Medication query

[Joeyy06]

Hi everyone

I have had hypothyroidism for a number of years and have been on 150mg of thyroxine. In the last month I have lost over a stone and my recent blood test showed my TSH was 0.07 and Free T3 & T4 normal. The doctor has told me to take 150mg 6 days a week and 100mg on one day a week. This doesn’t seem much of a difference to me. I have started to feel a bit jittery but not sure if that’s something else! Has anyone got any advice on this? Thank you!

[Buddy195 Administrator]

Welcome to the forum Joeyy06

So we can offer better advice, can you tell us more about your thyroid condition, eg ongoing symptoms other than weight loss, plus blood test results (with ranges in brackets) for:

TSH

FT3

FT4

Do ask your GP for copies of any tests; you are legally entitled to these.

It is useful to share any antibody and key vitamin tests (ferritin, folate, vitamins D and B12). Antibody tests show if your thyroid condition is auto immune (aka Hashimotos).

If your GP is unable to complete all the above (eg if TSH is within range, some surgeries may not be able to access FT4 and FT3 tests), you could look to do this privately, as many forum members do, for a better picture of your thyroid health:

thyroiduk.org/help-and-supp...

Many GPs lack knowledge on thyroid disorders and look at TSH only. This may be reason why your medication was reduced. Although many members report a weight increase if thyroid medication and key vitamins are not optimal, I seem to lose weight/ have palpitations/ fast pulse and tremor.

[Joeyy06 in reply to Buddy195]

Thanks for the welcome. My levels are:-

T3 - 4.7

T4 - 22.9

TSH - 0.07

These have been normal for years but the TSH has only dropped since I lost weight so I am guessing 150mg may be too much now. I used to be on 125 until put on weight! Hope that makes sense!

Thanks again

[Buddy195 Administrator in reply to Joeyy06]

We need to see the reference ranges for each test, as these can vary between laboratories. This will enable us to offer better advice.

Yes, it could be that weight loss means you need slightly less Levothyroxine. I have found through experience that I need to make adjustments (both increases and decreases) very slowly, eg 12.5 mg daily (&find a pill cutter useful for this). Once settled on this reduction, I then reduce again if needed. I would not reduce by 50mcg in one go, although many members can tolerate reducing by 25mcg.

Please ensure GP is retesting levels 6-8 weeks after a dose change. Also ask for key thyroid vitamins testing if you haven’t already.

[DippyDame]

Sorry, but Free T3 & T4 normal means nothing other than the result sits within the ref range.

You need to find the exact point within the range where you feel symptom free

Please add these reference ranges.

Your doctor may be dosing by TSH alone which is not a reliable marker

It sounds as if you are overmedicated and if so, them 'Yes"....dropping 50mcg a week is an odd solution

But without both FT4, FT3 labs and their respective reference ranges it's only a rough guess which is no help

[SlowDragon Administrator]

ALL thyroid blood tests should be 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)

Do you always get same brand levothyroxine at each prescription

ESSENTIAL to also test vitamin D, folate, ferritin and B12

What vitamin supplements are you taking

The doctor has told me to take 150mg 6 days a week and 100mg on one day a week.

What a sensible GP …..one who understands we need to fine tune dose and not change too much

Retest 8-10 weeks after any dose reduction

[Joeyy06]

Thanks everyone. All useful advice. GP is going to test in 6 weeks. Never had an issue until I lost weight (5:2 diet!) which makes sense really!

[DippyDame in reply to Joeyy06]

I think this may be the missing piece of the puzzle Joeyy06

Never had an issue until I lost weight (5:2 diet!)

You say above...

In the last month I have lost over a stone

That is rapid weight loss and not best suited to hypos

Extreme dieting can have negative health impacts. According to a 2014 study, weight loss can lead to a minimal decrease in thyroid hormone activity levels. The study suggests that drastic dieting and bariatric surgery can lead to potential thyroid issues.

pubmed.ncbi.nlm.nih.gov/239...

pubmed.ncbi.nlm.nih.gov/234...

Hope levels settle before your next test