accidentally taken wrong dose

[Gosierunn]

hi all

I just accidentally took 2 x 50mg of Levothyroxine instead of 1 x 50mg (I had been getting 25mg packets and therefor taking 2 x per day and just didn’t think!

What should I do?

[helvella Administrator Thyroid UK]

Do? Absolutely nothing - at least to begin with.

It is quite possible you won't notice any effect at all.

While it is obviously not a good idea to take a double-dose, it really is unlikely to have any important impact. Levothyroxine is one of the safest of all medicines except in extreme overdose.

At most, skip your dose tomorrow if you feel over-dosed today. But probably just take your intended dose tomorrow.

(By the way, the doses are in micrograms (mcg) not milligrams (mg)! )

[Gosierunn in reply to helvella]

Thanks ahh yes micrograms!

Yes, that’s what I was wondering - about skipping a dose or if I carry on a usual…

[helvella Administrator Thyroid UK in reply to Gosierunn]

Unless you really notice a difference, and that is negative, carry on as usual.

[SlowDragon Administrator]

How long have you been on just 50mcg daily

This is only the standard STARTER dose levothyroxine

Quite likely ready for next increase to 75mcg daily

Blood test should be done 6-8 weeks after any dose change or brand change in Levo

For full Thyroid evaluation you need TSH, FT4 and FT3 tested

Also both TPO and TG thyroid antibodies tested at least once

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

[Gosierunn in reply to SlowDragon]

Thanks SlowDragon - well interestingly I am due to test as been 6 weeks since I’ve been on the 50mcg…

[SlowDragon Administrator in reply to Gosierunn]

Approx how old are you?

Male or female?

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

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.

Just testing TSH and Ft4 is completely inadequate

Testing options and includes money off codes for private testing

thyroiduk.org/testing/

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

Only do private testing early Monday or Tuesday morning.

Link about thyroid blood tests

thyroiduk.org/testing/thyro...

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

Symptoms of hypothyroidism

thyroiduk.org/signs-and-sym...

Tips on how to do DIY finger prick test

See detailed reply by SeasideSusie

healthunlocked.com/thyroidu...

Medichecks and BH also offer private blood draw at clinic near you, or private nurse to your own home…..for an extra fee

[Gosierunn in reply to SlowDragon]

I’m 40, female, I was subclinical (6.7 - in a range 5.0) but have Hashimoto’s. I’m seeing a private dr and using medichecks for regular testing, I was started on 25mcg by my GP though, private dr said go up to 50 which I have been on for 6 weeks hence needing to retest soon.

[SlowDragon Administrator in reply to Gosierunn]

ESSENTIAL to test vitamin levels

So as you have Hashimoto’s have you had coeliac blood test done yet

If not get tested BEFORE considering trial on strictly gluten free diet

nice.org.uk/guidance/ng20/c...

1.1 Recognition of coeliac disease

1.1.1 Offer serological testing for coeliac disease to:

people with any of the following:

persistent unexplained abdominal or gastrointestinal symptoms

faltering growth

prolonged fatigue

unexpected weight loss

severe or persistent mouth ulcers

unexplained iron, vitamin B12 or folate deficiency

type 1 diabetes, at diagnosis

autoimmune thyroid disease, at diagnosis

irritable bowel syndrome (in adults)

first‑degree relatives of people with coeliac disease.

[Gosierunn in reply to SlowDragon]

Yes I have been having my vitamin levels checked, have had GI mapping and adrenal gland looked at and taking further action based on that, tested for celiac earlier this week still awaiting results. Have been on a strictly gluten free diet prior to that since July when I was diagnosed.

[SlowDragon Administrator in reply to Gosierunn]

what are your most recent vitamin results

No point testing for coeliac unless eating high levels of gluten daily for at least 2 months before test

Have you noticed improvement on gluten free diet

[Gosierunn in reply to SlowDragon]

I ate lots of gluten (2 meals per day) for 6 weeks prior to the test as guided by Coeliac UK website, No vitamins as of yet as my dr dealing with my gut first.

T4 - 11.1 pmol/L (9.00 - 19.00pmol/L)

B12 - 445 ng/L (187.00 - 883.00ng/L)

Folate - 3.4 (3.10 - 20.50ug/L)

Vit D - 59.8 nmol/L (>49.90nmol/L)

Ferritin - 52 ng/mL (15.00 - 204.00ng/mL)

Copper - 18.9umol/L (11.00 - 25.10umol/L

[SlowDragon Administrator]

Guess you haven’t retested since these results

healthunlocked.com/thyroidu...

Exactly what vitamin supplements are you currently taking

[Gosierunn in reply to SlowDragon]

Yes no I’m not taking any at the moment.

[SlowDragon Administrator in reply to Gosierunn]

You need good vitamin levels for good conversion of Ft4 to Ft3

And low vitamin levels tend to lower TSH

I would consider starting to add supplements

Only add one at a time….then wait 2 weeks to assess before adding another

Starting with vitamin D

[Gosierunn in reply to SlowDragon]

Thanks SlowDragon next step will be the gut and adrenal gland protocols now that I have had the coeliac blood test - and then after that we will be looking at supplements. Thanks for your advice and time .