At the moment I take 75 on Sat, Sun, Mon and Tues and 100 on Wed, Thur and Friday. I’ve been told I can swap a 75 day for 100. I’m finding on Thursdays and Fridays I’m feeling especially tired and would like to avoid this as these are the days my son isn’t at nursery.
Any help appreciated.
Also sorry if this is complicated. I tried to word it as simply as I could
It doesn't seem to be complicated so much as, ahem, unusual!
Alternate day dosing (e.g. 75 one day, 100 the next, repeating) is common enough.
And a few people do something like take a lower (or higher) dose once a week.
Some of us don't like that and prefer same dose every day. In your case that would need you to work out how to dose about 87.5 every day. (Achievable with tablet splitting.)
But I can't see any sense at all in four days the same, then three days higher. Your thyroid hormone levels spend four days dropping, then three recovering. Who advised this approach?
Is there any reason that you can't switch immediately to alternating 75 and 100 day by day?
Have you had any blood tests recently?
Thanks for the reply. I’m under a private endocrinologist as my GP says my levels are fine every time I get tested. Latest test results were T4 17.3 (range 11-21.2) and TSH 2.43 (range 0.27-4.2).
I’m more than happy to alternate the dose. Anything to stop me feeling so weird!
Also if it’s relevant at all I’m also on HRT so it could be that she’s putting some of my symptoms down to perimenopause
Free T4 (fT4) 17.3 pmol/L (11 - 21.2)
Ft4 only 61.8% through range
TSH 2.43 (range 0.27-4.2)
TSH over 2 is too high
These results suggest you are probably not on high enough dose
No Ft3 result or vitamin levels,
Do you always get same brand levothyroxine at each prescription
Exactly what vitamin supplements are you taking
Is your hypothyroidism autoimmune
Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine
For full Thyroid evaluation you need TSH, FT4 and FT3 tested
Also both TPO and TG thyroid antibodies tested at least once to see if your hypothyroidism is autoimmune
Very important to test vitamin D, folate, ferritin and B12 at least once year minimum
Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease
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)
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)
T3 ….day before test split T3 as 2 or 3 smaller doses spread through the day, with last dose approximately 8-12 hours before test
Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins
Post all about what time of day to test
healthunlocked.com/thyroidu...
Testing options and includes money off codes for private testing
Medichecks Thyroid plus BOTH TPO and TG antibodies and vitamins
medichecks.com/products/adv...
Blue Horizon Thyroid Premium Gold includes BOTH TPO and TG 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
support.medichecks.com/hc/e...
Medichecks and BH also offer private blood draw at clinic near you, or private nurse to your own home…..for an extra fee
Always the same brand.
Taking iron, vitamin d and a peri supplement.
Not autoimmune.
Blood test taken before thyroxine.
I think you need 100mcg levo daily
It sounds as if FT3 might be on the low side and increasing your levo may increase this by T4 to T3 conversion
Not complicated at all...easily understood.....not great dosing pattern though
Ask your GP for an increase to 100mcg daily...your labs show room for this
Don't be guided by TSH....science proves it's an unreliable marker
FT3 is the most important result followed by FT4
Until you see GP suggest increase Tuesday to 100mcg or better alternate 100mcg and 75mcg days
Fatigue is a text book sign of undermedication
Have fun with your wee one when he's not at nursery.
PS....the next time you have a thyroid test be sure to follow protocol....
At 9am
24 hours after last levo dose
At least an hour away from food and drinks... ex water
Thanks for your response! The endocrinologist said if I upped my dose too much I could flip to having hyperthyroidism and it freaked me out.
Far too much scaremongering by medics who are clueless....this one is likely a diabetic specialist.
Your endo is talking rubbish....if he claims that ask him to test FT3. You will only be overmedicated if FT3 is above ref range
As for flipping to hyperthyroidism....if you are hypothyroid it's almost physically impossible to become hyper....
Unless...
People with Hashi's do occasionally swing briefly to hyper but that is transient until the thyroid stops dumping extra hormones, then levels fall back.
Your labs, done when you took levo too close to test may have freaked him out....bet he didn't ask when you took your levo!
Also...
Hormones like estrogen and progesterone can bind to thyroid hormone and prevent absorption. Take the two medications an hour apart.
The HRT is patches so a continuous dose. Blood tests were done before taking my thyroid meds. I did tell her that but she said it makes no difference. Maybe I’ll just up the dose little by little and see what happens
Patches should be ok so long as you ensure you do not become undermedicated...it looks as if you have, so increased dose will help
Interactions between your drugs from drugs.com
Moderate
levothyroxine estradiol
Applies to: levothyroxine and Estradiol Patch (estradiol)
Before taking estradiol, tell your doctor if you also use levothyroxine. You may need dose adjustments or special tests in order to safely take both medications together. If you are already taking estradiol and levothyroxine, your thyroid levels may need to be measured if your dose of estradiol is changed or stopped. You should notify your doctor if you have symptoms of low thyroid such as tiredness, feeling cold, constipation, unexplained weight gain, depression, joint or muscle pain, thinning hair or hair loss, dry skin, hoarseness, and abnormal menstrual periods. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.
Sorry....but timing of dose/test does make a difference.
With advice like that it's little wonder so many of us end up struggling.
Sat, Sun, Mon and Tues....currently 75mcg
I would increase Sat to 100mcg then the following week increase Sun....and so on until 100mcg daily
Then wait 6/8 weeks on that steady dose and do a full thyroid test making sure you leave a 24 hour gap between dose and test....that ensures the dose is settled in the system...
or ...absolute minimum test ....TSH, FT4 and FT3
See Slow Dragon's details re testing to include esential nutrients
As I said above you are not in danger of becoming hyperthyroid....
..overmedication however must be avoided so testing is important
You should be fine when adequately medicated
No need to freak out
Mild over-medication is always a possibility when you increase a dose - mainly if you are already close to an adequate dose and the increase is possibly a bit heavy-handed.
But mild over-medication is just not a problem. If you feel slightly different, and your blood tests show a bit high, then you drop - a little.
In perfect health our bodies manage thyroid hormones in a way that means we go very slightly over, adjust, go very slightly under, adjust, etc., etc. This is a dynamic system that continually adjusts pretty much hour by hour.
But if our thyroid is not working properly, we just have to do the best we can. The mild over-medication, and mild under-medication, from making small dose adjustments is inevitably going to be less smooth than in perfect health. But that's about it.
The thing we can do that is wrong is not test, not adjust doses, lose awareness of the differences between being under and over.
And no over-medication is EVER hyperthyroidism. Just major over-medication feels rather like hyperthyroidism. But, unlike Graves (or other causes), it can and will be corrected by dose adjustment.
Thank you for this! This is so helpful and has defs put my mind at ease
Suggest reread previous post
healthunlocked.com/thyroidu...
Are you now completely off propranolol
Have you got vitamin D tested
If not….
NHS easy postal kit vitamin D test £31 via
Aiming for vitamin D at minimum over 80nmol
Vitamin D mouth spray by Better You is very effective as it avoids poor gut function.
There’s a version made that also contains vitamin K2 Mk7.
One spray = 1000iu
amazon.co.uk/BetterYou-Dlux...
It’s trial and error what dose we need, with thyroid issues we frequently need higher dose than average
Vitamin D may prevent Autoimmune disease
newscientist.com/article/23...
Web links about taking important cofactors - magnesium and Vit K2-MK7
Propranolol lowers magnesium. Are you now taking daily magnesium supplements
Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine
betterbones.com/bone-nutrit...
medicalnewstoday.com/articl...
livescience.com/61866-magne...
sciencedaily.com/releases/2...
Recipe ideas
bbc.co.uk/food/articles/mag...
Interesting article by Dr Malcolm Kendrick on magnesium
drmalcolmkendrick.org/categ...
Vitamin K2 mk7
betterbones.com/bone-nutrit...
healthline.com/nutrition/vi...
ideally you need to get BOTH TPO and TG thyroid antibodies tested. NHS won’t test TG antibodies as your TPO antibodies are negative
Significant number of Hashimoto’s patients only have high TG antibodies
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...
Completely off propanolol. Have been for months.
Great ….so likely now needing to slowly increase your levothyroxine
How much do you weigh in kilo
73.5kg
So eventually likely to need to be on at least 112.5mcg per day
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 (typically 1.6mcg levothyroxine per kilo of your weight per day)
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.
Some people need a bit less than guidelines, some a bit more
TSH should be under 2 as an absolute maximum when on levothyroxine
gponline.com/endocrinology-...
Graph showing median TSH in healthy population is 1-1.5
web.archive.org/web/2004060...
Comprehensive list of references for needing LOW TSH on levothyroxine
healthunlocked.com/thyroidu....
onlinelibrary.wiley.com/doi...
If symptoms of hypothyroidism persist despite normalisation of TSH, the dose of levothyroxine can be titrated further to place the TSH in the lower part of the reference range or even slightly below (i.e., TSH: 0.1–2.0 mU/L), but avoiding TSH < 0.1 mU/L. Use of alternate day dosing of different levothyroxine strengths may be needed to achieve this (e.g., 100 mcg for 4 days; 125 mcg for 3 days weekly).
You might need to fine tune dose
eg 112.5mcg 5 days and 125mcg 2 days
Thank you!
alternate dose on alternate days
Does alternating higher/lower doses of Levothyroxine on alternate days affect TSH?
Is it likely to feel dose difference
T4 to T3 dose difference
Will being on optimal Levo dose for weight make a big difference in mood etc? 
