Is it concerning that GP has doubled levo dose in elderly woman?

[Aquapuss]

My mother (92) and I (61) b@oth have underactive thyroid. Both on levo. Her GP recently doubled her daily dose to 150mcg daily due to her TSH being very high. She says she takes it regularly as my first thought was whether she had been forgetting to take it. I am completely thrown by why he would increase it, and not gradually at all. She has mobility ossues, is not active and this dose is highest its ever been. She is also tiny, under 5 ft, weighs about 8 stone. I'm double her weight, tallet, younger and thought doctors tend to reduce levo as you get older. She seems well on it, her mood and motivation to get out have improved. Any thoughts? Especially from any doctors on here?

[Aquapuss]

Sorry omitted to say I am on less dose than her now, so quite shocked she is on this dose

[helvella Administrator]

I'm going to suggest that the issue could be absorption rather than actual requirement for levothyroxine rising.

Whether because of her pattern of taking it (e.g. with food/drink/other medicines), make of tablets, other issues.

[Aquapuss in reply to helvella]

Thanks helvella, she takes it first thing with water, waits at least half hour before having breakfast. Has diabetes, which they also said blood sugar Hb1ac was very high. Not on insulin just meds for it. She doesnt eat a good diet unless I'm there to cook for her. Mostly scones, cakes, biscuits, not a lot of protein or vegetables which I'm working on!

[RedApple Administrator]

'Any thoughts? Especially from any doctors on here?'

Aquapuss, firstly, I must point out that this is a patient to patient forum. No-one here is medically qualifed.

Secondly, do you have any test results for your mother that you can share? Ideally the GP would have tested TSH, FT4 and FT3 to be sure a big dose increase is appropriate.

It's possible your mother is not absorbing the tabelts efficiently, so needs a higher dose for this reason.

[Aquapuss in reply to RedApple]

Thanks Red apple, I know its a patient forum however some doctors also have thyroid problems so thought there may be some on hrre who have better understanding of possible reasons for increase. How would they know its an absorption issue though just from TSH? I can't find out her test results as I don't have power of attorney for health just financial stuff (she is also blind so can't read now)

[RedApple Administrator in reply to Aquapuss]

It's possibe that there are medically qualified members here because they have thyroid issues themselves, but they're not allowed to reveal that fact. 😊

' How would they know its an absorption issue though just from TSH?'

They wouldn't which is why I said FT4 and FT3 should also have been tested. But if your mother feels and seems to be well, then it was potentially the right decision made by the GP.

[tattybogle]

how high was her TSH ?

was it a gradual sustained increase in TSH over time ,,, or a one off high result ?

any other results for T4 / or T3 ? ie. has T4 level dropped in line with higher TSH ?

maybe she stopped absorbing it very well for some reason ( so even though she was taking 75mcg .. might only be getting 40mcg or less ... kinda thing )

but yes ....doubling dose from 75 to 150 does seem very extreme i agree.

how many weeks has she been taking 150mcg now ?

it needs at least 6 wks to see how she feels on new dose , then do bloods.

[Aquapuss in reply to tattybogle]

Thanks Tattybogle, its about 6 weeks I think. I don't have access to her blood results, but they only measured TSH. She has been stable on 75mcg for years, so not a gradual increase. This was her routine annual blood test that led to changed dose.

[tattybogle in reply to Aquapuss]

ok ... i meant 'had there been a gradual increase in TSh'

without knowing her actual TSH result it's hard for anyone to comment meaningfully.... ' high' TSH could be 7 or 70 ........ if it was 70 then increasing to 150mcg might be a good idea.

also without knowing any of her previous TSH results it's hard to second guess why dose decisions have been made....

Ask her to find out the TSH numbers from the test that led to this increase and from some previous years . her GP receptionist should be able to give a printout of them if she asks.

when have they told her to get bloods retested on this new dose ?

[DippyDame]

How was that test carried out?

...At 9am, or close too

...24 hours after last dose of levo

...Before breakfast, on an empty stomach

This gives the most accurate results.....different test conditions will give different results.

TSH is not an accurate marker....that is FT3 followed by FT4. I would not rely on TSH alone!

Doubling dose to 150mcg is a big increase but it could depend on how low her hormone level had become and how much she is absorbing....but we don't have labs to compare. Can you post any?

You say she seems to have improved so maybe she does need 150mcg....we are all different with different needs so comparing one person's dose with that of another is not helpful!

It's worth remembering that what ultimately is important is the level of active (cellular) T3.....unfortunately there is no way to measure this! Symptoms are therefore also an important indication of hormone level.

Serum T4 has to enter/ reach the nuclei of the cells, attach to T3 receptors there and so become active and able to fulfil it's function throughout the body.

If absorption is poor, for whatever reason, a large dose may be required to ensure an adequate amount reaches into the cells and floods them(....the "leftovers" will be metabolised and eventually excreted......in other words a high dose of T4 may not result in a high/ excessive amount of T3. This might explain why your Mum is responding to a higher levo dose.

That's a long winded way to suggest you monitor any symptoms and test again 6/8 weeks after increase...to include both FT4 and FT3.....her GP should have pointed this out.

Accurate results will help point the way forward.

[SlowDragon Administrator]

strongly recommend you organise FULL thyroid and vitamin testing for her

What vitamin supplements does she take

Also get her a weekly pill dispenser so it’s easy to see if she has forgotten to take a dose

Adjusting dose levothyroxine based just on TSH is not sensible or advisable

It’s possible she had false high TSH due to interference in test results at lab - due to mouse antibodies (yes 🐭 really! )

ncbi.nlm.nih.gov/pmc/articl...

healthunlocked.com/thyroidu...

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)

Personally I would not have changed dose Levo until had full testing

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...

Medichecks and BH also offer private blood draw at clinic near you, or private nurse to your own home…..for an extra fee

Only do private testing early Monday or Tuesday morning.

Tips on how to do DIY finger prick test

support.medichecks.com/hc/e...

Monitor My Health (NHS private test service) offer thyroid and vitamin testing, plus cholesterol and HBA1C for £65

(Doesn’t include thyroid antibodies)

monitormyhealth.org.uk/full...

10% off code here

thyroiduk.org/testing/priva...

[AKatieD]

The others have given you good advice.

Just wanted to add that it is brilliant that an older lady has had her treatment changed which has improved how she is feeling! She seems to have needed it, not a reduction because she is older.

The g.p. testing has been inadequate so it is hard to know what is going on but at least she has not been ignored/ gaslit for being old.

Suggest perhaps you need to think about checking your own levels if the g.p. is a TSH only person (or that is all their lab will test).

[posthinking01]

Hi there surely if her TSH was very high she needed it and it seems to have had a good effect on her and not a detrimental effect.