Ageing and levo dose.

[MissDemeanour191]

HiWas wondering what thoughts are, medical reasoning behind reducing dose of levothyroxine as we get older, in 60's, when have been taking it for @15 years.

My GP is constantly trying to lower my dose, as my TSH is well below 1, has been 0.0 something last 2 blood tests, however, T4 is not too high, and T3 is highest it's ever been, at 5.

Am just little worried, as I am only 5 foot tall (short)!! and weigh @ 65kg so prob 125mcg levo permanent is too high dose?

I don't get palpitations, bit anxious, bit think that's with getting older. Know that they don't like you on high dose as you get older as can cause heart? Bone? issues? Is this proven?

Every ECG i've had has shown Left Axis Deviation, is this hypo related?

Am just worrying that as I get further into my 60's, is it safe for me to continue on 125mcg levo? I've tried alternating daily 125/100mcg, and seems to make me feel pretty rubbish, any advice from any other aging hypos would be appreciated!

[pennyannie]

Hello MissDemeanour :

Reducing my thyroid hormone replacement when I turned 65 seemed to be automatically decided - and to be honest at that point in time I trusted my doctor and simply followed ' orders ' -

Within the next 5 year period I became more ill than I had ever been in my life - and fell into this forum researching low ferritin - I found no resolve within the NHS - and refused both T3 and NDT by my surgery and only hospital in 2018 and now self medicate and am much improved.

If interested my story is on my Profile page - I do not wish to start thinking about this period and need to move on -

I'm with Graves Disease and post RAI thyroid ablation in 2005 and had to pay the NHS in 2018 to run my T3/T4 blood tests to find out the problem - low T3 - which they refused to acknowledge or treat.

You must be dosed and monitored on your T3 and T4 blood test results / ranges and we generally feel best when the T4 is in the top quadrant at around 80% through its range with a T3 tracking just behind at around 70% through its range -

and not on a TSH seem in isolation which is all most patients get at their NHS yearly thyroid function test

[SlowDragon Administrator]

Low vitamin levels are much more common as we get older

What vitamin supplements are you taking

When were vitamin D, folate, B12 and ferritin levels last tested

For good conversion of Ft4 (levothyroxine) to Ft3 (active hormone) it’s essential to maintain GOOD vitamin levels

Which brand of levothyroxine are you taking

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)

Was last test done this way

Please add actual Ft4 and Ft3 results and ranges

[greygoose]

This business of older people needing less thyroid hormone applies to euthyroid people, not hypos. But the difference is miniscule, not worth mentioning.

But, you know what doctors are like! Any excuse to reduce doses! They jumped on this like starving vultures on a dead body in the wilderness and started reducing doses right left and centre. And not only that, but using it as an excuse not to treat a lot of older people, telling them they didn't need it because at their age the needed less hormone, not more!

Just ignore it and if you feel well on your present dose refuse to reduce it. If you're hypo you need what you need, no more no less.

[MissDemeanour191 in reply to greygoose]

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[Tina_Maria]

A reduction in dose should always be based on your actual thyroid hormone levels, not because your age says you are a bit older now! For example, if you are having more absorption problems as you age (which can happen), you may actually need more!

Yes, it is true as we age, our kidney function declines gradually (the e-GRF reduces by around 0.8ml/min each year) and is not as efficient in removing drugs from our circulation. Therefore medication can accumulate and hence your levels can get higher, as more 'hangs around'. But that is a generalisation and very dependent on the individual. There are some younger people that have very low eGRF, such as people with co-morbidities (diabetes, heart disease, kidney disease) and there are older people, which have a great eGRF, which is not that different from a much younger person.

So instead of making a sweeping statement that you need to reduce your medication as you are getting older, you should measure the actual blood levels of the medicine in question and then make an informed decision based on that.

I think your GP is trying to reduce your dose based on the low TSH, but in many patients the TSH does not give an accurate reflection of your thyroid hormone status (as the TSH feedback is often not working as it does in a person without thyroid disease), therefore the free T4 and free T3 should guide the treatment.

[Obsdian]

Things like dropping estrogen and more prevalent heart issues (only for those who have heart issues) are reasons we may need less levo as we age. But don't reduce because of your age, reduce if your thyroid panel results suggest you should.