Levothyroxine and sleep disturbances

[ockerdoc]

Has anybody experienced problems sleeping and weird dreams? I seem to dream all night these days and I wonder whether it’ll get worse as I go up in dosage. I’ve taken some melatonin which has helped but I don’t want to take it regularly.

[SlowDragon Administrator]

Looking at previous posts you’re only on 25mcg levothyroxine…or have you now increased to 50mcg ?

Bloods will need retesting 6-8 weeks after each increase

As a bloke you’re going to eventually be on at least 100mcg levothyroxine……but we frequently have to increase dose slowly upwards

Poor sleep and bad dreams (possibly due to excess cortisol) common when under medicated …..and sleep should improve as dose levothyroxine increases

Do you take levothyroxine at bedtime or waking up?

[ockerdoc in reply to SlowDragon]

I take it first thing in the morning. I’m on 50mcg now as my own choice because I felt so bad on 25 but my GP wouldn’t increase my dose until the end of a 3 month period. That’s good to know it may improve then thank you 👍

[SlowDragon Administrator in reply to ockerdoc]

guidelines on dose levothyroxine by weight

Even if we frequently start on only 50mcg, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose

NICE guidelines on full replacement dose

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

Also here

cks.nice.org.uk/topics/hypo...

pathlabs.rlbuht.nhs.uk/tft_...

Guiding Treatment with Thyroxine:

In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months.

The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).

The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range.

……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.

The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.

[HealthStarDust]

Yes, very similar to experience. I posted about it and many had the same. I am having more pleasant dreams again with some weird ones thrown in now and again.

healthunlocked.com/thyroidu...

[ockerdoc in reply to HealthStarDust]

Thank you that’s good to know.