Thyroid problems, levothyroxine and prednisolone ... - PMRGCAuk

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Thyroid problems, levothyroxine and prednisolone ...

PMRpro profile image
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53 Replies

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!

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53 Replies
Longtimer profile image
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 profile image
PMRproAmbassador in reply toLongtimer

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 profile image
Longtimer in reply toPMRpro

Thank you will do....

SheffieldJane profile image
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 profile image
PMRproAmbassador in reply toSheffieldJane

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 profile image
SheffieldJane in reply toPMRpro

Thanks for this. 🤹🏻‍♀️

whitefishbay profile image
whitefishbay

You mean the GP might be wrong? 🤣

PMRpro profile image
PMRproAmbassador in reply towhitefishbay

Far be it for me to suggest anything ;)

whitefishbay profile image
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 profile image
PMRproAmbassador in reply towhitefishbay

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

Nightingales profile image
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 profile image
PMRproAmbassador in reply toNightingales

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 profile image
Sophiestree in reply toNightingales

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 profile image
PMRproAmbassador in reply toSophiestree

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 profile image
Nightingales in reply toPMRpro

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 profile image
PMRproAmbassador in reply toNightingales

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 profile image
Sophiestree in reply toPMRpro

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 profile image
Nightingales in reply toPMRpro

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

Sophiestree profile image
Sophiestree in reply toPMRpro

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

whitefishbay profile image
whitefishbay

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

123-go profile image
123-go in reply towhitefishbay

We'll all come!

whitefishbay profile image
whitefishbay in reply to123-go

Wouldn't that be great.

123-go profile image
123-go in reply towhitefishbay

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

whitefishbay profile image
whitefishbay in reply to123-go

💪 We could have a deep discussion.

Longtimer profile image
Longtimer in reply towhitefishbay

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

DorsetLady profile image
DorsetLadyPMRGCAuk volunteer in reply toLongtimer

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

Longtimer profile image
Longtimer in reply toDorsetLady

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

Constance13 profile image
Constance13 in reply toDorsetLady

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 profile image
123-go in reply toDorsetLady

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 profile image
Constance13 in reply to123-go

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

PMRpro profile image
PMRproAmbassador in reply toConstance13

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

Constance13 profile image
Constance13 in reply toPMRpro

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 profile image
Bachfugue in reply toConstance13

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

Constance13 profile image
Constance13 in reply toBachfugue

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 profile image
PMRproAmbassador in reply toBachfugue

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

Bachfugue profile image
Bachfugue in reply toPMRpro

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 profile image
Constance13 in reply toBachfugue

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

Bachfugue profile image
Bachfugue in reply toConstance13

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

PMRpro profile image
PMRproAmbassador in reply toBachfugue

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 profile image
Constance13 in reply toBachfugue

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

Bachfugue profile image
Bachfugue in reply toConstance13

Thanks Constance. And for you too 😊

123-go profile image
123-go in reply toPMRpro

Work till you drop!

123-go profile image
123-go in reply toConstance13

Stretchers on wheels? Shopping trollies?

PMRpro profile image
PMRproAmbassador in reply to123-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 profile image
123-go in reply toPMRpro

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 profile image
DorsetLadyPMRGCAuk volunteer in reply to123-go

I’m up for it!

PMRpro profile image
PMRproAmbassador in reply towhitefishbay

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

123-go profile image
123-go in reply toPMRpro

You could record a lively speech.

Rymer profile image
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 profile image
PMRproAmbassador in reply toRymer

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 profile image
Rymer in reply toPMRpro

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 profile image
PMRproAmbassador in reply toRymer

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 profile image
Rymer in reply toPMRpro

Thanks

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