too much thyroxine

[LadyLola]

at the end of last year my thyroxine was raised from 175mcg to 225mcg in one fell swoop. I began to experience exhaustion fatigue severe joint pains a generally feeling ill as well as low mood. Despite seeing GP on several occasions over a period of 3 months l wasn’t offered any explanation or solutions. In desperation l saw a different GP and insisted on a blood test as l knew the symptoms were Thyroid related. Sure enough the results revealed that my tag and t3 and t4 levels were all over the place. I was reduced initially to 200mcg and after further bloods back to 175mcg. I now feel much better but l had over 3 months of pure hell. Aileen

[helvella Administrator Thyroid UK]

Time and again I point my finger at prescribers who are heavy-handed in making dose adjustments.

Sometimes, like when someone is heading for a myxoedema coma or thyroid crisis (storm) large changes to dosing regime are essential. Whether that is to start thyroid hormone or to drop it, or just make a big adjustment to an exiting dose.

And there can be special considerations when someone has had a thyroidectomy and they need to start on a significant dose pretty much exactly when their blood thyroid hormone levels drop (assuming they started off being hyperthyroid).

It is also arguable that, when starting levothyroxine treatment, maybe we should start at anywhere between 50 and 100. (Or something like this. I'm only saying this so that this is another special case. Not to discuss it to the finest degree.)

But, most of the time, it is a case of someone having thyroid blood tests that indicate too low, or too high, a dose. With no particular urgency and no real risk in doing things slowly and carefully.

Why, then, do so many insist on making these heavy-handed adjustments?

Why increase by 50?

Why not increase by 25? Or even 12.5?

And the same arguments when dropping doses.

For the time it takes to adjust doses, maybe a few weeks, alternate day dosing is probably fine. (Though I prefer exactly the same dose every day in the longer term.) It is easy to adjust by 12.5 by adding/dropping 25 every other day. And this can be repeated to slowly add/drop by any amount.

Why not prescribe so that the person taking the levothyroxine can try 12.5 for a while, then, if they feel the need, go to 25? Give them a prepared blood test form to use when they have been at a dose for a few weeks and they are stable on it.

In this case, it certainly reads that no adjustment at all was needed. But a slow and incremental approach would have allowed it to be abandoned when they felt worse.

I'll also point out that just because a prescriber determines a dose, it does not force anyone to take it. You might end up having an argument with an unhelpful prescriber. But you can avoid the effects of too big a dose change. (Not entirely true in practical terms. You might need more tablets, or different dosages. But the principle is there.)