lowered thyroid dose

[Guidance]

after recent blood tests l was advised by go to lower my eltroxin from 75mcg to 50 mcg and then retested in 2 months time l,m 73 in June . I have mild asthma and use Quar 50 night and morning but since lowering dose have noticed a bit of breathlessness, could it be that lowering the dose maybe the cause.

[SeasideSusie Remembering]

Guidance

Breathlessness can be a symptom of hypothyroidism but as you have asthma you can't rule that out, it could be connected with that.

What were the results/reference ranges of your test which prompted the reduction, ideally you will have had TSH, FT4 and FT3 tested and not just TSH. If you don't already keep a record of your results just ring the surgery and ask the receptionist to arrange for you to have a print out of your results and say you will pick them up at their convenience. Here in the UK we are legally entitled to our results but don't accept verbal or hand written ones, always get a print out and that way no mistakes can be made. Some surgeries offer onine access to results so you could check out if yours does and register for that if they do.

Come back with results/ranges for further comment. Ranges are very important, they vary from lab to lab so it's essential to have them so we can interpret the result.

[Guidance in reply to SeasideSusie]

Hi, thank you for your reply, lbeen hypothyroid for 12 years and have been on 75mcg for about 9 years , my blood tests were my yearly check and my serum t Sh level was 0.09 my serum free t4 was 14.9 which said abnormal beside it was told to lower it to 50 mcg . Also my cholesterol levels (total) was 6 l was told it could be l was to higher dose of eltroxin, l had taken my 75 mcg at 7.0clock that morning but my bloods were taken at 3.30 pm which may have something to do with the result tests done on 22 /3/23 told to book in for tests in June,my b/tests in October 21 were serum folate 8.5 serum ferritin 100 vit b12 569 TSH 0.35. Hope this is helpful . Thank you any help woul be appreciated.

[SeasideSusie Remembering in reply to Guidance]

As mentioned before, we need reference ranges that come with your results, it's impossible to interpret them without.

Raised cholesterol is a symptom of hypothyroidism so undermedication can cause that.

To get the most accurate measure of your normal thyroid hormone levels, always advised here, when having thyroid tests:

* Book the first appointment of the morning, or with private tests at home no later than 9am. This is because TSH is highest early morning and lowers throughout the day.

In fact, 9am is the perfect time, see first graph here, it shows TSH is highest around midnight - 4am (when we can't get a blood draw), then lowers, next high is at 9am then lowers before it starts it's climb again about 9pm:

healthunlocked.com/thyroidu...

If we are looking for a diagnosis of hypothyroidism, or looking for an increase in dose or to avoid a reduction then we need TSH to be as high as possible.

* Nothing to eat or drink except water before the test - have your evening meal/supper as normal the night before but delay breakfast on the day of the test and drink water only until after the blood draw. Certain foods may lower TSH, caffeine containing drinks affect TSH.

* If taking thyroid hormone replacement, last dose of Levo should be 24 hours before blood draw. If taking NDT or T3 then last dose should be 8-12 hours before blood draw, split dose and adjust timing the day before if necessary. This avoids measuring hormone levels at their peak after ingestion of hormone replacement. Take your thyroid meds after the blood draw. Taking your dose too close to the blood draw will give false high results, leaving any longer gap will give false low results.

* If you take Biotin or a B Complex containing Biotin (B7), leave this off for 3-7 days before any blood test. This is because if Biotin is used in the testing procedure it can give false results (most labs use biotin).

These are patient to patient tips which we don't discuss with phlebotomists or doctors.

Your October 2021 test results wont be relevant now, they could have changed considerably.

[helvella Administrator]

Just want to pick up on the reduction from 75 to 50 micrograms.

That is a massive reduction when viewed as a percentage. A 33% cut.

Even if a reduction had been in order, it should have been a much more modest change. Maybe to 62.5 micrograms. (E.g. alternate days taking 75 and 50 - or splitting a 25 microgram tablet.)

Heavy-handed prescription changes like this cause no end of problems.

And remember, a reversal - back from 50 to 75 - would be a 50% increase.

[SlowDragon Administrator]

ESSENTIAL to always test thyroid levels early morning, ideally just before 9am and last dose levothyroxine 24 hours before test

The most important results are always Ft3 followed by Ft4

Looking for Ft4 (levothyroxine) to be at least 60-70% through range. Usually Ft3 (active hormone) will be a little lower but at least 50-60% through range minimum

Also extremely important to test vitamin D, folate, ferritin and B12 at least once a year

For good conversion of Ft4 to Ft3 we need good vitamin levels

When were these last tested

What vitamin supplements do you take

Using an inhaler can possibly lower TSH

[Longtimer in reply to SlowDragon]

Hi, I am asking on behalf of my sister who has RA, she takes Sulphazalasine for that, and has had underactive thyroid for about 25 years. After having a blood test a month ago the GP dropped her Thyroxine from 100 to 75, she had been ok for many years on 100. Now she struggles to get out of bed sleeps most of the afternoon....I am worried because it has changed her so much, and a holiday she has booked in a months time. ...she is wondering how she will cope. She has a blood test coming up in a couple of weeks, so I would really appreciate any advice for her. Thank you

[SlowDragon Administrator in reply to Longtimer]

Never agree to such large dose reduction based on just TSH or TSH and Ft4

ALWAYS test thyroid levels 9am latest and last dose levothyroxine 24 hours before test

what were the results that prompted this (perhaps inappropriate) dose reduction

Always get same brand levothyroxine at each prescription

ESSENTIAL to test vitamin D, folate, ferritin and B12 BEFORE considering agreeing to dose reduction

Essential to maintain OPTIMAL vitamin levels.

Lower vitamin levels more common as we get older and especially after dose reduction in levothyroxine

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’re sister can get GP to test vitamins then cheapest option for just TSH, FT4 and FT3 and includes BOTH TPO and TG antibodies -£29 

randoxhealth.com/at-home/Th...

Monitor My Health also now offer thyroid and vitamin testing, plus cholesterol and HBA1C for £65 

(Doesn’t include thyroid antibodies) 

monitormyhealth.org.uk/full...

10% off code here 

thyroiduk.org/getting-a-dia...

Only do private testing early Monday or Tuesday morning. 

Link about thyroid blood tests

thyroiduk.org/getting-a-dia...

[Longtimer in reply to SlowDragon]

Thank you for your prompt reply...I will print out and convey this to her. She is upset right now because Odthopaedics at the hospital just rang for her with very early appointments, she told them how unwell she was with RA and thyroid problems....and it would be a struggle to get to hospital that early. The receptionist replied ....... "I have RA and I got into work early this morning!" my sister was so upset she put the phone down. ....she is very different to me.....I would have asked her what she was implying......she lives alone....such a battle.Thanks again...