Hi , cab anyone tell me whether this is normal please. I've tried 100mcg but i was definitely over medicated , confirmed with a blood test. When I take 75mcg I feel undermedicated (not had a blood test yet..... but definitely feel worse as the weeks go on and symptomatic). My question is does anyone take a combination of dosages to balance them out ? I really feel like I wont cope on 75. I've been on 75 for 5 weeks, missed my period and look and feel terrible (not pregnant). Does anyone have any advice for me please ?
Dosgae question : Hi , cab anyone tell me whether... - Thyroid UK
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•
confirmed with a blood test
My advice would be to post your numbers from that blood test: results and ranges. That will give us a better idea of what is going on.
That said, yes, a lot of people take alternate doses, say 75 mcg one day, and 100 mcg the next.
Do you have Hashi's?
• in reply togreygoose
My over medicated results were
TSH 0.1
Free t4 23(range 11-22)
Free t3 6.8 ( range 3.1 - 6.8)
greygoose• in reply to
OK, well, that FT3 would be great for me! But, we're all different. And, if you felt over-medicated, you probably were a bit.
So, do you have Hashi's?
• in reply togreygoose
Yes I do. I have TPO antibodies at 80 give or take a few.
I was suprised to feel undermedicated on 75 but over on 100. Feels like such a huge difference in how I feel.
So my question is, do you think I'd be OK adding a little here and there to my 75, or shall I persist with the 75 and hope something picks up
greygoose• in reply to
Well, those highish results could have more to do with your Hashi's, than with your dose of levo - which would be why you felt so much worse on reducing the dose. Levels can fluctuate quite a bit with Hashi's. I think I would be tempted to go back to 100 mcg daily - which isn't a very high dose - and see how I felt.
Hello Francesca :
Well, if you feel 100 mcg is too much and 75mcg too low you could try taking around 88 mcg and sit half way through these two levels of medication.
What have you been diagnosed with to be taking T4 - thyroid homes replacement and do you have any blood tests to substantiate your feelings on over medication ?
There are some symptoms of hypothyroid that are very similar to those of hyperthyroidism, some even cross over and there is a fuller explanation and a full list of symptoms of both conditions on the Thyroid UK website who are the charity who support this forum.
• in reply topennyannie
Thank you. Id like to try 88 but my doctor said I shouldn't be splitting pills. When I was overmedictaed I felt worse than I ever have with hypothyroidism.Yes i have results on 100 I shall post at the bottom.
I've been taking t4 for 5 years
• in reply topennyannie
My over medicated results were
TSH 0.1
Free t4 23(range 11-22)
Free t3 6.8 ( range 3.1 - 6.8)
N
pennyannie• in reply to
Yes, I saw them when you first posted them earlier on.
Can I ask again - what have you been diagnosed with, is it a thyroid autoimmune disease ?
• in reply topennyannie
Just underactive thyroid. Dead common.
pennyannie• in reply to
But reading further on you say you did have over range antibodies indicative of having an auto immune disease called Hashimoto's so this now is starting to make more sense.
To be honest with those results - I would not want to change anything - but then I do not have Hashimoto's AI thyroid disease.
Likely your extreme symptoms were as a result of a " hyper " type flare common with people who have Hashimoto's AI thyroid Disease.
With Hashimoto's you are liable to erratic thyroid hormone production as with every immune system attack on your thyroid hormone production levels go a bit haywire.
But be aware that after this " hyper " type phase passes your thyroid will be a little worse for wear and may not be able to fully recover and you may then experience further symptoms of hypothyroidism.
I read of the necessity to heal the gut, and to do this you need to be looking at food intolerances to such things as gluten, dairy, wheat etc and may I suggest you look up the work and research conducted Dr Izabella Wentz who also has this AI condition.
SeasideSusieRemembering
Francesca0
I've tried 100mcg but i was definitely over medicated , confirmed with a blood test.
Which blood test confirmed you were overmedicated?
Was the full thyroid panel done - TSH, FT4 and FT3? It's only possible for a blood test to show overmedication when it's the FT3 test.
How did you feel?
• in reply toSeasideSusie
My over medicated results were
TSH 0.1
Free t4 23(range 11-22)
Free t3 6.8 ( range 3.1 - 6.8)
Would you suggest an increase
My over medicated results were
TSH 0.1
Free t4 23(range 11-22)
Free t3 6.8 ( range 3.1 - 6.8)
These were taken after 6 weeks on 100. I felt terrible. My doctor said to come back down to 75 , after 4 weeks on 75 I look and feel rubbish. Spotty , tired looking, missed my period some weight loss. He said he wants my tsh between 1 and 2. I had terrible gastro symptoms on 100 too ill spare you the details.
Do you think I should perist with 75 or add a couple of days of a bit more?
pennyannie• in reply to
Well, a dose adjustment takes around 6 - 8 weeks to fully settle in so I think you will need to wait and little longer than a few days to fully assess and see how 75 mcg feels for you.
Many people cut a 25mcg T4 tablet in half to achieve that middle dose of around 12.50 mcg.
• in reply topennyannie
I waited 4 weeks not a few days. I do feel worse its a bit frustrating 😕 I've also gone to 8 stone 12. I guess being over medicated made me gain weight too
I had terrible gastro symptoms on 100 too ill spare you the details.
Was 100mcg levothyroxine a different brand to 75mcg dose
Many people find different brands are not interchangeable
Teva brand upsets many people,
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
bestpractice.bmj.com/topics...
Guidelines are just that ....guidelines.
Some people need more ….some less
healthunlocked.com/thyroidu...
Research into dose by weight and malabsorption issues and possible advantages of liquid levothyroxine
frontiersin.org/articles/10...
Weight gain, gut issues and bloating suggests under medicated
• in reply toSlowDragon
No ive never used teva, always almus.
Reading replies , are you suggesting im under medicated and should increase my dose ?
So when on 75mcg Almus you cut a 50mcg tablet in half to get 25mcg dose
• in reply toSlowDragon
Sorry my bad, its Mercury pharma. Sorry used to be almus years ago
Hidden
TSH 0.1
Free t4 23(range 11-22)
Free t3 6.8 ( range 3.1 - 6.8)
So those results, with FT3 at top of range, suggest that you could possibly be very slightly overmedicated, if last dose of Levo was 24 hours before test. If Levo was taken before test then you have false high FT4.
If those were my results, and based on my own experience over the years of very fine tweaking of doses, I would make a small adjustment, instead of 100mcg every day, ie 700mcg per week, I'd drop it down to 650per week to start with, ie 92.85mcg per day. So 6 days at 100mcg and 1 day at 50mcg. If that's still giving you overmedicated symptoms then next I'd try 87.5mcg daily. I'd be making very small tweaks.
He said he wants my tsh between 1 and 2.
Doesn't matter where he wants TSH, it's where you need it to feel well that is important, and if that is below range then so be it, as long as FT3 is within range it can be low, even suppressed, see
Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (the professional magazine for doctors):
"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l. In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance. But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l. This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l).*"
*He recently confirmed, during a public meeting, that this applies to Free T3 as well as Total T3.
You can obtain a copy of the article by emailing Dionne at
tukadmin@thyroiduk.org
print it and highlight question 6 to show your doctor.
Id like to try 88 but my doctor said I shouldn't be splitting pills
Rubbish. Plenty of us here cut pills and it's fine. Or we can alternate if we are prescribed the right dose tablets to achieve what is necessary.
• in reply toSeasideSusie
Thanks for this information. Ill stay on 75 most days and add half 25 every other day just to take the edge of the symptoms and see how i go. Maybe its a part of dropping the dose or something. I generally feel ok these days but since I went on 100 its sent my body out of whack again.
One more thing sea side suzie, is that the reason they want the tsb to be closer to 2, is to see if that helps me to not miscarry. Since there are no reasons at all for me to keep having them, they're looking again at the possibility its due to over medicating levo. Can i have your thoughts on that too please ?
So instead of my tsh consistently being 0. Something or 0.0 something, they want to make it 2.
One more thing sea side suzie, is that the reason they want the tsb to be closer to 2, is to see if that helps me to not miscarry. Since there are no reasons at all for me to keep having them, they're looking again at the possibility its due to over medicating levo. Can i have your thoughts on that too please ?
OK, I have no experience of pregnancy and hypothyroidism (mine came after second baby and my ex daughter-in-law had multiple miscarriages prior to diagnosis). All I know is that TSH below 2.5 is recommended for successful conception and pregnancy. Sorry I can't be of more help regarding that.
• in reply toSeasideSusie
Its ok , thank you. Such a difficult one ! My tsh has been 0. Something for each miscarriage. I just thought theres nothing 6i lose trying to get my tsh a little closer to 2 , just so I can say I tried.
Its ok and thanks for the kind replies
Does everyone else think this is over medicated then? Or are those levels ok.
SlowDragonAdministrator
Just testing thyroid levels is inadequate
Essential to regularly retest vitamin D, folate, ferritin and B12
Low vitamin levels are EXTREMELY Common on levothyroxine
Being UNDER MEDICATED will tend to lead to weight gain
Do you always get same brand levothyroxine at each prescription
Which brand
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.
High thyroid antibodies confirms autoimmune thyroid disease also called Hashimoto’s
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 also offer just vitamin testing
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...
NHS easy postal kit vitamin D test £29 via
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 too
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...
• in reply toSlowDragon
Yes I always get the same brand vitamin levels are all good.I ate like a horse when I was on 100, my appetite was raging. On 75 my appetite seems more normal maybe thats why I've lost weight?
Would anyone agree those levels indicate over medication or not?
• in reply to
Oooh yes medicheck I've used them. They also always come back red for over medicated.
Have you had BOTH TPO and TG thyroid antibodies tested for autoimmune thyroid disease aka Hashimoto’s
Please add results and ranges if you have
Please add most recent results and ranges for
Vitamin D
Folate
Ferritin
B12
Have you had oestrogen and progesterone levels tested
Low progesterone linked to miscarriage
Have you had prolactin levels tested
• in reply toSlowDragon
Normal progesterone from multiple day 21 testing TPO only, consistently under 80. Range is up to 50.
Vitamins ive had tested by medichecks and often with the doctor, all are good levels. I will search for the exact numbers and post.
So you definitely have Hashimoto’s if TPO is over range
Are you on strictly gluten free diet
Next time you use Medichecks or Blue horizon include getting antibodies tested
• in reply toSlowDragon
Theyre 80 slow dragon. Have been for the entire time I've been diagnosed they never seem to fluctuate
SlowDragonAdministrator
Common as you initially increase dose to feel a little over medicated
But as levels settle this can disappear
Waiting 8-10 weeks often better before retesting
• in reply toSlowDragon
With that would you say the same for lowering dosage ? Initially feel undermedicated ?
I have Graves Disease and am post RAI thyroid ablation - I have therefore been hyper and I have now been made, medically, hypo -
Thank you for your time :
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