lowering thyroxine dose

[Lizzery]

I’ve been taking 100mg thyroxine for a number of years. Doctor has advised this is now too much, but feels 75mg would be too low, and has suggested a subtle reduction of missing one dose per week, which would give an overall reduction over time. Has anyone been advised to do this, as I had thought it was important to take this medication daily.

[helvella Administrator]

It is not unheard of for such approaches to be used.

However, if they decide you need to reduce again, they are likely to say do so two days a week - and suggest the weekend. Which, in my view is madness.

And I prefer to take exactly the same dose every day - even if I have to split tablets. So dropping a complete dose would not be acceptable to me.

But alternating 100 and 75 would be about 82.5 - which is both achievable and probably reasonable.

On what basis has the doctor advised this change? Test results?

[SlowDragon Administrator]

Please add most recent results …..

Was test done early morning, ideally just before 9am and last dose levothyroxine 24 hours before test

If Ft3 isn’t over range you’re unlikely to need any dose reduction

You need vitamin D, folate, ferritin and B12 tested before considering dose reduction

A subtle reduction would be 87.5mcg twice week and 100mcg 5 days a week

If you/GP meant zero levothyroxine one day a week (ie a reduction of 100mcg per week that’s far too much)

Never agree to dose reduction based just on TSH and Ft4

List of private testing options and money off codes

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

bluehorizonbloodtests.co.uk...

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/

[SlowDragon Administrator]

Looking at previous posts……if still on steroids these frequently lower TSH

Essential to always test Ft4 and Ft3 and all four vitamins before considering reducing dose levothyroxine

Always test early morning to get highest TSH

Only do private testing early Monday or Tuesday morning.

Beware of postal strikes at moment

[tattybogle]

That's just the cheapest way of doing it from GP's point of view . as they only need to prescribe 100mcg tablets. Some people would find they noticed feeling very different on the day without any levo with a knock on effect the next day, and would find it unsettling to do it this way ( i would) but some others would not notice at all . technically there is no reason why you can't do it, as the half life of Levo in the blood is about 7 days , so it acts as a long term store. So you can certainly try it for a while and see how it goes.

But personally i find it more satisfactory to take more or less the same dose every day, i wouldn't like a whole day with none.

removing one days dose would give total weekly dose of 600mcg = 85mcg / day

this dose can be achieved in a more even fashion by taking either:

alternate 100 mcg one day / 75mcg the next and so on = 87.5mcg /day

or taking exactly the same each day : 50mcg +25mcg + half a 25 mcg =87.5mcg

But these options cost the GP more ... they have to prescribe both 50's and 25's .. mind you Levo tablets only cost about £1 a packet, so it's hardly going to bankrupt them (apart from the 12.5mcg size they cost about £13 for some stupid reason)

My dose is 112.5mcg /day and i much prefer to take the same every day rather than alternate between 100mcg and 125mcg every other day... as i find i can feel the difference .

[SlowDragon Administrator in reply to tattybogle]

Teva is only brand that makes 12.5mcg …so,

A) they charge more

B) many people can’t tolerate Teva anyway

[Lizzery]

Thank you for your replies. I’m afraid I don’t know how the results of my last blood test was made up. I’ve never really checked how the thyroid test is made up, but rather have just kept on eye on my ESR and CRP relating to having PMR. I do feel at present I have symptoms of possibly having too much levothyroxine, and wasn’t surprised when I had a phone call my from the Doctor confirming this. I do however feel that missing a dose one day per week is not the way to approach a subtle reduction, and think alternate 100/75mg may be the way to go. I have a docs appointment shortly, so shall discuss this further before attempting to reduce.

Thanks again, especially for the useful links.

[greygoose in reply to Lizzery]

Just ask at reception for a print-out of your results. It is your legal right to have one. Where thyroid is concerned, it's very important you know exactly what was tested and exactly what the results were. If you doctor is reducing your dose just based on the TSH - a pituitary hormone, not a thyroid hormone - then that is the wrong way to do it. You need to know.

[SlowDragon Administrator in reply to Lizzery]

You are legally entitled to printed copies of your blood test results and ranges.

The best way to get access to current and historic blood test results is to register for online access to your medical record and blood test results

UK GP practices are supposed to offer everyone online access for blood test results. Ring and ask if this is available and apply to do so if possible, if it is you may need "enhanced access" to see blood results.

Link re access

healthunlocked.com/thyroidu...

In reality many GP surgeries do not have blood test results online yet

Alternatively ring receptionist and request printed copies of results. Allow couple of days and then go and pick up.

Important to see exactly what has been tested and equally important what hasn’t been tested yet

Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine

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

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

Which brand of levothyroxine are you currently taking

Many people find different brands are not interchangeable

The only brand that makes 75mcg is Teva

Teva brand upsets many people

So…..if you drop to 75mcg twice a week …..and avoiding Teva …you will need 50mcg plus 25mcg tablets if happy with Mercury Pharma brand

If on Accord (also boxed as Almus via Boots or Northstar via Lloyds) will need 2 x 50mcg and cut one in half to get 25mcg

Or cut a 100mcg into half and 2 x 1/4 to get 75mcg

The spare 1/4 tablets will make a 75mcg dose every week or so

[Lizzery]

Thankyou all so much for your replies. It is incredibly helpful. I think because of PMR, I just sort of let the thyroid issue take care of itself!! Thanks again.

[FancyPants54 in reply to Lizzery]

Sadly thyroid conditions rarely take care of themselves.

As for skipping a day, I usually feel fantastic if I do that. I can’t skip 2 days in a row though. I don’t know why missing a day makes me feel great. I never feel like that on medication days.