Taking levothyroxine at bedtime - weight gain?

[Essexlil]

Hi, I decided to change my dosage of levothyroxine from morning to bedtime. This has been a lot easier, but seems to coincide with me gaining weight so I’m thinking about going back to morning. Has anyone else had this reaction - if I hear others have had this problem I’ll definitely revert to morning dosage as I’m really depressed with my weight gain and I think my face looks either fatter or puffy. Any help would be much appreciated

[SlowDragon Administrator]

Recommend getting FULL thyroid and vitamins tested....perhaps you are just on inadequate dose levothyroxine

How much levothyroxine are you currently taking

Do you always get same brand

If still only on 75mcg, that’s only one step up from starter dose

What vitamin supplements are you currently taking

B12 was extremely low last test

No vitamin D or folate results

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 at least annually

Low vitamin levels are extremely common, especially if you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies

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

List of private testing options

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Thriva Thyroid plus antibodies and vitamins By DIY fingerpick test

thriva.co/tests/thyroid-test

Thriva also offer just vitamin testing

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code

thyroiduk.org/getting-a-dia...

monitormyhealth.org.uk/

NHS easy postal kit vitamin D test £29 via

vitamindtest.org.uk

[SlowDragon Administrator]

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...

Guidelines are just that ....guidelines.

Some people need more some less

healthunlocked.com/thyroidu...

[Essexlil in reply to SlowDragon]

Hi SloDragon, I felt really down and sluggish in January so asked for a blood test, which I was given an appointment for but had to cancel because unfortunately I caught Covid. I didn’t feel well enough until the end of March and had a blood test then. GP said my thyroid results were fine - mid range normal. My vitamin D levels were low so she told me to take 1000 a day and when I told her how bad my thyroid symptoms were she increased my dose from 75mcg to 100 and said to get another blood test in a couple of months. Only been on increased dose and vitamin D for three weeks. Still wondering if taking levothyroxine at bedtime has caused weight gain. I think I’m a bit more lively, definitely slightly improved.

[fuchsia-pink in reply to Essexlil]

"mid-range normal" isn't anywhere near good enough - you want actual numbers and lab ranges! And once on thyroid meds, you are really looking for TSH to be less than 2 and prob less than 1 (with a typical lab range of 0.3 - 4.2 your "mid-range" could easily be higher than this) - and you are likely to want your free T4 AND free T3 to be rather higher than "mid-range" to feel properly well.

A lot of the time I suspect they won't give us our actual results because that would show how little has actually been tested: just TSH is nowhere near enough but I'd bet the farm they haven't done free T3, which is arguably the most important result of all ...

[SlowDragon Administrator in reply to Essexlil]

It takes at least 8-12 weeks for each dose increase to have full effect

Bloods should be retested 6-8 weeks after each dose increase in levothyroxine

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

Which brand of levothyroxine are you currently taking

Do you always get same brand

How low was Vitamin D ?

You are legally entitled to copies of your blood test results and ranges

1000iu is unlikely high enough dose

Is this vitamin D tablet or mouth spray

Tablets should be minimum 4 hours away from levothyroxine

NHS Guidelines on dose vitamin D required

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

GP will often only prescribe to bring vitamin D 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...

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

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

vitamindsociety.org/pdf/Vit...

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

Test vitamin D twice yearly via NHS postal kit

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...

[Essexlil in reply to SlowDragon]

Hi ladies, thank you for your replies. Here’s my blood test results dated 21st March 2021:

Serum TSH 0.76 (0.27-4.2)

Serum free T4 16.1 Pmol/L (12-22)

Serum 25-Hydroxy vitamin D3 level 48.0 Nmol/L - insufficient 25-50 nmol/L

Serum B12 level 231 pg/mL (197.0-771.0)

Serum folate level 5.1 ug/L <3 ug/L suggestive of folate deficiency

I had a lot more tests as I suffer from Sjögren’s syndrome but I think the above are more in connection with my Hashimotos. My GP listened to me and increased my dose of levo from 75 mcg to 100, which I’ve been on for 3 weeks. I was also told to take vitamin D3, which I’ve been on for 4 weeks. I feel slightly better but my weight gain is depressing.

When taking 75mcg the makers were Teva, however the 100 mcg are PharmaMercury

Any help would be appreciated