Too much Levothyroxine?: Hi, just wondering what... - Thyroid UK

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Too much Levothyroxine?

Flump12 profile image
19 Replies

Hi, just wondering what anyone thinks of this or has had something similar.

I received 50mcg Levo after I had a level of TSH 4.87 (0.27 - 4.20) Serum free T4 11.6 pmol/L (9.0 - 26.0) Free T3 5.2 pmol/L (3.1 - 6.8) this took me to TSH 2.68 (0.27- 4.20). Serum free T4 level 15.4 pmol/L (9.0 - 26.0) Free T3 not tested this time. Then I was prescribed 100mcg of Levo which I have been taking for 4 days. I take Levo first thing in the morning and my problem is during the evening I start to feel a little uncomfortable in the chest and stomach like jittery and a bit like my chest is racing and I have butterflies. I also only sleep for three hours at a time, every night I sleep at 11.00 and wake at 2.00 and struggle back to sleep, then if I get another hour or two that will be all, along with the same feeling in chest and stomach. This didn’t happen before. I’m wondering if I should ask to drop to 75mcg of Levo or go back to 50mcg, I felt ok at 50mcg with only mildish symptoms. I’m not taking Levo this morning and see how I feel tonight. I have plenty 50mcg left and was thinking of taking this until I get to speak to doctor. I hope this makes sense.

B12 and folate normal / Serum cortisol normal / Vit D 49nmol/L (50-) and now taking supplements / Serum ferritin 18ug/L (10 - 150)

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19 Replies
sbadd profile image
sbadd

Levo is usually increased by 25mcg at a time and retested 6-8 weeks, jumping from 50 straight to 100 is a big increase.

Flump12 profile image
Flump12 in reply tosbadd

Thank you

SlowDragon profile image
SlowDragonAdministrator

Recommend only increase to 75mcg

Increases should be in 25mcg steps upwards

Essential to test vitamin D, folate, ferritin and B12

Have you had these tested?

Flump12 profile image
Flump12 in reply toSlowDragon

Yes they tested these, have updated post .

SlowDragon profile image
SlowDragonAdministrator in reply toFlump12

Please add actual results and ranges on B12 and folate

Optimal B12 is over 500 and folate at least half way through range

Flump12 profile image
Flump12 in reply toSlowDragon

B12 : 380 ng/L (191- 663) Folate 13 ug/L (3.3 - 19.3)

Flump12 profile image
Flump12 in reply toFlump12

I’ve started taking supplements for B12 as eat mainly plant based diet.

SlowDragon profile image
SlowDragonAdministrator in reply toFlump12

So B12 way too low

supplementing a good quality daily vitamin B complex, one with folate in (not folic acid) may be beneficial.

This can help keep all B vitamins in balance and will help improve B12 levels too

Difference between folate and folic acid

chriskresser.com/folate-vs-...

Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid.

thyroidpharmacist.com/artic...

B vitamins best taken after breakfast

Igennus Super B is good quality and cheap vitamin B complex. Contains folate. Full dose is two tablets per day. Many/most people may only need one tablet per day. Certainly only start on one per day (or even half tablet per day for first couple of weeks)

Or Thorne Basic B is another option that contain folate, but is large capsule

If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

Low B12 symptoms

b12deficiency.info/signs-an...

With such low B12 result taking a B12 supplement as well as a B Complex (to balance all the B vitamins) initially for first 2-4 months, then once your serum B12 is over 500 (or Active B12 level has reached 70), stop the B12 and just carry on with the B Complex.

B12 sublingual lozenges

cytoplan.co.uk/shop-by-prod...

amazon.co.uk/Jarrow-Methylc...

healthline.com/nutrition/me...

Flump12 profile image
Flump12 in reply toSlowDragon

Ok thank you I’ll try that.

Flump12 profile image
Flump12 in reply toSlowDragon

Hi thanks for all your help so far, just a little update and query, I’ve been reduced to 50mcg and 75mcg on alternate days. This is fine but on the 75mcg day the tablets are made up from a 50 tablet and a 25 and the brands are different, the 50 is mercury pharma group ltd and the 25 is teva uk, hoping this is usual and won’t present any probs?

SlowDragon profile image
SlowDragonAdministrator in reply toFlump12

Teva brand upsets many many people

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

Most easily available (and often most easily tolerated) are Mercury Pharma or Accord

Note Accord is also boxed as Almus via Boots, and Northstar 50mcg and 100mcg via Lloyds ....

but beware 25mcg Northstar is Teva

List of different brands available in U.K.

thyroiduk.org/medications-f...

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

Flump12 profile image
Flump12 in reply toSlowDragon

Ok thank you I’ll bear that in mind and see how I go, hopefully I will tolerate it.

SlowDragon profile image
SlowDragonAdministrator in reply toFlump12

If not put in yellow card and request new prescription for 25mcg ....Mercury Pharma make 25mcg

yellowcard.mhra.gov.uk

Have “No Teva” brand added to all future prescriptions

Bloods should be retested 6-8 weeks after being on 75/100 on alternate days

Then likely to need to increase to 75mcg every day.....testing again 6-8 weeks later

Etc

We often have to increase slowly....but likely to end up on 100mcg daily eventually

SlowDragon profile image
SlowDragonAdministrator

Previous posts show you have Hashimoto’s

2 months ago ferritin was very low at 18 (10-150)

GP should have done full iron panel test for anaemia

Never supplement iron without doing full iron panel test for anaemia first

Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption

List of iron rich foods

dailyiron.net

Links about iron and ferritin

irondisorders.org/too-littl...

davidg170.sg-host.com/wp-co...

Great in-depth article on low ferritin

oatext.com/iron-deficiency-...

drhedberg.com/ferritin-hypo...

This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.

healthunlocked.com/thyroidu...

Thyroid disease is as much about optimising vitamins as thyroid hormones

Helpful post about iron supplements and testing

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

restartmed.com/hypothyroidi...

Post discussing just how long it can take to raise low ferritin

healthunlocked.com/thyroidu...

Post discussing why important to do full iron panel test

healthunlocked.com/thyroidu...

Flump12 profile image
Flump12 in reply toSlowDragon

I’ll see if I get a test online and through the post, don’t think docs will do it.

SlowDragon profile image
SlowDragonAdministrator in reply toFlump12

Medichecks do one

SlowDragon profile image
SlowDragonAdministrator in reply toFlump12

Extremely difficult on plant based diet to maintain ferritin levels

Suggest you read many of humanbean replies on ferritin

SlowDragon profile image
SlowDragonAdministrator

Vitamin DGP will often only prescribe to bring levels to 50nmol.

Some areas will prescribe to bring levels to 75nmol or even 80nmol

leedsformulary.nhs.uk/docs/...

GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)

mm.wirral.nhs.uk/document_u...

NHS Guidelines on dose vitamin D required

ouh.nhs.uk/osteoporosis/use...

But with Hashimoto’s, improving to around 80nmol or 100nmol by self supplementing may be better

ncbi.nlm.nih.gov/pubmed/218...

vitamindsociety.org/pdf/Vit...

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

Test twice yearly via vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function. There’s a version made that also contains vitamin K2 Mk7

amazon.co.uk/BetterYou-Dlux...

It’s trial and error what dose we need, with hashimoto’s we frequently need higher dose than average

Calculator for working out dose you may need to bring level to 40ng/ml = 100nmol

grassrootshealth.net/projec...

Government recommends everyone supplement October to April

gov.uk/government/news/phe-...

Taking too much vitamin D is not a good idea

chriskresser.com/vitamin-d-...

Web links about taking important cofactors - magnesium and Vit K2-MK7

Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

2 good videos on magnesium

healthunlocked.com/thyroidu...

Flump12 profile image
Flump12 in reply toSlowDragon

Thank you for all the info, I’ll look into it.

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