Over-medicated (Levothyroxine)?

[Merrymoo]

Hello, I wondered if someone could help me? Apologies for posting lots of results below, but I thought it might help with context. I have just received my latest NHS results and I think I may be over-medicated still? Interestingly, I had a dose reduction 6 weeks ago and although my FT4 has reduced, so has my TSH. (All blood tests were taken between 8am-9am, before medication and with no biotin 5 days before). I should add that I have been taking various supplements in the last two months to potentially help with inflammation and possibly TSH levels under the advice of a functional doctor (although not a thyroid expert), which is the reason I have done several random blood tests. I also cut out gluten in November and Dairy in June. I have minimal symptoms compared to two months ago, but as I have osteopenia I am keen not to over-medicate and make this worse. I have an appointment with my GP on Weds and would really appreciate advice on how to guide the conversation! TIA:

26/08/2023 Medicheck / un-medicated

TSH 11.2 (0.27-4.2) (278.1)

FT4 13.1 (12-22 (11.1%)

06/09/2023 NHS / un-medicated

TSH 6.58 (0.27-4.2) (160.6%)

FT4 12.8 (12-22) (8%)

08/12/2023 NHS / un-medicated

TSH 2.4 (0.27-4.2) (54.2%)

FT4 14.6 (12-22) (21.7%)

18/12/2023 (Blue Horizon) / Un-medicated

TSH 10.6 (0.27-4.20) (262.8%)

FT4 12 (12-22) (0%)

FT3 3.1 (3.1-6.8) (0%)

Tg 263 (<115 )

TPO 166 (<34)

02/04/2024 (Blue Horizon) / Un-medicated

TSH 20.6 (0.27-4.20) (517%)

FT4 11.9 (12-22) (-1%)

FT3 4.1 (3.1-6.8) (27%)

Tg 235 (<115)

TPO 147 (<34)

18/04/2024 (NHS) / Un-medicated

TSH 11 (0.27-4.2) (273%)

FT4 14.5 (12-22) (25%)

28/05/2024 (Monitor My Health). Test after 4 weeks on Levo 50 and then 2 weeks on Levo 75 (advised to increase dose by GP as many symptoms)

TSH 0.1 (0.27-4.20) (-4.3%)

FT4 29.1 pmol/L (12-22) (171%)

Ft3 5.1 (3.1-6.8) (54.1%)

TPO 134 (<34)

NHS tested the same day with following results:

TSH 0.1 (0.27-4.2) (-4.3%)

FT4 26.7 (12-22 (147%)

*DOSE REDUCTION ADVISED TO LEVO 50*

02/07/2024 (Monitor My Health). Test after 4 weeks on Levo 50

TSH 0.06 (0.27-4.20) (-5.3%)

FT4 23.1 (12-22) (111%)

FT3 4.4 (3.1-6.8) (35.1%)

TPO 127 (<34)

16/07/2024 (NHS) Test after 6 weeks on Levo 50

TSH 0.08 (0.27-4.20) (-4.8)

FT4 20.00 (12-24) (66.7%)

[HealthStarDust]

Oh crikey. Something similar has just happened to me recently. I reduced dose once levels were too high, then very bizarrely the levels came back even higher 8 weeks later, then after 8 weeks of no levothyroxine my TSH is still suppressed and FT4 and FT3 still over range. Madness!

[Merrymoo in reply to HealthStarDust]

It's odd, isn't it? I should have added that I have had a recent thyroid scan which confirmed thyroiditis. I'm really not sure what to do now?

[HealthStarDust in reply to Merrymoo]

I’m wondering if that’s what I have right now and I am so very confused by it. I’m confused as to what thyroiditis actually is and if it’s what the group think here call the ‘hashi swing’.

You seem to be getting some care so that’s good. I’m having to fight for it with a GP not knowing what to do and local endocrinology not accepting referrals and being generally crap at giving GP advice. Seems like everyone is passing the buck. I should mention it’s all NHS.

Hapoy to compare notes via chat. We hear so often that people go from hypo to hyper, and hyper to hypo after surgery, yet what is happening to us makes so little concrete sense right?!

[tattybogle in reply to Merrymoo]

6 wks is really the earliest to look the effect of a stable dose on bloods , blood levels are likely to be swinging around a bit during the first few wks after adding thyroid hormone , or changing dose, as the HPT axis responds to the addition of T4 and rebalances TSH response.

since 50 mcg seems unlikely to be 'too much' given how low your T4 has been and how high you TSH has been before levo , personally , i think if you give 50mcg another few weeks to settle in.... you may find your TSH starts to rise again.

that would give you a better idea of how you feel on 50mcg .

how i feel on any dose will usually keep change over the first few wks ,i find week 8-12 is probably better for assessing how i feel.

[Merrymoo in reply to tattybogle]

Thank you tattybogle.

[greygoose]

Do you have Hashi's?

[Merrymoo in reply to greygoose]

Yes, I do.

[greygoose in reply to Merrymoo]

Then that is more than likely why your FT4 shot up, and nothing to do with your dose. But it's only temporary. Eventually the level will come down by itself and you'll be hypo again.

[Merrymoo in reply to greygoose]

Thanks GreyGoose.

[greygoose in reply to Merrymoo]

You're welcome.

[janeroar]

Before you started on meds did you have any symptoms?

Wondering if you’re thyroid is swinging between hypo and hyper thyroid which is not uncommon with Hashimotos- you can get flares- it account for the odd blood results

[Merrymoo in reply to janeroar]

Hi Janeroar, yes, I had lots of symptoms before starting meds,

[SlowDragon Administrator]

what are your most recent vitamin D, folate, ferritin and B12 results

Exactly what vitamin supplements are you taking

[Merrymoo in reply to SlowDragon]

Hello SlowDragon, the most recent vitamin results below. I'm planning on retesting in a couple of weeks, but still supplementing so doubt they have changed significantly:

Vit D (2/2/24): 107 (75-200 nmol/L )

Serum Ferritin (8/4/24): 85 (30-148 ug/L)

Active B12 (2/4/24): 127 (37.5-150pmol)

Serum B12 (18/4/24) : 674 ng/L (197-771 ng/L)

Serum Folate (18/4/24): 15.1 (3.9-26.8 ug/l)

Magnesium (2/4/24): 0.89 (0.66-0.99nmol/L)

Selenium (20/5/24): 115 (65-150 ug/l)

RBC Count (18/4/24): 4.06 (3.7-4.8 10*12/L)

I'm taking the following supplements, keeping 4 hours away from levo:

Calcium citrate

Iron

Curcumin

Magnesium

EPA/DHA

Vit C

Vit D3

Zinc

Vit K2

Multi B: including B12; folic acid, biotin; choline; B1; B2; B6; niactin (stopped 5 days before blood test)

Ashwaganda

Black Cumin sees

Myo-inositol

Digestive enzymes

[silverbelle51]

The most important tests are the ones you seem to be missing Iodine and Selenium . It seems to be the very ones none of them do before placing us all on thyroid replacement which does nothing , but make you sicker if your thyroid is healthy, but not being "properly fueled" I painfully know cause it happened to me . Here in the U.S.A. most doctors are totally ignorant to functional medicine aka how the body works. Too busy with "Protocol Manuals so many are so busy "trying to fill the gas tank while you actually have a slow leak in your tires" my feeble attempt at humor out of frustration ! Good Luck !

[Merrymoo in reply to silverbelle51]

Thank you. I have had private selenium tests, albeit after starting Levo, and it's all good (above). I'm actually getting my iodine results on Thursday!

[janeroar]

Is there a reason to be taking calcium? It’s generally not recommended. Can block your arteries.

[Merrymoo in reply to janeroar]

Hello Janeroar, I have oesteopenia so I take it to help my bones, but I also take Vitamin D and K2. I keep it to a dose of 400mg to boast my daily intake which would otherwise be low.

[janeroar in reply to Merrymoo]

hi there I’ve just tried to send you links about the risk of calcium supplements, in particular their links with heart disease in healthy women. For some reason I can’t paste the links here but a quick google will reap lots of studies. There’s increasing evidence for weight bearing exercises and a diet high in fruit and veg and protein (good vitamin c levels in food linked with lower rates of osteopenia) to regain lost bone mass plus integrating calcium rich foods in your diet

[Merrymoo in reply to janeroar]

Janeroar, thank you for taking the time to bring this to my attention - kind of you. I'll take a look at the studies. My GP tried to put me on 1,000mg of calcium carbonate a day just over a year ago, which I refused to do and have since been supplementing with between 300mg and 450mg of calcium citrate a day, but I will definitely reconsider. I do weights, resistance and upped my protein (useful for Hashimotos too). I have also started HRT, so hopefully this will help. Thank you again !