Zoning out.

[BlueKeith]

Ive got hypothyroidism and on 75mcg of levothyroxine. I've been on this for about 8 months and posted a few problems on this site with a lot of helpful replies. Recently I've been zoning out, like losing time in the middle of conversations at home and at work. I can be totally switched on one minute thoroughly engrossed in a conversation giving input and absorbing information and then completely switching off and going into a daydream to the annoyance of family and work colleagues. Just wondering if anyone else suffers from this and if it's the hypothyroidism or medication causing the problem.??

[SlowDragon Administrator]

75mcg levothyroxine is only one step up from starter dose

How long since you had thyroid and vitamin levels tested

Do you always get same brand levothyroxine at each prescription

Which brand

What vitamin supplements are you currently taking

Approx how much do you weigh in kilo

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...

[BlueKeith in reply to SlowDragon]

My brand is teva

[SlowDragon Administrator]

See GP for FULL Thyroid and vitamin testing

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested.

EXTREMELY important to also 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...

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 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

[shaws Administrator]

I would get a Full Thyroid Hormone blood test (few doctors will do so - except if you are a 'private patient'.

I shall give you a link to a some f labs who do a 'home' blood test and if you decide to do so, make sure you are well hydrated a couple of days before and that your arms/hands are warm. Always draw blood at the earliest as results can drop throughout the day.

thyroiduk.org/help-and-supp...

Request, TSH, T4, T3, Free T4, Free T3 and thyroid antibodies.

Post your results, on new post for comments.

[BlueKeith]

I am having a blood test on Friday after constant begging for it even though the doctors have been making out I'm a hypochondriac. Getting everything checked. Really pi**""ed off about being ignored but never asked for anything from a doctor all my life until recently since I've been put on levothyroxine. Doctor finally taking notice about insomnia anxiety and zoning out which is something I've never had until I got diagnosed with hypothyroidism and got put on levothyroxine. Hope they find something.

[SlowDragon Administrator in reply to BlueKeith]

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

Just testing TSH is completely inadequate

What vitamin supplements are you currently taking

If taking any supplements that contain biotin stop these a week before ALL BLOOD TESTS as biotin can falsely affect test results

Are you lactose intolerant, that you’re taking Teva?

Have you tried any other brands

Teva is only brand that makes 75mcg tablets

Teva upsets many, many people.

Teva contains mannitol as a filler, which seems to be possible cause of problems.

But for some people (usually if lactose intolerant, Teva is by far the best option)

Teva, or Aristo (100mcg only) are the only lactose free tablets

Most easily available (and often most easily tolerated) are Mercury Pharma or Accord

Mercury Pharma make 25mcg, 50mcg and 100mcg tablets

Accord is also boxed as Almus via Boots, and Northstar 50mcg and 100mcg via Lloyds ....but Accord doesn’t make 25mcg tablets

beware 25mcg Northstar is Teva

List of different brands available in U.K.

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

Posts that mention Teva

healthunlocked.com/search/p...

Teva poll

healthunlocked.com/thyroidu...

Once you find a brand that suits you, best to make sure to only get that one at each prescription.

Watch out for brand change when dose is increased or at repeat prescription.

New guidelines for GP if you find it difficult/impossible to change brands

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.

healthunlocked.com/thyroidu...

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

Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).

Levothyroxine is an extremely fussy hormone and should always be taken on an empty stomach and then nothing apart from water for at least an hour after

Many people take Levothyroxine soon after waking, but it may be more convenient and perhaps more effective taken at bedtime

verywellhealth.com/best-tim...

No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.

Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away

(Time gap doesn't apply to Vitamin D mouth spray)

If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal

[BlueKeith in reply to SlowDragon]

I'm not taking any vitamins at the moment just trying to eat a wide variety of foods.

[SlowDragon Administrator in reply to BlueKeith]

When hypothyroid we frequently have low stomach acid, this leads to poor nutrient absorption and low vitamin levels as direct result

Good diet has little to do with vitamin levels when hypothyroid

Low vitamin levels tend to lower TSH…..essential to test TSH, Ft4 and Ft3 plus vitamin D, folate, ferritin and B12 ….plus thyroid antibodies if they haven’t been tested yet

High thyroid antibodies confirms autoimmune thyroid disease also called Hashimoto’s….about 90% of primary hypothyroidism is autoimmune thyroid disease

GP unlikely to test more than TSH.

[JAmanda in reply to BlueKeith]

What they will find is that you’re under medicated, I imagine, with those symptoms - except they might not find that because they won’t test your T3. I’d order a Medichecks test kit for the same day and ensure you test t3 (and vits if you can afford the bigger test) then you’ll have the complete picture to base an argument on for an increase in t4 of a trial of T3.

[waveylines]

To be really honest do not rely on GPs to ensure you are optimally treated for hypothyroidism. You are best to order a full thyroid blood test your self. They are not expensive and post results on here. Secondly you need to read up as much as possible and become an 'expert' patient. This is because GPs know very little about hypothyroidism and in all likely hood will leave you under treatment. This is probably the case for you but need the blood tests to check this. Your GP will have ordered a TSH test. This is not a full thyroid panel (TSH Ft4 &ft3). FT3 & FT4 are the tests that test the the level of thyroid hormone in the blood. Hypothyroidism is known as the great mimicker and can have very wide ranging symptoms....you need the full thyroid panel blood test to check this out really.

[BlueKeith in reply to waveylines]

I think you are right about becoming an expert patient. This website is helpful but need to start reading up on it and not relying completely on GP. Thanks

[waveylines in reply to BlueKeith]

Have a look on Thyroid Uk website - they gave a list of recommended books. A good one to start with is called Your Thyroid and how to keep it healthy. thyroiduk.org/product/your-...

[SlowDragon Administrator]

And test thyroid antibodies, if not been tested yet

[Josephineinamachine]

Yes, zoning out is a hypo/under medicated symptom. I’ve had this a lot. Staring at blank walls for ages, complete loss of concentration, switching off from everything around me. It has started to go away now which I think means I’m getting to the correct dose finally. I’ve relied on private testing to get there - GP not very helpful I’m afraid 😳

[BlueKeith]

Thanks josephineinamachine . Hopefully the blood tests will show I need dose increase and that will stop the day dreaming. I think I've been blaming the levothyroxine but now realising it's just getting that accurate dose.