Hypothyroidism for 8 years. Now aged 64. Struggling recently with excessive fatigue. Keep reasonably fit cycling 20 miles x 3 times a week. Doctor questioned how I was taking pills and stated take early morning 30 mins before drink or food. This did not work effectively.
I changed the regime. I set the alarm for 4am! (body clock now does this for me). Take tablets. Back to sleep. Cup of tea 6.30am.
Resolved my fatigue in about 3 weeks.
I appreciate it's a massive bind to get up at 4am but I feel so much better in the day.
Personally I don't think 30 mins in anywhere near enough before drink or food.
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I wouldn't adjust your dose based on fT4 and TSH alone, the key is knowing how well you are converting to fT3 as this is the active hormone
150mcg isn't huge I'm guessing you weight around 90kgs? If you feel well I wouldn't recommend reducing, have you had blood tests for folate, ferritin, B12 and Vit D?
'looking to reduce dose downward gradually from 150mg which I guess is quite high.'
Do bear in mind that levothyroxine is not a 'drug' in the conventional sense. It's a replacement hormone. You need what you need and everyone is individual in how their body absorbs and utilises the exogenous hormone.
'I appreciate it's a massive bind to get up at 4am '
Lots of people take their levothyroxine at, or during the night. Many people need to use the bathroom during the early hours 😊 so that makes it a convenient time for them. But if not, as you suggest, set alarm and have tablets ready with small glass of water on bedside table within arms reach.
I take my thyroid hormone replacement at a toilet break at around 2/3 in the morning and go back to sleep for a couple of hours and this works very well for me.
As we age, and metabolism ' slows down ' it's likely our ability to convert T4 into T3 the active hormone that runs all our bodily functions also becomes slowed - as you have found by allowing more time for your body to digest and absorb your medication by taking it in the early hours of the morning.
It is essential that you run a T3 alongside the T4 and TSH blood test - as you need to maintain a good level of T3 to allow you the energy, health and well being to want to ride your bike and enjoy your free time.
I believe there is some guideline somewhere suggesting that thyroid hormone replacement needs reducing when patients reach ' an age ' - presumably to mimic ' real life of a healthy person ' and no thought is given as to why and what you were diagnosed with and why you were even prescribed this medication in the first place.
Please do not allow your dose to be adjusted down on this ' thought ' that you are on too much T4 - if you are well and happy and getting on with your life - stay where you are and insist - or run your own blood test so to establish where your T3 needs to be maintained to support your health and well being.
No thyroid hormone replacement works well until the core strength vitamins and minerals of ferritin, folate, B12 and vitamin D are up and maintained at optimal levels -and down regulation of T4 to T3 can also be compromised by inflammation, antibodies, any physiological stress ( emotional or physical ) depression, dieting and ageing.
Thyroid uk the charity who supports this patient to patient forum has a web page dedicated to Private companies who can run the necessary blood test and you then start a new post with the results and ranges and you will be given considered opinion as to where optimum levels sit - as just being in an NHS range somewhere,when some ranges are too wide to even be sensible, not helpful.
When replying to someone you need to ensure their name comes up in the reply as they then get notified they have a message waiting - so just make sure you reply by pressing the reply button within their post to you.
Just to add rgarding T3 - you need a thyroid panel to include the Free T3 and Free T4 drawn at the same blood - a T3 test seen in isolation doesn't tell us anything.
Dieting is not advised as again this can down regulate T4 to T3 and if you care to share we an offer considered opinion on any blood test reading and ranges.
Levothyroxine is an extremely fussy hormone and should always be taken on an empty stomach and then nothing apart from water for at least an hour after
Many people take Levothyroxine soon after waking, but it may be more convenient and perhaps more effective taken at bedtime
No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.
Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away
(Time gap doesn't apply to Vitamin D mouth spray)
If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test
If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal
Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine
Or after changing how you take your levothyroxine
For full Thyroid evaluation you need TSH, FT4 and FT3 tested
Very important to test vitamin D, folate, ferritin and B12 at least once year minimum
Also both TPO and TG thyroid antibodies tested at least once to see if your hypothyroidism is autoimmune
About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high TPO and/or high TG thyroid antibodies
Autoimmune thyroid disease with goitre is Hashimoto’s
Autoimmune thyroid disease without goitre is Ord’s thyroiditis.
Both are autoimmune and generally called Hashimoto’s.
Significant minority of Hashimoto’s patients only have high TG antibodies (thyroglobulin)
20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis
In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)
Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease
or as we get older
Are you currently taking any vitamin supplements
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)
Very unlikely that GP can test Ft3 or lab will refuse to test
Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins
Testing options and includes money off codes for private testing
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