Does anyone know if being undermedicated (I have no thyroid and am on 5 x 100 & 2 x 0.75mcg Levo per week), can this affect eye health.

[Pepekins]

I am 70+ have had my Levo reduced for a year due my endo believing I am too suppressed and that it might be bad for my bone health. Recently have been told I have an eye problem, could there be a connection? Had thyroid removed 20 years ago because of a thyroid tumour and was over medicated for years, now think I could be undermedicated. Never had an eye problem before!

[SlowDragon Administrator]

Reading previous posts,

Can you add results and ranges from when on 150mcg

And results from now on 100mcg

Approx how much do you weigh in kilo

Guidelines on dose by weight is approx 1.6mcg per kilo

Many, many people when adequately treated will have very low or suppressed TSH

Most important results are always Ft3, followed by Ft4

When adequately treated most people will have Ft3 at least 50-60% through range and Ft4 will be at least 60% through range, and usually higher at 70-80% through range

Being UNDER medicated on too low a dose levothyroxine will result in high cholesterol

Also osteoporosis can be caused by LOW Ft3

Osteoporosis and low Ft3

thyroidpatients.ca/2018/07/...

[SlowDragon Administrator]

Suggest you look at seeing different endocrinologist

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,

"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)."

(That’s Ft3 at 58% minimum through range)

You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctor



please email Dionne at

[e-mail]

See reply by Diogenes (leading thyroid specialist)

healthunlocked.com/thyroidu...

the best paper on this that I have seen indicates that a TSH of 0.03-0.5 is best on therapy. Above that is insufficient and below MAY or MAY NOT indicate slight overdosing

academic.oup.com/jcem/artic...

Interestingly, patients with a serum TSH below the reference range, but not suppressed (0.04–0.4 mU/liter), had no increased risk of cardiovascular disease, dysrhythmias, or fractures. It is unfortunate that we did not have access to serum free T4 concentrations in these patients to ascertain whether they were above or within the laboratory reference range. However, our data indicate that it may be safe for patients to be on a dose of T4 that results in a low serum TSH concentration, as long as it is not suppressed at less than 0.03 mU/liter. Many patients report that they prefer such T4 doses (9, 10). Figure 2 indicates that the best outcomes appear to be associated with having a TSH within the lower end of the reference range.

[Buddy195 Administrator]

Pepekins, can you tell us a bit more about your eye condition. What are your symptoms? What did your optician suggest? There is certainly a link between some eye symptoms & the thyroid.

[jgelliss in reply to Buddy195]

Buddy195 your so right. In my experience when my T4 was low(ish) for me and I was supplementing with T3 my exam did not go so well. I saw foggy. A year later being on a higher dose T4 with no additional T3 my exam was perfect. My Dr made a comment that the my eyes improved a lot from the last exam.Thank you for commenting that optimal thyroid meds are most definitely connected with our eyes too.

[Debimmm]

Yes! Speak to your optician they can explain more about how being under medicated affects eye muscles and function, they can refer you to gp if they can see the problem. Also a change of brand ( the fillers they use) can affect your absorption of synthetic thyroid so check if your brand is different last prescription and discuss this with pharmacy to keep you on one brand that you know works, for me TEVA brand caused many issues including double vision and Trigeminal neuralgia because my facial muscles were compromised.It can be different brands for different people so you may have to try them out for 3 months to know you feel well. Mannitol ( artificial sweetener replacement for citric acid) is another ingredient ( cost cutting) filler not well tolerated by many so look out for that too.

Intolerances for fillers means malabsorption so you can always try to take sublingually to help problem too. But first things first go to opticians to have eye health checked (rather than vision) and get tested on current brand.

[RedApple Administrator in reply to Debimmm]

Debimmm, ' Speak to your optician they can explain more about how being under medicated affects eye muscles and function, '

If only that were true! Personally speaking, I have yet to see an optician who has any knowledge of this at all!

[Debimmm in reply to RedApple]

Well I can recommend the one I saw if needed;It was the first time I went there, he said I’m referring you to gp I think you have a thyroid problem, I explained I already did ( 20 years) and he said well your medication is not right. He had no prior knowledge regarding me, so therefore looks line some opticians do know. I had to go opticians because GPs don’t see you for eye problems anymore.

[Josephineinamachine in reply to Debimmm]

Crikey…we may have a stampede of people towards their opticians now. Definitely going to go see mine!

[SlowDragon Administrator]

You’re last post shows you are under medicated

TSH 1.50 mu/L 0.55-4.78

Free T4 14.6 pmol/L 11.5-22.7 = 28% through range

Free T3 3.9 pmolL 3.5-6.5 = 13% through range

The aim of a treated Hypo patient on Levo only, generally, is for TSH to be 1 or lower with FT4 and FT3 in the upper part of their ranges, if that is where you feel well.

Suggest you get dose reinstated to 125mcg

Ferritin low because you are under medicated

Cholesterol high for same reason

On levothyroxine we need optimal vitamin levels

[Sicm]

What problem are you having with your eye

[annnsandell]

Fascinating for me but obviously not for you as my surgeon is suggesting the same dose for me. I have had deliberate suppression for 10+ years and they are now thinking that it is ok to change that in view of risks. Currently TSH .06 on 100 mg. Bone health is excellent (bone density scan) but heart/blood pressure not so good. No decision made yet. I note that the recommended 'guidelines on dose by weight is approx 1.6mcg per kilo' are for under 65's, not sure about older. I am due for an eye test so I might arrange that. Be good to see your follow-up to this later. Good luck.

[shaws Administrator]

I m sorry you have hypothyroidism, I am also sorry you have had a thyroidectomy.

I have my thyroid gland but could not improve at all on levothyroxine as it gave me severe palpitations..

I think it would be kinder for Endo to prescribe a combination of thyroid hormones, i.e. levothyroxine/liothyronine (T4 - T3) due to you having no thyroid gland at all.

There used to be a replacement hormone (now withdrawn) made from animals' thyroid glands that contained all of the hormones a healthy gland would have and is called Natural Dessicated Thyroid hormones (NDT) but unfortunately it has also been removed from prescribing.

It was the very first replacement given from 1892 without the need of blood tests but doctors going by the clinical symptoms alone.up until recently when it was withdrawn.

I hope you feel better soon and millions of people seem to do o.k. on levothyroxine which is the standard replacement.