What should I do now?: It is now almost 4 weeks... - Thyroid UK

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What should I do now?

dottyb09 profile image
8 Replies

It is now almost 4 weeks since I had my hyper swing and so I have just had the results of a test from Monitor My Health.

TSH 7.65 (0.27 - 4.2 mU/L)

Free T4 4.3 ((12 -22 pmol/L)

Free T3 1.5 (3.1 - 6.8 pmol/L)

Do I now start taking my Thyroxine that I was prescribed at 175mcg or do I start at a lower dose? Strangely, I don't feel bad. I have just finished painting my bedroom and this week I have gone back to the charity shop where I work and have done two mornings. One thing which bothers me is that I have an oximeter and the heart rate is accurate as I have checked it against the clock but my oxygen level averages 94, never goes above 95. Is this why I am breathless when walking? I am eating liver once a week now and taking one sachet of Spatone each day. I haven't noticed an improvement yet but it has only been three weeks.

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8 Replies
SlowDragon profile image
SlowDragonAdministrator

Looking at previous post....it wasn’t a hyper “swing” but possibly on too high a dose at 175mcg

Which brand of levothyroxine is it that you have

Now you are extremely hypothyroid

You definitely need to be back on levothyroxine

How much do you weigh in kilo approx?

Suggest you start on 100mcg ....see how that is ....ideally remain on that dose for 6 weeks before retesting

guidelines on dose levothyroxine by weight

Even if we frequently 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 eventually 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.

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...

dottyb09 profile image
dottyb09 in reply to SlowDragon

I don't understand how I can be over medicated on 175mcg thyroxine when, for years, I have taken 4 grains of NDT with results of a suppressed TSH and an FT4 around 19. When I started thyroxine again at 200mcg my FT4 was 22.4 so how it can shoot up to 33 when the thyroxine is lowered is very strange. My weight has increased since being on thyroxine by about 7 kilos and I am now 79 kilos and I hate it. The 100mcg levothyroxine I have is Accord. I took 100mcg last night.

SlowDragon profile image
SlowDragonAdministrator in reply to dottyb09

On levothyroxine, as it has no T3, it’s likely your vitamin levels dropped rapidly

We need optimal vitamin levels for levothyroxine to be used.

Low vitamin levels leads to poor conversion of Ft4 to ft3...results in high Ft4

As you are now extremely hypothyroid, vitamins likely crashed right to the floor

What vitamin supplements are you currently taking

You need to test vitamin D, folate, ferritin and B12

dottyb09 profile image
dottyb09 in reply to SlowDragon

My vitamin D3 was over the limit at 240, B12 was 144pmol/L, Folate 31.6 nmol/t and Ferratin (which I am trying to raise) 53ug/L. I take Igennus Super B Complex, D3, Selenium, Magnesium and Omega 3. These results were 4 weeks ago.

humanbean profile image
humanbean

One thing which bothers me is that I have an oximeter and the heart rate is accurate as I have checked it against the clock but my oxygen level averages 94, never goes above 95. Is this why I am breathless when walking?

Low oxygen in the blood could certainly increase breathlessness.

The low oxygen could be caused by any of the following ---- anaemia, iron deficiency, B12 deficiency, folate deficiency. There are probably lots of other causes too.

You might find this link helpful : davidg170.sg-host.com/wp-co...

dottyb09 profile image
dottyb09 in reply to humanbean

Thank you humanbean . I think the best thing to do is ask the doctor to do an iron panel I had a chest x-ray, ECG and echocardiogram a couple of years ago when I saw the doctor about the breathlessness and everything was ok.

Mary1226 profile image
Mary1226 in reply to dottyb09

Hi, i would check the ingredients in the levothyoxine, i had some what the same problem. My breathing wasn't normal and i always had shortness of breath i was checked in the ER several times everything came back normal, so i had to do my own research and found that mannitol was a inactive ingredient in levothyoxine that has bad side effects and for me it was shortness of breath which caused me anxiety MYLAN is the manufacturer . I switched my manufacturer to a different one who does not have mannitol in the ingredient . Also if you have hypothyroidism ashwagandha root works very well for breathing ect. Its not good for hyperthyroidism but please look it up first. Hope you feel better

dottyb09 profile image
dottyb09 in reply to Mary1226

Thank you Mary1226 I'll check the ingredients in my levothyroxine.

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