insomnia

[Specky1981]

hi, been diagnosed with border line Hypothyroidism. Have tried 2 different brands of Levo but both affect my sleep. I recently started HRT as was getting 2-3 hours a night , and the HRT has improved that. Now I’m scared to try different Levo incase the insomnia comes back. My symptoms for hypo are hair thinning and falling out loads, and always cold and tired ! Please advise …..many thanks

[helvella Administrator Thyroid UK]

I'm one of those people who suffer from poor sleep if I don't get enough levothyroxine.

And I take mine at bed-time.

When hypothyroid, I will fall asleep OK, but wake after a short while. Then be unable to get back to sleep for ages - sometimes not at all that night.

You could be taking too little levothyroxine.

Did you notice the reply by SlowDragon here:

healthunlocked.com/thyroidu...

[Lalatoot]

Specky, it is not the brands of levo you need to consider but the dose of levo. The starting dose for levo is usually 50mcg. Some folks start on 25mcg. Both these low doses can lead to a worsening of symptoms or new symptoms. Put simply, the body stops struggling to produce thyroid hormones when you take levo; however the initial dose is not high enough to replace the amount of hormones that the body was struggling to produce so initially things are worse.

Everything with thyroid is slow and steady and folks need to work through the initial phase so that there body can adapt to the levo. Blood tests should be after 6 weeks on the initial dose and 6 - 8 weeks thereafter after every dose change until you are on a daily dose that suits you.

[Specky1981 in reply to Lalatoot]

That’s great thank you. But my sleep was fine when I don’t take any Levo which suggests I should stop taking it? I have a demanding job so need to be able to sleep.

[Lalatoot in reply to Specky1981]

I all but stopped taking 75mcg levo as it was in my mind causing lots of symptoms I didn't have before. I felt fantastic for 3 months when I all but stopped ( I stayed on a 25mcg dose). BUT then the reality hit and I was very hypo and ill. It turned out that my symptoms were caused not by the levo but by being on too low a dose of levo. My doctors were happy that my TSH was in range at 4.5 and my ft4 was in range at 15 (10 - 25). I didn't know any better then and believed that the endo would know what was best. I now know that my TSH should have been nearer to 1 and that I needed my ft4 much higher and that the endo hadn't a clue.

[Pearlteapot]

I have also found insomnia to correlate with feeling undermedicated in other ways. Being cold and your hair falling out suggest that you are still undermedicated. After reading comments by various people here about taking Levothryoxine at bedtime I have just started that and I think it is also improving my sleep. Also important to do the sleep hygiene things like not looking at blue screens/phones for an hour or two before bed, having blackout blinds, relaxing with a magnesium salts bath before bed. I find that these things really do help (but not as much as the thyroxine!)

[SlowDragon Administrator]

What were your thyroid results BEFORE starting on levothyroxine

How old are you

Unless over 65 years old, standard starter dose levothyroxine is 50mcg

Blood retested 6-8 weeks after each dose increase

Typically, unless extremely petite, likely to eventually be on at least 100mcg levothyroxine per day

Levothyroxine doesn’t top up failing thyroid, it replaces it….essential to be on high enough dose

Low vitamin D and low B vitamins linked to being under medicated and linked to poor sleep

Have you had vitamin D, folate, ferritin and B12 tested

Please add most recent results

What vitamin supplements are you currently taking

pathlabs.rlbuht.nhs.uk/tft_...

Guiding Treatment with Thyroxine:

In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months.

The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).

The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range.

……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.

The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.

[Specky1981 in reply to SlowDragon]

That’s great, thanks for the advice. I will find my results and post them on here as they are confusing ! I am 47, and weigh approx 60kg…. I haven’t had my vitamin D or B checked but know my ferritin is 111 ….