Levothyroxine increase causing anxiety?

[Bluemoo98]

I have hashimotos and for the last ~3 years my meds have been stable and I was comfortable with the symptoms I had (mild fatigue, cold etc., nothing I couldn't live with). I changed GP recently and my new GP increased my levo dose from 50 to 100, saying that I was under medicated the last 3 years. Since then I've experienced severe anxiety with panic attacks. I contacted my GP and although they didn't seem convinced this was due to my meds being changed, they agreed to reduce my levo to 75. The anxiety got slightly better after this but it's still severe and much worse than anything I've experienced prior to the change to 100. It occurs almost every day and I'm struggling to work now because of it as I barely sleep and any small stress that would've worried me a little before, now triggers a full blown anxiety attack with racing heart, nausea, diarrhea, insomnia, I feel boiling hot etc. Has anyone else experienced this? Could it be a reaction to my new levo dose?

[humanbean]

It could be a reaction to your new dose. A few comments ...

1) Increasing by 50mcg per day after three years on the same dose is too big a jump for many people. Normally people raise their dose by 25mcg, wait 6 - 8 weeks then re-test. If necessary, increase another 25mcg, wait 6 - 8 weeks and then re-test again, and keep up this routine of increase then wait then re-test until levels are high enough without causing unpleasant side effects.

2) If blood tests show the patient's Free T4 and Free T3 are at a good level and the patient is feeling okay then the patient can stay at the dose they feel good at. But it is fairly common for people to overshoot a little bit. In that case reduce dose by 12.5mcg per day. Alternatively, wait until levels are quite close to being good for the patient but not perfect, and increase by 12.5mcg per day.

3) Another option... Some people feel better if they cut their Levo dose in half and take a smaller dose twice a day. If the experiment helps then that's great. If it doesn't then go back to single dosing.

4) Rather than splitting the Levo dose you could change the time of day you take it. If you are used to taking it in the morning try switching to bedtime, and vice versa.

5) One thing that often reduces tolerance of thyroid hormones is having too low a level of the basic nutrients. It would be worthwhile to get your levels of Vitamin D, Vitamin B12, folate and ferritin measured. Once you have the results post them along with their reference ranges and we can tell you which nutrients need supplementing, at what dose, and can suggest some good options to supplement with.

[Buddy195 Administrator]

This has happened to me several times, so I now only increase (or decrease) in lots of 12.5mcg, waiting a week or two before changing the dose. Best wishes to you!

[SlowDragon Administrator]

Having been left woefully under medicated for years it can be hard to increase dose

You may need to increase in 12.5mcg steps

So 50mcg and 75mcg alternate days (or cut 25mcg in half to get 12.5mcg increase every day

Wait 6-8 weeks before increasing again

Have you had change in brand of levothyroxine

Many people find different brands are not interchangeable

Essential to regularly retest vitamin D, folate, ferritin and B12

If been left under medicated likely vitamins are low

Improving low vitamin levels to OPTIMAL levels can significantly improve symptoms

[SlowDragon Administrator]

Bloods should be retested 6-8 weeks after any dose change or brand change in levothyroxine

Meanwhile you might want to get vitamin D, folate, ferritin B12 tested now via GP or privately

Getting vitamins tested and supplement to optimal can really help tolerate dose increase in levothyroxine

What vitamin supplements are you currently taking

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

Low vitamin levels are extremely common, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)

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 all relevant vitamins

List of private testing options

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

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

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

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

bluehorizonbloodtests.co.uk...

Thriva Thyroid plus antibodies and vitamins By DIY fingerpick test

thriva.co/tests/thyroid-test

Thriva also offer just vitamin testing

If TPO or TG thyroid antibodies are high this is usually due to Hashimoto’s (commonly known in UK as autoimmune thyroid disease).

About 90% of all primary hypothyroidism in Uk is due to Hashimoto’s. Low vitamin levels are particularly common with Hashimoto’s. Gluten intolerance is often a hidden issue to.

Link about thyroid blood tests

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

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

List of hypothyroid symptoms

thyroiduk.org/if-you-are-un...

Come back with new post once you get vitamin results

[underact15]

Morning Bluemoo98, I’m struggling with the same. Stable on 100 for years (albeit with annoying symptoms but nothing hugely debilitating - not compared to now anyway!!!). My endocrinologist increased my dose to 125 due to elevated TSH (3.9) and low-ish T3 (4.4) and ongoing symptoms. I felt horrendous and struggled to get through the 6wks before more bloods but it did lower my TSH to 0.74. It didn’t really affect my T3 (4.5) but my T4 went slightly over (22.5) so she said I was slightly overmedicated. She therefore reduced my dose to 125 three days a week and 100 four days a week. Things have definitely been a little bit easier (it’s been 3 months now) but I’m still hugely struggling with day to day life and now I have the problem that my thyroid clearly needs more! Alternating 125 and 100, my TSH is now 4.2, my T3 is 3.5 and my T4 is 21.3, all worse than when I was on 100 every day She says this is as good as my thyroid will get for now (because I’ve tried increasing levothyroxine and couldn’t/can’t tolerate it, she thinks T3 will have the same anxiety/panic affect) so she’s talking to a haematologist (and my ferritin is consistently quite low) and a neurologist for me (on account of me feeling like my nervous system is incredibly sensitive!! Literally anything seems to switch it on!) 🤷🏽‍♀️ I will keep you posted….ever hopeful!!!! 🤞🏽🎉 Oh and my vitamin levels are pretty good apart from ferritin which, despite iron pills, won’t go higher than 20s/30s.