Thyroxine

[ShellBellc1979]

Hi i forgot to mention in my last post that the doctor recommended in the letter that i start levo thyroxine from 1st October. Is this not a bit soon as my levels are still high 🤔

[PurpleNails Administrator]

You are currently on 20mg carbimazole & you been told to increase to 40mg. Have you started higher dose yet?

How long after to take levo? How much?

If adjusting carbimazole alone doesn’t improve levels or levels either fluctuate or FT4 / FT3 wildly out of kilter (eg low FT4 & High FT3) there is an alternative method called  ‘block & replace’

Higher dose of carbimazole to totally block thyroid function & a levo replacement to prevent hypo.  

You now have 2 variables but once stable - you’ll likely stay stable.  I think sometimes doctors opt for this as long term it requires less monitoring.  

I didn’t think you were far off getting under control on carbimazole alone.  Ask them to explain the rationale. 

The down side is your on a higher dose of carbimazole longer term which carries higher risk (over 30mg seems to have higher risk of serious type side affects) and if levels do start to naturally ‘sort themselves’ out you wouldn’t see the improvement on block & replace.  

Often after 18 months doctors say stop both and see if Graves in in remission, which I think is a shock to the system and may be triggering a recurrence in some cases.

The plus factors are you’d be stable while on regimen and you know how you get on with Levo should you need it in future.  

[ShellBellc1979 in reply to PurpleNails]

i haven't started higher dose as felt it was a bit extreme to double dose, im confused so is it possible for me to remain on carbimazole alone if my levels were to drop in the next few weeks on 20mg? Or would i always need to take levo thyroxine at some point?

[PurpleNails Administrator in reply to ShellBellc1979]

You need to discuss with doctor.  As you haven’t increased dose to block all thyroid function introducing Levo to replacement is not necessary.Doctors really should have discussed & explained the plan to you.  If doctors are going by TSH you appear hyper.  You results are coming down into range. 

[ShellBellc1979 in reply to PurpleNails]

Thank you so much

[pennyannie]

Hey there again :

This is another treatment option called Block and Replace :

The idea is that you increase the AT drug to fully block your own thyroid hormones production BUT that on it's own will take your T3 and T4 down below the range and give you equally disabling symptoms of hypothyroid SO a measured dose of T4 - Levothyroxine is added back into the mix to keep your T3 and T4 at some acceptable level within the ranges.

Too high a T3 reading and you can experience symptoms of hyperthyroidism just as too low a lvel of T3 and you can experience symptoms of hypothyroidism - balancing your T3 and T4 to find a ' happy medium ' is what this treatment option attempts to do.

What it can't control, what nobody can control is your immune system response and this is just another treatment option if you are not currently finding relief of symptoms.

It might help if you dip into Thyroid UK - the charity who supports this forum - thyroiduk.org

as there is a list of both hyper and hypo symptoms - and yes it's not that simple as some symptoms can be experienced when either hypo or hyper but it might just help you find where you feel you are if currently seesawing in symptoms.

[ShellBellc1979 in reply to pennyannie]

thank you so much