idea why you would want to give patients a full replacement dose. This appears NOT to be clinical practice.
Many, many members find small doses of T3 alongside levothyroxine and especially a small dose of T3 at bedtime improves sleep dramatically
Looking at previous posts you had very low B12 and vitamin D. Low vitamins tend to result in poor conversion of Ft4 to Ft3 ......resulting in higher Ft4 and lower TSH
thanks, I have found levo threshold, if I go 12mcg above it I get insomnia within 10 days, if I stay below it it goes away. The cause/effect is as clear as day to me. I cant be certain of the biology but have been through 3 cycles of this now so stick it.
p.s. I am happy to be educated otherwise but have yet to find anyone explain in another way. I am taking my next test in the new year so will look out for conversion again.
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
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.
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.
Thanks for the info. So even if you were slightly hypothyroid as long as you stat under 125 say for 75 kg man. You are unlikely to be overmedicated in long run as your body will adjust natural production?
I ask because I'm scared of damaging kidneys further by being overmedicated . And think that maybe why they are damaged
Low GFR is linked to being under medicated ....not over medicated
How long have you been on just 75mcg levothyroxine
Do you always get same brand of levothyroxine
Which brand of levothyroxine?
Remember to always test thyroid as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test
Hi yes I know. But I'm more worried about long term kidney disease.
Eg. Hyperthyroid makes your gfr better in short term but damages kidney in long run, whilst hypothyroid doesn't aplarently in long run .
Curing hypothyroid to right thyroid level would be great as should be best for kidney and would improve gfr levels but not hyperthyroid/overmedicated.
The study says it damages the nephrons, by three mechanisms like higher pressure, angiosten or something and something else
So I really don't want to reduce my kidney function further as is borderline .
I now take b complex , wellbutrin , fish oil when I get up. At 8am
11am levo
Lunch sometime after 1
Floridax and iron, vit d, vit k at 8pm
I used to take Floridax right after levo when I woke up and sometimes breakfast which I realise now is stupid, this was my last two tests. Also my test at 50mcg I was iron deficient
As soon as anyone starts on replacement thyroid hormones, it’s inevitable that you will need to slowly increase dose up until on, or near , full replacement dose of 1.6mcg per kilo of your weight
The feedback mechanism means that once you start on levothyroxine as TSH drops, your own failing thyroid stops working so hard and you need next dose increase.
I would agree with kidney problems and under medication. Before I started on NDT I had so many kidney infections and issues I used to joke they should have a frequent visitor program in the hospital. Since being dosed correctly with NDT I have not had an infection in ages. I don't know if that helps. As far as the amount of the dose, each person is different. It is not by weight but by the value of your hormones. You need to test T4, T3, FT4, FT3. TSH is not a big deal. Mine is wayyy below normal. Also you should check cortisol, magnesium, ferritin, VD, and several others mentioned here.
HelloI was a contractor of dialysis services for 30 years in Los Angeles where I worked with Doctors and patients from all over the world. I never came across levothyroxine causing or accelerating kidney failure. Of course you can have both but it may be 2 different things.
Then again just because I never saw it doesnt mean it cant be so.
Monitor kidney function separately and be vigilant about it.
Losing thyroid function is a daily pill but loosing renal function is a tough haul.
If your GFR is dropping the cause would be nice to know!
You haven’t said exactly what sort of kidney damage you have and what the medical diagnosis is? Just wonder why you think thyroxine the problem.. 75mcg seems a low dose of medication especially for a man. My brother was on 175 at max. Do you take other medication? Antacids? I had kidney stones from Omeprezole - changed diet - no more antacids or stones.
If you have an underactive thyroid (hypothyroidism), treatment may be delayed until this problem is treated. This is because having an underactive thyroid can lead to an increased cholesterol level, and treating hypothyroidism may cause your cholesterol level to decrease, without the need for statins. Statins are also more likely to cause muscle damage in people with an underactive thyroid.
this was 4 weeks ago when i had been at 75mg for 4.5 weeks. Ive felt weak recently been inconsistent with dosing with my recent exams.
im thinking of now going to 100mg at 11am, 2 hours after other meds and 2 hours before lunch.. Im going to be super healthy for the next few weeks and stick to 100mg.
ill let you know in 5 weeks what my results are
.......my reply on that post was
Suggest you wait and stay on 75mcg getting bloods retested after 6-8 weeks
Taking levothyroxine on its own will be much more effective and equivalent to dose increase in itself
.....presumably you have been taking levothyroxine on its own since this previous post
My sister who had thyroid cancer is constantly over medicated. The Endo says this is to suppress her TSH to stop any cancer returning. She has been hospitalised with kidney failure and often her bloods show issues with her kidneys. I’m now wondering if high doses of Levothyroxine can cause kidney issues. It’s recorded on her NHS record that she has kidney disease could this be to do with over the range Levothyroxine dose for many years.
I had thyroid cancer and had a TT. I have been over medicated (they say!) the whole time for the same reason. I am now told this is not appropriate and I was treated incorrectly, even though this was the gold star treatment at the time, and I was personally advised this was the best treatment by the Mayo clinic in the US, which is the world-leading clinic in thyroid problems. However, dropping me down to 100mcg per day from my usual 125 caused a huge raft of symptoms, chief of which was a dramatic rise in TSH and drop in everything else. The endo knew a good deal less about thyroid issues than my dog does, but finally agreed that he wouldn't change my dose and I remain at 125mcg. I have had no issues with my kidneys and next year I 'celebrate' 25 years without my thyroid.
I have no idea what my last numbers were, because it was back in the spring it was done and we entered lockdown just afterwards and I have been unable to get through to the doctor's surgery since. TSH usually sits about 0.001 and my T4 was about 19 last time I saw results. I have been over medicated for the majority of the 25 years. I had about 3 years where I was dropped to 100mcg and I struggled the whole time - constantly cold, hair falling out by the handful, eyebrows disappearing, nails splitting, skin sloughing off, the works. I couldn't remember my own name half the time and my work suffered. It was got slowly better when I went back to 125.
I don't think I'm over medicated. My doctors do. The endo appears to think anything over 75 is overmedicated and has tried to reduce a friend's dose to nothing, when she has also had a TT because of thyroid cancer. In fact, I would say I could do to go up a bit yet, but short of buying thyroxine somewhere online, that won't happen.
oh , i see.Not so much 'Patient Over-Medication' as 'Doctor Under-Education' then .
I do wish they'd stop telling people they're overmedicated or even worse (like DizzyD's reply below) 'hyperthyroid' when what they mean is "your TSH is a bit lower than we'd ideally like, so let's discuss the risk's/benefits like grown ups " !!
Hi due to cancer of thyroid had a total thyroidectomy in 1992, since then I have been over medicated with thyroxine and was hyperthyroidism most of the time. Had thyroxine reduced to 75mcg January 2020 and now I am hypothyroid. Over medicated and consequently long term hyperthyroidism has caused heart problems but my kidneys have been fine.Hope you find some clarity
My serum creatinine went up and eGFR went down over 5 years (along with my red blood cell count – kidneys release a hormone that stimulates the production of red blood cells). This was when my dose of levothyroxine was too low, I was on 100mcg for too long. I mentioned all of this to various GPs and they completely denied that it was related to my thyroid. This year I increased my levothyroxine, it seemed to slightly improve my serum creatinine and my eGFR, but it wasn't until I added liothyronine (T3) that my serum creatinine and eGFR returned to how they were 5+ years ago. I think your problem is that your dose is too low.
An underactive thyroid can cause kidneys to have a reduced rate of recleaning toxins from the blood. Being hypothyroid further negatively affects kidney function and health by (4–9): Reducing blood flow through the kidneys. Narrowing blood vessels in the kidneys. Undertreatment has also the same effect.
Maybe this helps: "Hypothyroidism may be accompanied by an increase of serum creatinine and reduction of glomerular filtration rate (GFR), whereas hyperthyroidism may increase GFR. Treatment of thyroid disorders may lead to normalization of GFR. Primary and subclinical hypothyroidism and low triiodothyronine (T3) syndrome are common features in patients with chronic kidney disease (CKD). " pubmed.ncbi.nlm.nih.gov/246...
Make sure you are not confusing the term 'overmedication' with studies referring to 'Hyperthyroidism'.
Hyperthyroidism is the continuous overproduction of both thyroid hormones (T4 and T3) usually to 3 or 4 times the normal level, and this does lead to suppressed TSH.
Studies that say hyperthyroidism causes 'xyz' cannot be interpreted to mean that a TSH of similarly low levels~ caused as a result of taking thyroid hormone ~ will cause the same adverse effects as long term T3 & T4 levels that are many times higher than what you get from slight overmedication of Levo , or Levo+T3.
T3 is the active hormone and high T3 is what causes hyperthyroidism symptoms and put's strain on bodily systems. TSH is not, and does not.
Most people taking thyroid hormone replacement who are told that they are 'overmedicated' (or 'have hyperthyroid results') have fT3 results that are only mid way through the range ie 'normal', and perfectly safe.... but the doctors don't know that , because they refuse to test the fT3.
So they just look at the TSH and panic instead.
And start telling people they are overmedicated or 'hyperthyroid', because it's quicker than explaining, (or more worrying, because they don't really understand it themselves!)
Yes this is good points, and makes me feel a better about juggling the two diseases.
You are right Suppressed tSH with the right T3 doesn't sound like it should cause any kidney problems
When I say over medicated I meant too high T3 for body's normal range.
I think when I was on NDT I was way too high for a while. Right now i feel really overmedicated on 75mcg as I recently changed the way I take levo, I was before taking it with some iron and other stuff, and I think my body has properly recovered from an illness i had last year, which caused a lot of this. My iron levels are up now , from like 20. And Ive had a week of rest.
So I'm really not sure what level I should be at. I think my body can have normal thyroid function it's just liable to go awry when the rest of my health isn't there. Hence why Ive found dosing very hard .
I'm very concenernd about preserving my reduced kidney function so I can still do mentally demanding work and have enough mental energy in the day , but currently doing a master's which is very intensive in 2 month blocks. So I can't just experiment for a few months of very low dose to see if my thyroid picks up now.
I' currently not sure if I should go down 25mcg or 50mcg and see what happens in 3 weeks, which is when I need to start having a lot of energy.
On previous post you mentioned taking caffiene dose ? and other supplements with your Levo. Assuming you have now stopped doing this ? If so, that will have the same effect as a small increase in Levo dose, (no one can say how small)
So, from the date you stopped taking caffeine etc with Levo .... wait 6 weeks ... get a blood test.... that's it ...... Don't mess with your dose until then. and don't jump to conclusions about how you will feel on 75mcg until at least 8/10 weeks have gone by. the body takes quite a while to settle down every time you change dose.....
If you decide for some curious reason to reduce your dose now from 75mcg to 50mcg or even 25mcg then i think you can pretty much guarantee that you will feel much worse in 3 weeks time than you do now.
Why are you talking about "experimenting with a low dose for a few months to see if your thyroid picks up"..... what has given you the idea that your thyroid is capable of getting better ?. If the cause is Autoimmune, it's damaged already, and will continue to get damaged .That is why it stopped being able to produce enough hormone , and why you are taking it by mouth instead.
I got the impression from a previous post you mention that the NHS are not aware you are treating yourself for hypothyroidism ?
If they are also treating you for Kidney Disease, and other serious conditions i think it would be sensible to let them know what you are taking , even if this does result in disagreement about dose.
Hi biowarriorI've had several abnormal kidney results before and after my diagnosis of hyperthyroidism (graves) obviously my thyroid went massively over active eventually making me go in to thyroid crisis, but before my doc did any blood work on my thyroid he saw the following 👇
My gp never informed me of these findings I found them after aquiering my medical records 😠.. Results after TT on medication first T4.. 175mg I was so hyper I could not stand it.. Put on T3 125mg again so hyper put T3 down to 10mg split.. My TSH is now 19.32... T4 is low but to be expected.. Results now👇
I've been in hospital twice this year with kidney stones ect, my kidney function has been compromised the endo told me, I'm really lost on the thyroid drug, as 10mg T3 didn't give me any symptoms of hyper feelings but when I increase I can feel the hyper symptoms creeping in... As now been on increase of 5mg for around 5 days and I'm starting to sweat again have electric shock feeling in arms legs and head, I had these symptoms when I was over active... So it's not under medication, it feels like over medication 🤷♀️🤷♀️🤷♀️ but my kidney function has not improved 🤷♀️
Kidney functon doesnt improve once youve lost it generally.
So that's good that youve mantained it? your creatinine is exactly the same.
Im not sure about thyroid issues, especially hyperthyroidism. I do think being overmedicated or hyper should be avoided if kidneys are fragile.
The creatinine is a pretty rough metric. Mine is 125-130 , but I am male.
Depending on your age 57-60 is actually good and if you can maintain it shouldnt limit you. It depends how old you are, but yes it is below average, and hyperthyroidism probably caused some damage, but hard to say. Also I wouldnt take the GFR as absolute, creatinine is a rough estimate, less rough estimate for woman, but drugs can increase the creatinine, even your thyroid medication, may increase it.
I have! And a few weeks ago I was in the ICU for acute kidney failure! I had 4 rounds of dialysis and was on a ventilator!! I had no idea it could be from my thyroid meds! I don’t have diabetes, although it runs in my family, but I’ve been on high dose of levothyroxine and cytomel/t3 for several years now.
What is that? I don’t know but one of the kidney function levels was 12 when I went to the hospital and it’s supposed to be less than 1 I think. I see kidney doc again tomorrow. Before I went to the hospital I had been throwing up so much for a couple days I couldn’t keep down my meds or any fluids or food, if I took even a sip of water or ginger’s ale i projectile vomited a minute later. So my stomach was super acidic and empty when I went to the hospital
Acute is what you want!! As kidney may recover a lot. If it's chronic aka CKD, depending on the severity it is a big life change, and not reversible really.
Sounds like a really tough time. I hope you can recover take it very easy.
The number was probably your creatinine, which can be a proxy for kidney function. Obviously 12 is complete failure
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