dose increase of levothyroxine

[CarolMSM]

morning…so I’ve been on my reduced dose of 75 mcg for about 6/7 weeks now and feeing tired. My previous dose of 75/100 alternate days proved too high on blood tests. I am having another blood test soon and regardless of the result I want to increase again…maybe the last dosage was too high and I’m going to ask the dr to increase again..should I go up by 12.5mcg alternate days or take 100 mcg just once a week and stick to 75 the other six days. I know this is trial and error…any advice would be very welcome..Thankyou.

[SlowDragon Ambassador]

looking at previous posts

You take levothyroxine at bedtime

Make sure to adjust time of last dose before test

Last dose should be 24 hours before test

If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal

And you need vitamin D, folate, ferritin and B12 levels tested

Exactly what vitamin supplements are you taking

[CarolMSM in reply to SlowDragon]

Ive changed from taking at bedtime to early morning as i have to take gaviscon at night and the timing was difficult. Will take my dose afterblood test next time.Vit d..multivits without iodine. Vit c. B12 spray. Fish oils. Magnesium at night calcium and iron. Ginseng ginger. B complete. Selenium. Some of these I'll stop whenpack isfinished.

[SlowDragon Ambassador in reply to CarolMSM]

Essential to test vitamin levels

[Tina_Maria]

Have you had a detailed thyroid function test measuring T4 T3 and TSH? A TSH of 0.94 normally does not necessarily warrant a reduction in dose and actually 75 mcg is not that high. Are you sure that you are not under-replaced rather than over-replaced? Hyper and hypo symptoms are quite similar and as you are feeling very tired, I suspect that you may not have enough thyroid hormones available.

A general replacement dose is 1.6 mcg levothyroxine per kg of bodyweight. So someone weighing 63 kg would need around 100 mcg thyroxine. This is in the prescribing guidelines:

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

If your practice will only test TSH, you could do a private test and assess T4 and T3 as well, so you can exactly see where your levels are.

If you are taking a multivitamin, this is also not recommended, even if they are without iodine, most contain iron - which blocks the absorption of other nutrients - and most are dosed far too low, so you would not get an adequate replacement if you are deficient. And you don't want to supplement something that you are not deficient in either!

I would also test your nutrients to see, if you are deficient and in what. I'd test folate, iron, Vitamin B12 and Vitamin D. These will also help with the conversion of your T4 to the active hormone T3, which will help with your energy levels. Also, if your nutrients are in good shape, you may tolerate an increase in medication much better, so definitely worth checking these.

[thyroid-warrior]

Wanted to share my own experience about alternating dosage. I was on 87.5mg previously for a while and it worked well.

Towards beginning October, I started getting extreme fatigue, body aches, brain fog, joint pain and constant cold fingers/toes. When I went for blood tests (TSH and FT4), everything was within range. GP said it was definitely not the thyroid.

The symptoms got worse towards end October and further blood tests in other areas proved negative.

Running out of ideas, I decided to increase my own medication to 91.75mg (50+25+12.5 + half of 12.5).

It was my first time trying to adjust my dosage without a proper doctor's advice so I was hesitant to go directly up to 100mg.

It worked!! I had more energy and the symptoms improved and I finally didn't feel like staying in bed all the time.

However it wasn't ideal as the energy was still not consistent. There were still a few days in a week where I felt more of the symptoms.

When I tried going up to 100mg for 5 days, I started having heart palpitations and more anxiety on day 4 and 5.

As such, I went back to 93.75. But the symptoms were still preventing me from doing full days of work.

I decided to alternate between 96.875mg and 93.75mg and finally felt more like a normal person after a week to have the energy to do more things after work.

I'm currently working towards getting more consistent energy (with no symptoms) everyday after I wake up instead of potentially 2-5 hours after I wake up.

From my own experience, there are a couple of things that can affect the amount of T3 needed by the body, what's available and potential conversion issues to have consistently good energy everyday.

What I understand is, a healthy body is able to release the hormones and convert them throughout the day. While with medication, we are inputing it into the body at one single time.

So sometimes if the body is not regularly converting when T3 needed, it might result in the symptoms we are experiencing.

Also, some days when I was walking more or exercising, I seem more tired on other days - I'm guessing it could also be I was using up more T3 and not enough is converted after those intensive days?

Right now, I'm testing to take 75.875 in the evening and 12.5mg in the morning while waiting for a T3 prescription. It's not the ideal way I would like to take the medication but I thought splitting the dosage (more in line with how the body produces the hormones) could be an option before I get any T3.

[CarolMSM in reply to thyroid-warrior]

oh Thankyou for that sounds very similar to my experience . I’m wondering whether to just try one day a week 100 mcg and he rest 75. Will be seeing the dr in two weeks so will see how that goes or to increase every other day by 12.5. It’s so frustrating but I need more consistent energy. Thanks for the information though..it’s very helpful.

[thyroid-warrior in reply to CarolMSM]

Something else I did throughout late December and January - I tried to do a food/energy log. Just to see how I feel everyday, I gave a score for brain and physical energy when I woke up.

Like a 3/4 if I struggled and 5 if I managed to wake up but can't do much and like a 7/8 if I could think coherently and do my work. So it helped to see each day when the brain fog lifted or body felt normal (rather than achy or heavy) or if I was still feeling cold hands and toes. On my good days, even though I could work with a clear brain, I still had cold fingers and toes. When I had a clear brain, body felt fine and could heat up properly, oftentimes it was already late in the evening 😂.

Most of the time, the body just turns up the heat and turns down at random times - like a broken thermostat.

The logging gave me more clarity on how the symptoms were coming up everyday.

Hence when my FT3 results came up, it sort of in a way reaffirms that my T4 to T3 conversion wasn't ideal.

I would recommend to give food and energy/symptoms tracking a try. I've to admit, it was alot of work but it reaffirms my decision to get T3 after my last test results.

[CarolMSM in reply to thyroid-warrior]

Ok thanks so much for that info. X