Hand tremors, are they a Levo side effect?

[Lionmess]

Back in January 2020 I sought my GPs advice regarding Hand tremors. I thought he might discuss Hypo symptoms or even refer me to an Endo but instead I was referred to a Neurologist. In 3 years (partly understandably through Covid) I never met the Neuro, he just phoned up and asked questions and left me on a wait list until a face to face appointment opened up. It never did and he signed me off without any diagnosis.

I have a father with Parkinson's, hence my fears.

In frustration I paid for a private Neuro consultation. After a very thorough exam, I was told it was a Levothyroxine side effect and to ask my GP for Beta Blockers. There are Heart issues in my family history so I have not done this yet. I'm reluctant to take another drug to fix an issue caused by the first.

Is this something that the lovely folk here have experience of?

Background:

Hypothyroid diagnosed in 2015 though symptomatic for several years before. On 100mg Levo and feeling OK ish. I NEVER get the same Levo brand and have been trying to determine if one or other results in fewer shakes. Sometime I find the tremor alarming, it can be an effort to use a knife and fork, my left hand is worst

I welcome your advice.

[HeartWoman]

I am so sorry you are going through this. It is so frustrating when we have symptoms, but no real help. I doubt that it is the active ingredient, but possibly an inactive one. Have you kept any kind of journal of how you feel on the various brands?

Have you had blood work done recently? Could you possible be undermedicated? Thyroid effects the central nervous system, so if you are not getting enough, I can see that being a problem.

I don't think that our experts on here (I am not one of them.), may be able to assist you more if you could share any of the bloodwork you have had done.

I hope you get this resolved quickly.

[Lionmess in reply to HeartWoman]

From a few months ago. I was supplimenting with B12 at the time but was inconsistant. I'm now more regular hoping to see a reduction in tremors but haven't noticed any difference so far.

Iron Status

Ferritin 92 ug/L (Range: 13 - 150)

Vitamins

Folate - Serum 4.1 ug/L

If no change in dietary habits,a normal serum

folate makes folate deficiency unlikely.

(Range: > 2.9)

Vitamin B12 - Active 81 pmol/L (Range: 25.1 - 165)

Vitamin D 76 nmol/L

Interpretation of results:

Deficient <25 nmol/L

Insufficient 25 - 49 nmol/L

Normal Range 50 - 200 nmol/L

Consider reducing dose >200 nmol/L

(Range: 50 - 200)

Thyroid Hormones

TSH 0.81 mIU/L (Range: 0.27 - 4.2)

Free T3 4.8 pmol/L (Range: 3.1 - 6.8)

Free Thyroxine 19.3 pmol/l (Range: 12 - 22)

Autoimmunity

Thyroglobulin Antibodies 20.1 IU/mL

Method used for Anti-Tg: Roche Modular

(Range: 0 - 115)

Thyroid Peroxidase Antibodies X 146.0 IU/mL (Range: 0 - 34)

[Regenallotment Ambassador]

I had a neurology test with the little shocks because I had tingling in my fingers and numbness, it was after a car accident but nothing showed up. Taking a B Complex resolved that, turned out my B12 was very low. I realise yours is different with shaking, could you be over medicated? Hand tremors can be a symptom, when did you last test ?

[HeartWoman]

Is is possible to get a little T3? It looks to me like you don't convert your T4 to T3 very well since your T4 is pretty good. That is my guess, but hopefully more knowledgeable folks will be along soon.

[jimh111]

A fine hand tremor is a sign of hyperthyroidism - too much thyroid hormone activity. So, it is possible that you are on a little too much levothyroxine. I'm not a doctor but I think a safe test is to skip three days levothyroxine and see if the hand tremor goes away. This will reduce your T4 levels by about 25%. You could then take a double dose for two or three days to restore your normal levels. If the hand tremor doesn't go away you can be quite sure it is not due to levothyroxine treatment. I think the quick sharp approach is better than slowly reducing your dose little by little over time, you will be hypo for a much shorter time and any change will be more obvious.

[Lionmess in reply to jimh111]

That sounds reasonable to try, thanks

[Lionmess]

Thanks. Back in April 2022 my GP tested TSH only and said at 0.165 I was over medicated and reduced my 100 dose to 75mg. 9 weeks later my TSH was 15.6 so I got put back on 100 mg Mon-Friday and 75mg at weekends.

My repeat prescription gives me enough 100 and 50+25mg to be able to trial the different brands at 100mg a day for weeks at a time so I am doing my own brand v/s symptoms research. I've been on the non Teva brands so far for 6 weeks.

[TiggerMe Ambassador]

I'll flag up your very low folate, so a B complex wouldn't be a bad idea 🤗

It's annoying when the don't give you an actual range but at least double figures would be good... > isn't very helpful is it 🙄

[Meerkat1234]

I was on levothyroxine 25mcg then went up to 37.5 mcg and got tremor in my left hand and blurry vision. The leaflet said the tremor was a side effect of levothyroxine and blurry vision. I am soon going up to 50 mcg so I hope it doesn’t come back as it went as my body adjusted.

[Lionmess in reply to Meerkat1234]

I hope so too Meerkat1234. All the best

[Meerkat1234 in reply to Lionmess]

Thanks Lionmess. All the best to you too. Take care.

[SlowDragon Administrator]

Are you on strictly gluten free diet and/or dairy free diet

Vitamin D and folate levels need improvement

What vitamin supplements are you currently taking

[Lionmess in reply to SlowDragon]

I still eat Gluten but very infrequently. I have an addiction to cheese so not dairy free either.

Currently taking B12 (H&B brand) which I have taken consistently for 5 months. I think there was a slight improvement in my shake since I became more regimented about it but not significantly.

[SlowDragon Administrator in reply to Lionmess]

Rather than just taking a B12 supplement

Now your Active B12 is over 70 (or serum B12 level has reached 500) , you may be able to reduce then stop the B12 and just carry on with the B Complex.

If Vegetarian or vegan likely to need ongoing separate B12 few times a week 

supplementing a good quality daily vitamin B complex, one with folate in (not folic acid) 

This can help keep all B vitamins in balance and will help improve B12 levels too

Difference between folate and folic acid 

healthline.com/nutrition/fo...

B vitamins best taken after breakfast

Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule) 

Thorne currently difficult to find at reasonable price, should be around £20-£25. iherb.com often have in stock. Or try ebay 

Other options 

healthunlocked.com/thyroidu....

IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate folate supplement (eg Jarrow methyl folate 400mcg)

[Hollyminou]

I have recently been having problems/symptoms re underactive thyroid, have occasionally had hand tremors which, initially thought was due to my asthma Inhaler although I have been taking it for over 30yrs. My recent blood test shows low TSH looked up symptoms for hyper thyroid and it does mention hand tremors.

[tattybogle in reply to Hollyminou]

a ' fine tremor in the fingers' is a well known sign of overmedication.

much larger hand tremors (of the kind you'd associate with eg parkinson's) are not.

To test for overmedication:

~ hold arms straight out in front , palms down , fingers loosely extended.

~ look for fine tremor in fingers .

(it can be difficult to see, balancing a sheet of A4 paper on the back of the hand makes it easier to see)

This was how a GP figured out i was overmedicated.. and when she did bloods my TSH had indeed fallen lower than my 'usual' .

my handwriting had become really spiky/ small and i was really jittery / jumpy. i was also getting a bit clumsy with small movements .. eg hitting the teaspoon on the side of the cup instead of getting it in, that sort of thing.

[Lionmess in reply to tattybogle]

That's so helpful, thank you. I did as you said but in my case it's definitely my whole hand that trembles. It's good to confirm that overmedication is not likely to be my issue as when the GP lowered my Levo last year I lost a lot of hair

[arTistapple]

As is often said on the forum. Many symptoms can be indicative of both over and under medicating. Changing dosages for me virtually always bring on undesired symptoms. Some are too awful to live with. Others I can work through more easily. Tremor and similar I have experienced both whilst putting meds up and down. I notice I have a tremor now but I know I am under medicated so not too worried about it. jimh111 gives a good example of a quick experiment. I have to say from my personal experience it could be something as simple as ‘tweaking’. Totally understand your concern about Parkinson’s BUT hypothyroidism is good at emulating almost any other disease process. Do the minimal to try to find out what’s going on so you don’t upset your system further.

[Lionmess in reply to arTistapple]

I will thank you so much for sharing your experience

[Batty1]

My mother has Essential tremors she can’t hold a cup without spilling or write without looking like a scribble…. Is this what your tremors are like ?

[Lionmess in reply to Batty1]

Thanks, I'm not in that situation at the moment. I'm right handed but it primarily affects my left. I had expected Essential Tremor to be the diagnosis but it didn't get a mention by either the NHS over the phone Consult or the Private one. The Private Neuro said she sees the symptoms quite often with Levo patients hence my query.