Thyroid problems, levothyroxine and prednisolone ...

[PMRpro]

This is a question that crops up from time to time and this Fast Quiz popped up from Medscape recently and again today - I thought others would be interested,

reference.medscape.com/view...

If you read through you will find a question about drugs that interfere with assessment. One third of patients are on something that does this - and this does lead to poorer management of the thyroid management. In our case, it may well contribute to the fatigue.

In a study prednisolone was found to be one of the most common culprits.

medscape.com/viewarticle/94...

So if you are on thyroid medication and you feel there is something not right even though your GP insists the lab results are fine - maybe you are right!

[Longtimer]

Excellent but....try arguing that point with the arrogant GP`s, well especially the one that rang me last week, the one that hadn`t looked at my notes!...just can`t understand it when a reading is so low and a patient is prepared to try it!....how do you get past that....grrrr

[PMRpro Ambassador in reply to Longtimer]

I know - maybe get a copy of the study - it was ENDO 2021 so pretty new which gives the GP a bit of get out!!! Mention it to Max - since HE provides the pred ...

[Longtimer in reply to PMRpro]

Thank you will do....

[SheffieldJane]

I saw this, and did the quiz and then felt stumped. I cannot imagine my GP doing anything other than point me back to my Rheumatologist and this is not her territory. I struggle for basic care, never mind something that looks beneath the surface. My thyroid blood tests have been satisfactory and never led to an alteration to my Levothyroxine dose. Any suggestions PMRPro - something is definitely not alright and I cast about for the culprit?

[PMRpro Ambassador in reply to SheffieldJane]

No it isn't Sarah's field BUT if pointed to the ENDO 21 study she MIGHT mention it to her very good endo friends at Leeds ... And how you feel is part of her remit really.

[SheffieldJane in reply to PMRpro]

Thanks for this. 🤹🏻‍♀️

[whitefishbay]

You mean the GP might be wrong? 🤣

[PMRpro Ambassador in reply to whitefishbay]

Far be it for me to suggest anything

[whitefishbay]

I have asked if I need to go to the Endocrinologist and the GPs alway poo poo this. No your level is fine. End of discussion.

[PMRpro Ambassador in reply to whitefishbay]

Copy of the study and press it into their sweaty little paws ...

[Nightingales]

Thank you so much for posting this. I had no idea that Prednisolone affected Levothyroxine. The article states that meds that can interfere should be taken four hours apart. I take it two hours apart but I am wondering if I should move the Levo to the evening. This might explain the awful fatigue that I suffered for two years. My thyroid tests were always borderline.. my GP decided to try me on a low dose of thyroid meds and lo and behold my fatigue has lifted. I also didn’t know Levo could cause hair loss. Mine has stopped growing and is very thin and course. I was going to try Biotin but now I see it interferes with the blood tests. Any advice is as ever very much appreciated.

[PMRpro Ambassador in reply to Nightingales]

I have mentioned it before - but getting doctors to believe it is hopeless. I wondered if this appearing in medical media with links might be helpful in persuading a GP to be less sceptical.

[Sophiestree in reply to Nightingales]

What does Biotin interfere with? It was suggested to me and I havectaken in the past many years ago.I also take my levo about two hrs apart from my pred. Urgh another thing I might be doing wrong

🙄

[PMRpro Ambassador in reply to Sophiestree]

Various blood tests:

testing.com/articles/biotin...

Many treatments are based on lab results - for example, TSH should be in a defined range if the thyroid is producing its hormones correctly. If it is too low it is shown by TSH (thyroid stimulating hormone) being raised, kicking the thyroid harder, and medications are often given to stimulate thyroid function. Biotin can interfere with the tests - but not reliably, i.e. you don't really know what the TSH level really means.

It is by no means the only tests affected - so if you take it, you MUST tell the healthcare professionals, especially the ones in the labs!!!

[Nightingales in reply to PMRpro]

Thanks. That’s a good reference and I am happy to hear that you are all coming with me to my next drs apt. I will hire a bus 🤣 Any suggestions about the four hour gap between thyroxine and Prednisolone?

[PMRpro Ambassador in reply to Nightingales]

Many nowadays take their thyroid medication before bed since a study discovered it works at least as well and often better providing it is 3 hours or more after dinner:

drugs.com/medical-answers/y...

[Sophiestree in reply to PMRpro]

OH my, I am going to have to rethink now after over 20 years of taking it in the morning..... I'm so forgetful....But sounds like it's worth a try.

[Nightingales in reply to PMRpro]

Thank you. That is so helpful. That’s what I will do from now on.

[Sophiestree in reply to PMRpro]

Interesting read, had no idea. Not that I have taken it that regularly. So much to learn

[whitefishbay]

Haha. You make me laugh. Can you come with me next time?

[123-go in reply to whitefishbay]

We'll all come!

[whitefishbay in reply to 123-go]

Wouldn't that be great.

[123-go in reply to whitefishbay]

Yes. Banners, loud hailers, the lot..and Dorset Lady on her Viking chariot!

[whitefishbay in reply to 123-go]

💪 We could have a deep discussion.

[Longtimer in reply to whitefishbay]

We would be on TV with our PMR banners called "Patients Marching Rowdily!" .......bad I know but couldn't resist it!..😂

[DorsetLady PMRGCAuk volunteer in reply to Longtimer]

Maybe shuffling rather than marching! ….otherwise we’d be told ‘you don’t have PMR anymore’ ..🙄

[Longtimer in reply to DorsetLady]

Oh yes....crawling!....

[Constance13 in reply to DorsetLady]

I must admit the last time I saw my rheumy was about 2 1/2 years ago, and I did "shuffle" a bit when entering his office. He asked the usual questions, made notes on his computer, asked how I felt in general, etc etc, not once did he offer any advice or 'touch' me. Then said "come beck in 6 months". All in all I was in there five minutes.

I had waited 1 hour in the waiting room for that!!!

Have listened to PRO (most of the time)🤪 instead.

[123-go in reply to DorsetLady]

To make more of an impact we could hold one another up. Those in remission could pair up and carry a stretcher for any one who falls by the wayside. Getting hysterical now. Forgive me!

[Constance13 in reply to 123-go]

"Carry a stretcher" at our age. You MUST be joking!!

[PMRpro Ambassador in reply to Constance13]

Retirement age for paramedics is now 67. And rising ...

[Constance13 in reply to PMRpro]

Daft, isn't it?

An acquaintance of ours was a tiler and was looking forward to retiring at 66. They've moved the retiring age to 68!! Nearly 70 years old and has to climb all over roofs carrying heavy material. Mad, mad, mad!!!

[Bachfugue in reply to Constance13]

I’m 72 and still working full time in academia. Too much to do ……

[Constance13 in reply to Bachfugue]

If it is your choice to work that's fine. It's those who are forced to work that I am against. They often have so little money they MUST carry on!!!

[PMRpro Ambassador in reply to Bachfugue]

Perhaps you would feel differently if you weren't in academia - it is hardly a physically demanding job compared with most things.

[Bachfugue in reply to PMRpro]

Yes I get that. However, the stress levels can be horrific especially when I’m in the midst of ‘brain fog’ and get v tired. My timetable for this week is just silly yet I can’t let my students down. They have to come first. All research and writing gets left to one side.

[Constance13 in reply to Bachfugue]

Time to retire then! We all have to make that decision sometime.😂👵🏻

[Bachfugue in reply to Constance13]

Would love to retire but need the income. But it will probably be my last year full time x

[PMRpro Ambassador in reply to Bachfugue]

It is amazing how much less you can manage on once you aren't commuting/buying clothes for work/needing convenience foods etc because you are timepoor! I'm so very grateful OH decided we could manage on a lot less so very early - and our savings have increased the entire time!!! Just as well for me now.

[Constance13 in reply to Bachfugue]

Ah! I wish you luck. Hope things turn out well for you. 💐 🍀🍀

[Bachfugue in reply to Constance13]

Thanks Constance. And for you too 😊

[123-go in reply to PMRpro]

Work till you drop!

[123-go in reply to Constance13]

Stretchers on wheels? Shopping trollies?

[PMRpro Ambassador in reply to 123-go]

They have plenty of them - it's the stairs and poor house design that make patient retrieval so difficult! Doesn't do to drop someone

It's even a problem here if the patient needs to be kept flat - stupid little lift will hold a chair and one attendant. The option is a cherry picker up to the balcony ...

[123-go in reply to PMRpro]

Some time ago I heard of an elderly patient being dropped off at her door and she hadn't got her keys. Needless to say ambulance had driven off probably rushing to get to another call. Supply and demand is wanting.

[DorsetLady PMRGCAuk volunteer in reply to 123-go]

I’m up for it!

[PMRpro Ambassador in reply to whitefishbay]

If it weren't so far I would organise a deputation ...

[123-go in reply to PMRpro]

You could record a lively speech.

[Rymer]

Replying a bit late - but I can't open the article without registering. Am I missing anything? I would like to read it as my latest Thyroid Function test shows that it is a little high which I don't feel like it is and I have been on this dose for many years now and it has always suited me well.

[PMRpro Ambassador in reply to Rymer]

Only you can decide that - I thought it was worth it or I wouldn't have posted it. It is easy enough and free to register unless things have changed.

[Rymer in reply to PMRpro]

No problem - I will continue with the registering process but just wanted to be sure I was at the right place. Thanks for the info.

[PMRpro Ambassador in reply to Rymer]

If you feel OK you probably are OK - I posted it because there are lots of people on pred who DON'T feel fine but the GP won't listen because the TSH level looks fine - or so they think. Being on pred can interfere with the lab assay and suggest you are fine when you aren't.

[Rymer in reply to PMRpro]

Thanks