Afternoon crash

[Bridkid67]

Hi ive posted before currently on 75mcg of levothyroxine I always take it early morning around 6.30 / 7 leave a good couple of hrs before food drink etc I only take a good fish oil and garlic and B12 spray in late afternoon about 5 I feel shocking muscles aches feel irritable and generally cannot be bothered last time I spoke to my Dr he said my TSH level was steady at 2.8 I,have a review next week for urine and hopefully bloods was thinking should I take my levothyroxine at 2 different times ?any advice is appreciated thanks .

[greygoose]

Your TSH may be steady but it's too high. Should be more like 1 or under. So, you obviously need an increase in dose - obvious to anyone who knows anything about thyroid, which excludes doctors.

By taking your levo at two different times, do you mean splitting your dose? A lot of people do that and find it beneficial. But if you're not taking enough, it won't help much. You still need an increase in dose.

[Bridkid67 in reply to greygoose]

Thanks yea was thinking about splitting my dose but I've a review next week so going to lay it on the line to them because Mr Dr is to clued up he thought my low good cholesterol level of 0.65 was ok?

[greygoose in reply to Bridkid67]

As far as doctors are concerned - and I quote - cholesterol can never be too low! Idiots. That's because they have no idea what it is or what it does. Doctors are useless where thyroid and nutrition are concerned and they have no idea about interpreting blood test results. I really don't know why we bother with them... Well, I don't anymore.

[Ashupan in reply to greygoose]

I was told if TSH high, then thyroxine needs to be decreased.? Is this wrong?

[PixieElv in reply to Ashupan]

the opposite is true. As GreyGoose says, it should be around 1 or below and if it’s higher you need more Levo.

[greygoose in reply to Ashupan]

One thing I've noticed over the years is that doctors sometimes don't know the difference between 'up' and 'down', and will say that TSH is 'high' when it's around 0.05 or something, and 'low' when it's over 10! Yes, as incredible as that sounds, it does happen! So, maybe whoever told you that was one of those doctors?

The higher the TSH, the lower the thyroid hormone levels. Therefore if TSH is high, the dose needs to be increased. That's about the only use the TSH result has.

Once it gets below 1 it doesn't tell you much so dosing should be done by the thyroid hormone levels: FT4 and FT3. For example, the TSH does not distinguish between T4 and T3 and cannot therefor tell you how well you're converting. But, that is far to complicated for the majority of GPs to understand. I find them a very dim-witted lot, on the whole.

[Ashupan in reply to greygoose]

Ok. My TSH is low.0.27

But after thyroidectomy and on thyroxine, TSH is reduced.

Correct Greygoose? I am trying hard to get my head round all this.

The Endo said even if he lowered my dose a smidge, it prob wouldn’t change my TSH much.

[greygoose in reply to Ashupan]

Why would he want to reduce your levo? How much are you taking?

No, reducing your dose a smidgen probably wouldn't change your TSH? But so what? It's not about the TSH, it's about thyroid hormone levels. And it would probably change your FT4. So, unless that is high, you don't want your dose changed.

[Hidden in reply to Ashupan]

Sorry we couldn’t continue our PM conversation. Hope you’re now feeling better.

That TSH is too high for the early days following thyroidectomy and RAI when a more suppressed TSH is essential. You need more thyroid hormone and it would be better if that included some T3. There’s a general acceptance that without a thyroid you can’t feel well without T3.

The blood results you showed me on PM also showed high Thyroglobulin antibodies. These need to be much lower. They are a vital indicator of the presence of cancer cells.

Even now, 12 years after TT I am tested for Thyroglobulin.

[jgelliss in reply to greygoose]

GG Great Response as Always. Those times that I feel that my day was more physically stressful I get a slump in the afternoon. I take 2.5mcg T3 and it's Very Helpful .

[tattybogle]

If they say your TSH is ok at 2.8 and won't increase , show GP some of these , they all advise GP's to keep TSH below 2/ 2,5 in all patients on levo, They show your dose could safely be increased a little :

healthunlocked.com/thyroidu.... my-list-of-references-recommending-gps-keep-tsh-lower-in-range

[Josephineinamachine]

hi I would also lay on with the ‘classic’ symptoms as GPs often only seem to recognise these - so you could say you have terrible ongoing constipation, debilitating fatigue and feel low; that you’re losing your appetite still and gaining weight. Usually that’ll do the trick. Good luck - you definitely need an increase!

[tattybogle in reply to Josephineinamachine]

agreed , you have to keep it very "simple's" for most GP's .... if you report being 'constipated and feeling very cold' and they will hopefully think 'hypo'.

If you say the words 'tired all the time , low mood' ... they will unfortunately think 'antidepressants'

[Bridkid67 in reply to tattybogle]

That's true he has already mentioned Mental health unbelievable.

[SlowDragon Administrator]

Just testing TSH is completely inadequate

With such high TSH on levothyroxine your Ft4 and Ft3 likely low

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

Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease and/or when on inadequate dose of levothyroxine

Essential to test vitamin D, folate, ferritin and B12

Lower vitamin levels more common as we get older

For good conversion of Ft4 (levothyroxine) to Ft3 (active hormone) we must maintain GOOD vitamin levels

What vitamin supplements are you taking

VERY important to test TSH, Ft4 and Ft3 together

What is reason for your hypothyroidism

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)

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

thyroiduk.org/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...

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

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 somewhere near full replacement dose (typically 1.6mcg levothyroxine per kilo of your weight per day)

cks.nice.org.uk/topics/hypo...

bnf.nice.org.uk/drugs/levot...

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).

[SlowDragon Administrator]

In previous posts you say (correctly) your GP wanted to get your TSH down to around 1

You are clearly in need of next increase in dose Levo to 100mcg daily

Get full thyroid and vitamin testing done 2-3 months after increase to 75mcg

Remember to stop vitamin B complex 5-7 days before any blood test

[SilverSavvy]

Completely concur with everything these guys have said. I've been titrating up on levo and every time my body adjusts and I'm no taking enough I get the afternoon crash. If I am taking sufficient, don't get it..simple as that..and I take all of mine in the morning and always have.

Once when went up to too much my tests revealed it and so I dropped back a tad. So trust how you feel and trust the numbers. Getting them ALL is really important.

Optimising your vits also helps a great deal.

They know far more on here than any doc I have ever seen. Over 1 when medicated is too high. Trust their sage advice and good luck getting optimised on both vits and levo.

[Easylover in reply to SilverSavvy]

Nice reply!

[Bluekipper]

have you suggested T3 to your doctor. Some are quite amenable to idea. As we all know from this site, T3 really should be used first due to conversion problems etc. but as my endo, said T3 costs NHS too much which is why they stopped it. If you can persuade dr. To give you a trial it is not too expensive from Roseway labs.

[Hidden in reply to Bluekipper]

There shouldn’t be any quibbling after TT.

[Easylover in reply to Bluekipper]

I think you gave good advice!

[Galadrie]

You’ve had a few responses based on medication levels etc but in my own life I always look to the whole of my lifestyle when questioning how I am feeling and it’s worth monitoring how your daily routine might impact upon you physically. Long before I had thyroid issues I would experience slumps in energy late afternoon. Hectic work schedules, taxing situations, juggling responsibilities, all take a toll on physical energy levels. Some societies sleep all afternoon to replenish for the evening, it’s recognised as normal to need rest within a long day. I am not one who believes everything can be solved by medication alone, with many medical conditions it requires an adjustment of behaviour too. Maybe listen to your body and rest up more when it tells you it needs it? Schedule your days so you can preserve more energy earlier on. Maybe you already do but as you haven’t mentioned these aspects I thought a holistic view might be worth adding.

[Bridkid67 in reply to Galadrie]

True but some conditions like thyroid issues I don't believe cannot be corrected by that alone it needs medication the same as that is missing I do try to eat healthy don't drink never smoked etc take supplements like fish oil and B12 and garlic, multi vitamins I feel are inadequate as for sleeping during the day not viable iam afraid do agree lifestyle changes along with medication can be both beneficial to our health.

[Easylover in reply to Bridkid67]

I would have the doctor test your T3. Take your new labs with T3 and T4 and post them so GreyGoose can instruct you. Ignore the TSH.

[Easylover in reply to Bridkid67]

healthunlocked.com/thyroidu.... That had good advice!