Another decrease in Levothyroxine : Hi All, I... - Thyroid UK

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Another decrease in Levothyroxine

misschris profile image
32 Replies

Hi All,

I posted in April about a decrease in medication and most who replied thought I shouldn’t have had a decrease because my blood tests where in range. I was taking at that time of blood test 150/125mg alternative days, I was asked to stop the 50mg and take 125mg daily and retest in 8-12 weeks, just a reminder my blood results in April 2021 :

Serum free T4 level 20. 7 pmol /L (11 .0 - 22. 0 )

Suppressed TSH level suggests over replacement with thyroxine

!Serum TSH level 0 . 4 miu /L ( 0 .34 - 5.44 )

My retest blood results July are :

Serum free T4 level 19 . 2 pmol /L ( 11 . 0 - 22 . 0 )

(MA) - Normal

Target for T4 treatment is usually TSH within reference range

!Serum TSH level 0 . 07 miu / L ( 0.34- 5.44

I was told by my GP on the 22/7/21 to reduce my meds further as they say am over medicated, which I have but last week, I was soooo tired,I was falling asleep in the day, I went to my friends for tea and as she talking to me I could feel my eyes closing so I ended cutting the visit short and I’ve just not got any energy, the tiredness is affecting my mental state, I get confused, I use to be organised and now I can’t seem to be organised with anything, my body aches and I’ve started getting a feeling of a tight band around my chest. I’ve made an app with GP for Wednesday morning, I know they will only tell me to get more tests done and they will probably be in range.

I think I need to be referred back to my endocrinologist but don’t know how that works today with this pandemic. I know I can’t carry on being this tired.

Chris

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SlowDragon profile image
SlowDragonAdministrator

Just testing TSH and Ft4 is completely inadequate

Do you always get same brand levothyroxine at each prescription

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

Is this how you did your test

Are you still taking prednisone?

Prednisone lowers TSH

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

What vitamin supplements are you currently taking

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...

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

Come back with new post once you get results

misschris profile image
misschris in reply to SlowDragon

Thank you SlowDragon for replying to me.

The first test I had I did eat and drink because it was an afternoon blood test, the last blood test I had, I had nothing before the test.

Unfortunately I don’t always have the same brand as the chemist say they only get what the manufacturer gives them, even tho I have Mercury Pharma on my prescription, I rang round other local chemist and they too did not have that brand in stock so I am on Teva which makes me sweat but no one seems to care if the brand doesn’t suit you or not. It’s almost like you have to put up and shut up or they disbelieve that you have problems with certain brands.

I take vitamin b12 and Vit D.

Looks like I will have to do private test as I know my GP will refuse to do any of the tests you recommended.

Chris

SlowDragon profile image
SlowDragonAdministrator in reply to misschris

Print this out and give it to GP and pharmacy

gov.uk/drug-safety-update/l...

If a patient reports persistent symptoms when switching between different levothyroxine tablet formulations, consider consistently prescribing a specific product known to be well tolerated by the patient.

If symptoms or poor control of thyroid function persist (despite adhering to a specific product), consider prescribing levothyroxine in an oral solution formulation.

SlowDragon profile image
SlowDragonAdministrator in reply to misschris

I rang round other local chemist and they too did not have that brand in stock so I am on Teva which makes me sweat but no one seems to care if the brand doesn’t suit you or not

Small independent pharmacies are often more helpful

Mercury Pharma is now called Advanz

Contact Advanz direct if have supplier issues

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

misschris profile image
misschris in reply to SlowDragon

SlowDragon,

That info is great to know, I will print that off thanks.

I did not know Mercury Pharma is now known as Advanz , they are always changing names 🤷‍♀️

Teva and Actavis I don’t do well on at all.

Chris

SlowDragon profile image
SlowDragonAdministrator in reply to misschris

Activis is now called Accord (Almus via Boots or Northstar via Lloyds)

misschris profile image
misschris in reply to SlowDragon

Oh my, it’s a minefield when they change the name, I mean I getvacswollen throat on Activas and yet I could be given Accord or Northstar and wouldn’t know that I would be very unwell 😱😱

helvella profile image
helvellaAdministratorThyroid UK in reply to misschris

You can visit, ring or email numerous pharmacies until you find one that has what you need.

Finding Local Pharmacies

Members often need to locate pharmacies in their locality. Each of the four nations has its own way of looking up pharmacies.

ENGLAND

Find a pharmacy

Information:

Do not go to a pharmacy if you have symptoms of coronavirus (a high temperature, a new, continuous cough or a loss or change to your sense of smell or taste).

Use the NHS 111 online coronavirus service to find out what to do

Enter a town, city or postcode in England

nhs.uk/service-search/find-...

NORTHERN IRELAND

Pharmacy opening hours

You can find details of pharmacies near you and their opening hours using the link below.

• Pharmacy locations and opening hours(external link opens in a new window / tab)

nidirect.gov.uk/articles/co...

SCOTLAND

NHS Pharmacy First Scotland

Overview

Pharmacy services during the coronavirus (COVID-19) pandemic

With current public health advice around coronavirus, some services may:

• not be available

• be operating different opening times

• be closed temporarily

We recommend that you contact the service prior to attending.

Find your nearest pharmacy

nhsinform.scot/care-support...

WALES

All Wales Information

The information held about pharmacies and their services is supplied to us by the All Wales Pharmacy Database. Should you have any comments or concerns about the information held please contact the pharmacy concerned.

Services near you

Please select

111.wales.nhs.uk/LocalServi...

misschris profile image
misschris in reply to helvella

Thank you Helvella for that info I will look into that.

Chris

knitwitty profile image
knitwitty in reply to misschris

Hi , The MHRA recently said that patients should remain , where possible on the same brand of levothyroxine especially if that brand suits them. If this is not possible the should be retested after being on a change of brand after 8 weeks, if you tell the doctor that you will need repeat tests after 8 weeks they may specify the brand you need at each prescription . See the link below.

gov.uk/drug-safety-update/l...

misschris profile image
misschris in reply to knitwitty

My GP has put it on the prescription for mercury Pharma but when I went the chemist (next to GP surgery) they said they only had Teva and that they only get given what their suppliers bring in. I did phone around local chemist but not had it in stock and because I needed them the next day I had no choice and just knew I would have a bad 3 months 🤦‍♀️

Chris

helvella profile image
helvellaAdministratorThyroid UK in reply to misschris

Easy to say after the event, but you could have asked the pharmacy if they would give you an emergency supply of a few tablets of whatever they had - rather than the entire three-month supply. That might have opened up a window to find what you wanted.

misschris profile image
misschris in reply to helvella

Didn’t even think of that helvella 🙈

helvella profile image
helvellaAdministratorThyroid UK in reply to misschris

Next time...

(Hope you don't need to!)

You can always ring up a week or so before you even get your prescription to ask around.

knitwitty profile image
knitwitty in reply to misschris

That's awful. I think some of the pharmacies are too idle to source different brands of levo, as SlowDragon says the smaller pharmacies are often better than the big chains, my pharmacy go out of their way to get me Mercury Pharma every time.My mum recently had a very bad reaction to Teva, in the end we changed her dispensing pharmacy because they delivered the wrong medication on 3 occasions and were most unapologetic, they even said that she'd be better off taking the teva than taking nothing, that was the final straw because they obviously had no regard to an anaphyltic reaction. Good luck getting sorted out. :)

misschris profile image
misschris in reply to knitwitty

Thanks Knitwitty 😊

SlowDragon profile image
SlowDragonAdministrator in reply to misschris

You need to insist that GP give you a prescription a head of time …..so that you have time to track down the right brand

Request 2 prescriptions together…..then you have a prescription in hand

misschris profile image
misschris in reply to SlowDragon

That’s a really good shout that, I will do that SlowDragon 🤞

fuchsia-pink profile image
fuchsia-pink

You are ONLY over-medicated when free T3 goes over-range - and to know if that is the case, they're going to have to test it ... I'd go back to the GP and say that you are uncomfortable that you are now showing serious signs of being under-medicated and you don't want to endanger your health* so you NEED your previous level of levo restoring please. But if s/he's not comfortable doing that, you are very happy for them to test your free T3 which will show (a) if you're actually over-medicated and (b) a good enough converter

* I suspect you aren't actually endangering your health, but (a) they won't know either and (b) you're not feeling good enough - which is reason enough to make a fuss. I only got free T3 tested (and then lio prescribed) when I started using emotive language like this when I was in the same position, which clearly got them a bit worried - and refusing to lower my dose of levo once I'd started feeling unwell, despite being told I was over-medicated too. Since I finally had free T3 tested and got the lio I've been feeling great - so it IS worth making a bit of a fuss

Good luck x

misschris profile image
misschris

Thanks Fushia-pinkI am deffo going to take that stance with my GP, I am fed up with them not listening to me, I don’t feel like am functioning at all, I have at least in the last week, forgotten a couple arrangements I’ve made, which has been embarrassing and they have all been in days of one another.

If he is not willing, I am going to ask to be referred back to my Endo, she was brilliant and thought outside the box, not like my GP who is scared to do that.

Chris

VLJones profile image
VLJones in reply to misschris

When i go to pick up my levothyroix if its not the brand i won't i refuse the presciption because once you have left the pharmacy they won't change it. Just a little tip. Do you know which brand that suits you? I can not take teva at all.

helvella profile image
helvellaAdministratorThyroid UK in reply to VLJones

Best thing is always check before you even leave the counter.

I take the bag, and immediately open it while they are still there - saying something like "I always check ", and smiling.

If there is an issue, it can be resolved without having to put the medicines in the bin. If you walk away, even within the shop, they should not re-issue any medicine.

FancyPants54 profile image
FancyPants54 in reply to helvella

I do this too. Open the bag immediately and check it's not Teva, which was dreadful for me. I raised a yellow card on it because it gave me terrible nose bleeds. One for over 1hr that left me and the bathroom looking like I'd butchered something in there. GP didn't believe me, but pharmacist did and put it on their system for me.

I use a tiny pharmacy in a village. They go above and beyond to get what I need. Great service. It's part of a group called Knights Pharmacies.

Partner20 profile image
Partner20 in reply to helvella

Better still, get the pharmacist to open the bag and check before it leaves the counter and is handed to you. Then it has not officially been dispensed and collected.

misschris profile image
misschris in reply to VLJones

That is so true.

pennyannie profile image
pennyannie

Hello Misschris :

I have just read that you had a total thyroidectomy so it's very likely you will need to take some T3 - synthetic Liothyronine alongside your T4 and that can currently only be prescribed by an endocrinologist.

A fully functioning working thyroid would be supporting you on a daily basis with T1. T2 and calcitonin plus a measure of T3 said to be at around 10mcg plus a measure of T4 said to be at around 100 mcg.

T4 is a storage hormone and needs to be converted by your body into T3 the active hormone that the body runs on : T3 is said to be around 4 times more powerful than T4 with the average person needing to utilise around 50 T3 daily just to function.

By not replacing your own T3 thyroid hormone you have in effect been down regulated by some 20% of your overall well being and overtime this will pull you down even further.

The thyroid is a major gland responsible for full body synchronisation including your mental, physical, psychological, emotional and spiritual wellbeing, your inner central heating system and your metabolism.

I seriously do not understand why when the thyroid produces and supports you daily with 5 known hormones it is seen acceptable to prescribe just 1 , and that one, an inert hormone that needs your body in tip top condition to be able to utilise well.

I found as soon as I introduced a little T3 it was as though my pilot light has been switched back to " on " and my brain and cognitive functions were the first noticeable areas of improvement in my thyroid health journey.

Some people can get by on T4 only, some people find T4 seems to stop working as well, at some point in time, some people need a little T3 alongside their T4, some people need to take T3 only and some people prefer to take Natural Desiccated Thyroid which contains all the same known hormones as that of the human gland.

No thyroid hormone replacement work well until ferritin, folate, B12 and vitamin D are at optimal levels and you may need to supplement these yourself as you will likely be in the range, but not for someone who is hypothyroid and needing to convert the thyroid hormone replacement medication.

T3 is currently a bit of a post code lottery due to CCG's restricting it being prescribed due to inflated, unnecessary costs that the NHS has been charged.

There a bit of a stand off - but your health is at stake in all this stupidity and suggest you get the Thyroid UK list of friendly endos, both NHS and private, and be referred to someone who has the knowledge, and professional integrity to treat you with the respect and care you deserve.

I am with Graves post RAI thyroid ablation and now manage lingering Graves, thyroid eye disease and hypothyroidism. i was unable to be prescribed anything other than T4 through the NHS and so now I self medicate. I tried a T3/T4 combo and that worked and then I tried NDT and that was much easier to work and suited me better and I think more sensible as I'm replacing like with like.

Having just skipped through your previous posts, I see that you have had experience of taking both T3 and NDT and am now unsure why they haven't worked for you and am questioning how your trials of these treatment options were advised and monitored.

misschris profile image
misschris in reply to pennyannie

Hi pennyannie,

I was having a lot of palpitations and sweating while taking NDT and did not persevere with it till I got it right. As for T3 I only had it for a month from my Endo and my GP would not prescribe it, plus at the time of taking T3 I became unwell and in a lot of pain and I thought it was a reaction to taking T3 but I had nothing to do with that, I was diagnosed with Polymialgia and my Endo had discharged me. I wouldn’t know how to source T3 and how I would go about taking it without seeing my Endo again.

Chris

yesendi profile image
yesendi

Can your Doctor write a DAW(dispense as written) on the script? If he/she does then the pharmacist must give you exactly what your doctor prescribed and nothing else.

misschris profile image
misschris

I could ask him tmrw but my GP is not very friendly. ☹️

yesendi profile image
yesendi in reply to misschris

Sorry to hear that, maybe a change in doctors is in order?

misschris profile image
misschris

Spoke with GP and they are going to send me for bloods, I have asked to test T3 she just went onto say that the TSH is a good guide, so I think I will only be getting the basic test AGAIN grrrrr!!! Got to pick up blood form tmrw.Thank you to everyone who responded to my post 🙏🏻

Chris

tattybogle profile image
tattybogle in reply to misschris

i have just written a reply to someone else on here... healthunlocked.com/thyroidu... take a look and read the links in it... it applies to you too. re consequences of GP lowering dose again.

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