Increase in levothyroxine to 50 feeling worse - Thyroid UK

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Increase in levothyroxine to 50 feeling worse

KatyMac68 profile image
19 Replies

Diagnosed with possible subclinical hypothyroidism and put on 25 levothyroxine (Also struggling with meno and have exciting CFS/ME, FM, hypermobility, IBS)

After 12 week raised it 50 levothyroxine, that was last Wednesday & I feel like shit!

Saw the GP the week before (about falling over) & my blood pressure was raised for the first time ever and it also dropped when I stood up. I had an ecg and everything is 'fine'

My relationship with my gp is poor and when I was stubborn about wanting to be tested in 6 or 8 weeks she responded by wanting me to go on statins

Currently: I am so tired, my heart is racing, my bp is high (I've been asked to monitor it) my appetite is fluctuating, I have a regular headache, I'm not really thirsty and staying in bed all day is a very attractive option & my anxiety is fairly high

Could 50 levothyroxine be too high for me? Could something else be going on (meno? These aren't normal CFS/ME relapse symptoms for me)?

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19 Replies
SlowDragon profile image
SlowDragonAdministrator

which brand was 25mcg

Which brand is 50mcg

Many people find different brands of levothyroxine are not the same

Try splitting the dose …..taking 25mcg waking up and 25mcg at bedtime

Have you had vitamin D, folate, B12 and ferritin levels tested yet

Or thyroid antibodies

KatyMac68 profile image
KatyMac68 in reply to SlowDragon

Antibodies checked in Nov 21 and negativeB12, D and ferritin/folate all high as I supplement

25 was wockhardt & 50 is Mercury, can I chop it in half?

SlowDragon profile image
SlowDragonAdministrator in reply to KatyMac68

Yes try chopping in half

Use sharp scalpel

Mercury Pharma contains Acacia

It might be Mercury doesn’t agree with you

Are you lactose intolerant?

Mercury Pharma make 25mcg, 50mcg and 100mcg tablets 

Mercury Pharma also boxed as Eltroxin. Both often listed by company name on pharmacy database - Advanz

Accord only make 50mcg and 100mcg tablets. Accord is also boxed as Almus via Boots, 

Wockhardt is very well tolerated, but only available in 25mcg tablets. Some people remain on Wockhardt, taking their daily dose as a number of tablets 

Lactose free brands - currently Teva or Vencamil only

Teva makes 25mcg, 50mcg, 75mcg and 100mcg

Many patients do NOT get on well with Teva brand of Levothyroxine.

Teva is lactose free.But Teva contains mannitol as a filler instead of lactose, which seems to be possible cause of problems. Mannitol seems to upset many people, it changes gut biome 

Teva is the only brand that makes 75mcg tablet.

So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half

But for some people (usually if lactose intolerant, Teva is by far the best option)

Aristo (currently 100mcg only) is lactose free and mannitol free.

March 2023 - Aristo now called Vencamil

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

List of different brands available in U.K.

thyroiduk.org/if-you-are-hy...

Posts that mention Teva

healthunlocked.com/search/p...

Teva poll

healthunlocked.com/thyroidu...

Once you find a brand that suits you, best to make sure to only get that one at each prescription.

Watch out for brand change when dose is increased or at repeat prescription.

Government guidelines for GP in support of patients if you find it difficult/impossible to change brands

gov.uk/drug-safety-update/l...

If a patient reports persistent symptoms when switching between different levothyroxine tablet formulations, consider consistently prescribing a specific product known to be well tolerated by the patient.

academic.oup.com/jcem/artic...

Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).

And here

pharmacymagazine.co.uk/clin...

Discussed here too

healthunlocked.com/thyroidu...

SlowDragon profile image
SlowDragonAdministrator in reply to KatyMac68

Have you tested BOTH TPO and TG antibodies

NHS won’t test TG antibodies unless TPO antibodies are high

Significant minority of Hashimoto’s patients only have high TG antibodies

Would need to test privately via Medichecks or Blue horizon

20% of Hashimoto's patients never have raised antibodies

healthunlocked.com/thyroidu...

Paul Robson on atrophied thyroid - especially if no TPO antibodies

paulrobinsonthyroid.com/cou...

DippyDame profile image
DippyDame

This is very possibly your body adjusting to the sudden increase from 25 to 50mcg.

If you've had low thyroid hormones for some time this can happen, so you need to keep any increases low and slow.

Instead of adding 25mcg it may have been easier on your system to increase in 12.5mcg increments until your system adjusts....it may take a few months

You don't appear to have any (recent) FT3 results and I suspect you are being dosed by TSH.

For good health every cell in the body needs to be flooded with T3 by way of an adequate and constant supply.

I suspect your FT3 is low

Research shows that low T3 can cause CFS/ME....I was diagnosed with both FM, ME and IBS My (cellular) T3 turned out to be deficient.

frontiersin.org/journals/en...

Optimal nutrients is a good start they support thyroid function and T4 to T3 conversion

If your T3 is low cholesterol level can rise....it will fall when on adequate thyroid hormone replacement. Mine did!

GPs are too quick to prescribe statins and are sadly lacking in thyroid knowledge...so they grasp the wrong straws!!

Postural hypotension is a symptom of low thyroid hormone

guysandstthomas.nhs.uk/heal...

Tick off your symptoms from this list and use it as evidence if needs be....they all suggest hypothyroidism as you can see in this link

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

So....No! 50mcg is not too much it is actually the usual adult starting dose. You are likely to need considerably more T4.

Your main problem is an ignorant GP!!

Unfortunately there is no quick cure and the road to improvement will need time and patience...understanding what is happening is important!

Meantime, split your dose following Slow Dragon's advice and hang on in there...things will improve

We're all here to help...just ask!

KatyMac68 profile image
KatyMac68 in reply to DippyDame

My results (now I'll read the rest now)

Feb 24

Serum TSH level 5.13 mIU/L [0.27 - 4.2]; Above high reference limit

Serum free T4 level 15.7 pmol/L [12.0 - 22.0]

Started levothyroxine 25

Sept 22

Serum TSH level 4.10 mIU/L [0.27 - 4.2]

Serum free T4 level 12.3 pmol/L [12.0 - 22.0]

Nov 21

Serum TSH level 7.00 mIU/L [0.27 - 4.2]; Above high reference limit

Serum free T4 level 14.6 pmol/L [12.0 - 22.0]

Jun 21

Serum TSH level 2.20 miu/L [0.27 - 4.2]

Serum free T4 level 12.1 pmol/L [12.0 - 22.0]

Nov 18 (after surgery to remove my ovaries)

Serum TSH level 2.87 miu/L [0.27 - 4.2]

Serum free T4 level 15.0 pmol/L [12.0 - 22.0]

Feb 18

Serum TSH level 3.18 miu/L [0.27 - 4.2]

Serum free T4 level 14.9 pmol/L [12.0 - 22.0]

DippyDame profile image
DippyDame in reply to KatyMac68

Yes...you need more levo!

Best if you can include FT3, TPO and TG antibodies in a test

Many of us test privately

thyroiduk.org/testing/priva...

KatyMac68 profile image
KatyMac68 in reply to DippyDame

Yes I can't test privately; I've run out of money as I'm not working

I'm saying no to new meds (statins) while I am getting used to the new levothyroxine

I've done tonnes of blood pressure tests and they are all high so I'm getting ready to refuse high blood pressure meds too - I need to keep side effects/improvements one medicine at a time

I'm just so tired

DippyDame profile image
DippyDame in reply to KatyMac68

Best then to very slowly increase the levo and your GP should do some tests.

Take care

KatyMac68 profile image
KatyMac68 in reply to DippyDame

Thanks, testing is on the list along with a root canal and new glasses!

I hope I can work soon

humanbean profile image
humanbean

Personal anecdote : I couldn't tolerate Levo when I first started taking it. In my case the main cause was very low iron and ferritin (iron stores). You could ask your doctor for a full iron panel - not just ferritin like they usually do - and get a copy of the results from your surgery when the results are in, then post them here, including reference ranges.

Please note that iron supplements that the NHS prescribes can be bought in pharmacies in the UK without a prescription, and they aren't hugely expensive. (Under a tenner for a box of 84 ferrous fumarate 210mg when I last bought them.)

Low iron can cause fast heart rate aka tachycardia. If low iron gets bad enough it can cause chest pain. Of course, if this chest pain is investigated and the doctors don't find a blockage in the heart to explain the chest pain they tell you that you have non-cardiac chest pain and they decide this is caused by anxiety or hypochondria. (That's what happened to me anyway - I had to fix my own low iron/ferritin, and hey presto! it cured my recurring chest pain.)

KatyMac68 profile image
KatyMac68

I take 2 floradix three times a week and a daily methyl folate

The last time my ferritin was checked it was lovely I think (i'll double check)

Anxiety and hypochondria, how kind of them - I'll bet you felt special! I got "functional leg pain" before my fibro diagnosis! Not that fibro is much better as a diagnosis!

KatyMac68 profile image
KatyMac68

Arr these iron related?

Serum folate level > 20.0 ug/L; Please note change in the reference range for Folate

effective from 08/10/2018.

<3 ug/L suggestive of folate deficiency.

Haemoglobin A1c level - IFCC standardised 37 mmol/mol [20.0 - 41.0]

Haemoglobin A1c level 5.5 % [4.0 - 5.9]

helvella profile image
helvellaAdministratorThyroid UK in reply to KatyMac68

You can find a summary of iron-related tests here:

Iron Tests

Also Known As

Fe tests

Iron Indices

Formal Name

Iron Tests, Iron studies/profile

labtestsonline.org.uk/tests...

Folate is very closely tied to vitamin B12

Vitamin B12 and Folate

Also Known As

Vitamin B12 or Cobalamin

Folic Acid

RBC folate

Formal Name

Vitamin B12 and Folate (or Folic Acid)

labtestsonline.org.uk/tests...

Haemoglobin A1c is blood sugar related.

HbA1c Test

Also Known As

Haemoglobin A1c

Glycated or glycosylated haemoglobin

Formal Name

HbA1c

labtestsonline.org.uk/tests...

KatyMac68 profile image
KatyMac68 in reply to helvella

Thanks 😊

humanbean profile image
humanbean in reply to KatyMac68

Folate is a vitamin often discussed in connection with vitamin B12, as helvella said. Another rarely used name for folate is Vitamin B9. The body needs adequate levels of folate in order to make use of Vitamin B12.

Your level of >20 micrograms/L is very good. It would be useful to know what your B12 level is too.

Iron is not a vitamin it is a mineral.

Haemoglobin A1c is used by doctors to diagnose pre-diabetes and diabetes, Your level is well within range so you aren't pre-diabetic or diabetic.

There is another reference to a Haemoglobin (Hb) test in the FBC (Full Blood Count) but it isn't measuring the same thing as Haemoglobin A1c. The Hb in the FBC is used by doctors to determine whether someone is anaemic. Anaemia is diagnosed when Hb is below range.

There are multiple causes of anaemia, but by far the commonest one globally is low iron. But it can also happen with low B12 and/or low folate, and other conditions :

irondisorders.org/wp-conten...

Doctors rarely test an iron panel in my experience, they only test ferritin (iron stores). This means they can miss indications of low iron, particularly if you have inflammation or infection anywhere in your body, because inflammation and/or infection raise ferritin making iron look better than it really is.

This all means that doctors will rarely treat iron deficiency if there is no anaemia. But iron deficiency should be treated with or without anaemia.

cmaj.ca/content/cmaj/184/11...

onlinelibrary.wiley.com/doi...

There is a finger-prick test for an iron panel available online, for a fee :

medichecks.com/products/iro...

There is also a 10% discount code available for Medichecks here :

thyroiduk.org/testing/priva...

helvella profile image
helvellaAdministratorThyroid UK in reply to humanbean

But iron deficiency should be treated with or without anaemia.

Just as well airline pilots don't behave like this. Supposed to be flying at 30,000 feet but actually descend to 3,000 feet and only then decide to increase thrust and climb again. It would be one thing if they didn't realise they'd dropped to 3,000 feet (imagine a faulty altimeter) - but altogether another if they'd seen 20,000, 10,000, 5,000, 4,000 and just ignored until the Ground Proximity Warning System alerted them.

KatyMac68 profile image
KatyMac68

My b12 is over 2000 I cheat!

I take floradix regularly, but I think testing will have to wait until we have enough money

I take methyl folate too and ubiquinol - plus the normal magnesium, zinc, potassium, d, k2 - I flirted with rosehip for a bit but I was on the wrong progesterone so that needs a new trial

Oh and a probiotic

Diabetes is the one thing i thought id develop - my childhood gp regularly tested me for it and was confused into adulthood why I wasn't- so I assumed type 2 would arrive and not yet!

KatyMac68 profile image
KatyMac68

The pharmacist at the surgery agreed to try wockharst again

But the chemist can't give it to me until the pharmacy say that brand and 25 (so I take 2)

So 4 phone calls later

And now I have a burst blood vessel I my eye, my head is killing me and I feel a bit anxious/panicky

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