I'm back here again after doing so well for the last few months! Been on 50mg levo for about five months and after initial settling, I've been fine. Then 5/6 weeks ago I started feeling tired, just mildly at first but it's been getting worse. I'm now at the point that I know it's the thyroid tiredness, I recognize it from last time, same symptoms, same feelings. Last blood test was in Feb when TSH was 0.05, very low I know but I was feeling fine, so doc left me on 50mg. That's all that was tested at that point. This week TSH is 0.39 and free T4 19.3. Doc sent me a message saying I'm in normal range so won't increase meds and that I have to go see her if I'm still having symptoms. I will of course (no doubt it'll be two weeks before I can get an appointment) but I just want to go in armed with information.
I know technically I'm in range, but it has increased slightly, doesn't that indicate something?
Wondered about asking if I need T3? I've read on here about how some people need that to help converting T4, but I have been fine with just the levo until now.
They don't seem interested in testing anything else (vitamins etc.). Should I ask to be referred to an Endocrinologist?
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Loopnova
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Sorry, don’t understand…..if you were on 75mcg levothyroxine in February
Why are you only on 50mcg levothyroxine now
Teva brand levothyroxine upsets many people
Get new prescription
Many people find Levothyroxine brands are not interchangeable.
Many patients do NOT get on well with Teva brand of Levothyroxine.
Teva contains mannitol as a filler, which seems to be possible cause of problems. Teva is the only brand that makes 75mcg tablet. So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half
But for some people (usually if lactose intolerant, Teva is by far the best option)
Teva, Glenmark 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 only make 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
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.
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).
Sorry maybe I wrote it confusingly. I’m on 75 now and have been since December.
Ok, thanks, that’s good info about Teva so I can ask for a different brand. Do you know how long it takes for a brand change to start affecting you negatively?
Did you test first thing in the morning, fasting and drinking only water? 75 mcg is still quite a low dose. Also without testing free T3, how can your Dr know if you are converting?
Yes I did, I’ve kept every test to those strict conditions 😀. I’m going to ask doctor about the converting thing, it’s not something she’s ever mentioned. I only know about it from this forum.
Hi your results are showing hyperactive signs. I had that recently. You are having symptoms of hyperactive thyroid, it’s hard to tell the different. Lower your dose by 6mg which is 1/4 of a tablet if you are n 25mg tables and your symptoms will ease
If you are hypo - as the OP obviously is because she's been prescribed levo - the thyroid cannot suddenly start being over-active. It doesn't work like that. She could be over-medicated, but you cannot possibly tell without the range for the FT4, and an FT3 result and range. You are only over-medicated if your FT3 is well over-range.
The TSH is low, but that is meaningless on its own. When taking exogenous hormone, the TSH will very often be low - even below-range - but this does not automatically mean over-medication. Once on thyroid hormone replacement, and the TSH drops below 1, it becomes a very bad indicator of thyroid status. I very much doubt that her TSH is under-range, anyway - it certainly isn't suppressed as it would be with hyperthyroidism. It looks pretty good to me.
It's very difficult to dose by symptoms alone, too, because so many cross over and are symptoms of both under and over-medication, which is why we need labs to back them up. One can always suggest that a person tries reducing their dose to see if it helps, but one cannot promise that it will, or make a bald statement that it will, because one just doesn't know - and can't know very much, anyway, without seeing ranges and an FT3 result.
The problem probably is that the OP is a poor converter, and although her FT4 may look high, if it isn't being converted into enough T3, then she will still be hypo. If you reduce the levo, the FT4 will reduce - although not by very much with just a 6.25 mcg reduction - but so will the FT3, which could make her feel worse. The FT3 is always the most important number, because T3 is the active hormone.
I’m back with an update. Thought it might be useful if anyone ever searches for similar problems in future (that’s what I do!).
My doc was really helpful, got her to write specifically Almus/accord on my prescription. Not quite perfect as they gave me 50 Almus and 25 Mercury Pharma. I had said give me two 50s and I’ll cut them up but oh well.
Anyway a few weeks on and I’m feeling better! Not as tired as I was, not feeling like I need a nap in the day.
The only thing is my low heart rate has come back a bit. I used to have it go below 40 when asleep (so my Apple Watch said) and that stopped when I got on my 75mg. Don’t know why it’s started again now but it has. I’ll monitor it. Last time I had an ECG at the GP surgery to check it, they’ve labelled me with Bradychardia but left it at that. I’ve always had a generally low resting HR.
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Been given a reluctant temporary increase in meds
Fluctuating TSH should I increase meds
Well! Doc wasn't 'interested' just clueless!
Thyroid meds have been increased 
GP won't increase dose
