Husband in hospital with collapsed lung problems. Lost 20 kg since Feb Should his Levothyroxine have been adjusted to a lower dose?

[Rockky]

Just a couple quick questions re the above. I don't even know if they have been testing his levels but will question this today. I am presuming they are but who knows. He is quite ill and his lung is not healing well. Has had lung drain in for 2 months now. He is constantly losing weight and they are giving him "build up" drinks. Could it be that he is now over medicated? he has dropped to 60kg - cannot walk unaided and was 82 kg in Feb. He is on 150mcg Levothyroxine and has on this dosage for at least 18 months. Levo dosage is done by weight also, is that right? Could the weight be dropping off him because of his dosage now being too high or as his Docs think because of his uncontrolled Rheumatoid Arthritis?

Have been told the collapse is probably due to his Rheumatoid Arthritis and Rheumatoid nodules in his lungs.

Thanks everyone.

[SlowDragon Administrator]

Need to test full thyroid, TSH, Ft4 and Ft3 and also vitamin D, folate, ferritin and B12

Test should be early morning and last dose levothyroxine 24 hours before test

Does he always get same brand levothyroxine at each prescription

Is he taking levothyroxine waking or bedtime, always on empty stomach and then nothing apart from water for at least an hour after. No other medications or supplements within 2 hours

What vitamin supplements is he taking

Yes likely he may need dose reduction in levothyroxine

Come back with new post once you get results

[Rockky in reply to SlowDragon]

I cannot do those tests as he is in hospital atm. He takes first thing in morning and with water, and no food for an hour.He is on a Calcium & Vitamin D chewy tablet. other meds after 2 hours.Always has same brand Levo. Not taking any other vitamins. But on quite a few other meds.

Sept T4 20.8 (9.5 - 22.7)

Sept serum ferritin 382 ug/l (22-322)

These were take from Patient Access records.

[SlowDragon Administrator in reply to Rockky]

obviously just testing Ft4 is completely inadequate

Request they test TSH, Ft4 and Ft3 and vitamin D, folate, B12 and ferritin

Is he taking calcium at least 4 hours away from levothyroxine

[cjrsquared]

Your husband may require a dose change but it is extremely unlikely that his levothyroxine dose is responsible for his weight loss. With any auto immune condition a flare up can also influence metabolic rate, absorption of nutrients from the gut, the normal function of cells. It sounds as if there is an acute flare up of your husband’s rheumatoid arthritis and until this settles down any changes in levothyroxine will only be a small part of treatment. One would hope that he has had some blood tests to check levels but due to all going on in his body it won’t be a reliable figure only a snapshot. You also need to remember that dose changes are in small increments, normally 25 mcg which take 6 weeks to see the effect with repeat bloods and further dose change as necessary.

I really hope your husband’s health improves soon.

[SeasideSusie Remembering]

Rockky

Levo dosage is done by weight also, is that right?

No. It's a suggestion in the guidelines that upon diagnosis the starter dose may be worked out by weight and then adjusted as necessary. After that we need what we need based on whether symptoms are alleviated and where our thyroid test results sit within their ranges.

Could the weight be dropping off him because of his dosage now being too high

Sept T4 20.8 (9.5 - 22.7)

You can see from his September test result that his FT4 is well within range, it is 85.61% through range. If it was over range one might suspect that he is overmedicated but you would need FT3 testing to confirm that.

However, last dose of Levo should be taken 24 hours before testing to give a measure of the normal amount of circulating hormone, any longer you get a false low FT4 result, too close to the test and you get a false high result.