Sleep abnormalities after starting levothyroxine?

[GreenhouseGal]

Hi there. Im in week 3 of levothyroxine 50mcg. Starting about 4 days ago, my body is getting minimal deep sleep. Plenty of REM, deep sleep is almost nonexistent. Nothing has changed other than this med. I used to get tons of deep sleep. I feel run down, like I'm getting sick, now that my sleep has been like this for 4 days. It's a tad scary. I'm still cold all the time, so nothing has changed that I can tell. I hope this is normal! 🤞🤞🤞

[SlowDragon Administrator]

Each dose levothyroxine takes mini 6-8 weeks to have full effect

Likely to need further increase (s) in dose over coming months

[GreenhouseGal in reply to SlowDragon]

You know the funny thing? Just had my patient's doctor here- internal medicine. He said that for my tsh being under 6, he'd only give 25mcg, total! I was surprised, based on the "it doesn't top it up" thing. I agree with that. It's common sense, if taking t4 stops your thyroid from producing, that you are no different than a euthroid person in terms of levo dose. Am I wrong? 🤔🤔🤔 I'm learning a lot! 😂😁

[SlowDragon Administrator in reply to GreenhouseGal]

Change doctor

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.

[GreenhouseGal in reply to SlowDragon]

Yeah mine is 108mcg based on weight. Thankfully he's not MY doctor, just my clients. His tsh was 5.4, (my client) and the doc won't treat it- but that's expected since he has severe, end stage frontal-temporal lobar dementia, and has no real hypothyroidism symptoms. But I agree, if he was mine, I'd bolt. 😂

[SlowDragon Administrator in reply to GreenhouseGal]

Many elderly people have extremely low vitamin levels with low thyroid levels

Especially B12 deficiency

B12 deficiency often mimics dementia

verywellhealth.com/is-it-al....

neuro.psychiatryonline.org/...

I would get him to have FULL thyroid and vitamin testing ASAP

[Jaydee1507 Administrator]

It's completely normal to feel worse in many different ways on lower doses of Levo. Sleep can definitely suffer and may take time to recover to where you were before.

So many changes are happening in your body at the moment and as yet you are on a low dose that may not be as much as your own thyroid was putting out. Levo replaces and doesn't 'top up' your thyroid hormone.

Have you checked your key vitamns ferritin, folate, B12 & D3?

What are you supplementing with?

[GreenhouseGal in reply to Jaydee1507]

Hi there 🙂. All my hemoglobin and blood tests for basics were normal- but I haven't had anything else tested. I See the new doctor next Thursday. (Primary doctor that is a D.O., highly rated... i hope he's good with endocrine stuff!! 🤞) I take Iron, half of a 27mg biglycinate(?) Version, daily; I take a b- complex with b-12 (1,250% dv), and take 10,000 iu vit-D per day. Also supplement with... (bear with me 😅) Magnesium malate, algae oil (omega 3 version due to fish/shellfish allergies), zinc, vitamin k2, vitamin c, selenium, cloves, gingko biloba, quercetin, quinine, betaine HCL (found out i have minimal stomach acid), and NAC (just started). 😮‍💨😂🙈

I'm trying to do everything I can to help support my system to heal- and to rid it of other halogens I do not need (a whole other rabbit hole subject 😆😆😆).

My poor thyroid!

I'm just having a lot of surreal feels- almost feel like reality is sketchy. Feel out of it- which I can deal with- but not feeling like I got more than 2 hours sleep is debilitating- especially since I drive 3 hours a day for work commute. I have to pull over ALL THE TIME. Just scary. Any advice is much appreciated!!! 🤗

[SlowDragon Administrator in reply to GreenhouseGal]

Remember to stop vitamin B complex 5-7 days before any tests as contains biotin

Biotin can affect test results (it’s used in lots of lab test equipment)

[Sunflower535]

I am just over 6 weeks on thyroid and I can relate to that out of it feeling, it's like things around you are a dream. This feeling disappeared after a while. I think I got it about week 5. It was strange but it doesn't last. My sleep wasn't good but when I started magnesium it sorted itself out. Sorry I can't help in any way. I am new to all this but just thought I would let you know that you are not on you own. There are so many on here that are so knowledgeable and will be able to help. Take care.

[GreenhouseGal in reply to Sunflower535]

Thank you 💛💛💛