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Pins and needles

Hi, new to this site. I currently take 100 of levothyroxine, on my way down from 150 as I have paroxysmal Atrial fibrillation. I have suffered with pins and needles in the soles of my feet for years. Now creeping up my legs and in my hands. My feet also feel like they are burning up. When I mention this to a Dr he just said let's get your heart sorted first.

Does anybody else have the same problems


21 Replies

Hello and welcome, check out all your vitamin levels, you can do that before you get your heart sorted and it might even help your heart if you get any deficiencies sorted. Have you seen a cardiologist? Who has diagnosed your heart problem?

Lots of people who have come to this site discover low vitamin levels, it often goes hand in had with thyroid conditions. Could some of your symptoms be low B12 possibly?


There's nothing to sort out.

A-Fib is caused by thyroid dysfunction because the thyroid is the regulator of the heartbeat. If the thyroid is not getting what it needs in order to function properly, irregularities with the heart beat surface.


Most conventional doctors have been taught that only hyperthyroidism causes A-Fib (and severe palpitations). With Hashimoto's (90% of all hypo cases), patients can go from hypo to hyper quite often. This gets missed by conventional medicine. They just don't "get it." Therefore, those diagnosed with hypothyroidism can and often do experience A-Fib.

A study of rats with insufficient thyroid hormone (low T-3 levels and high TSH), were shown to develop A-Fib. It is not uncommon for this to occur in humans. It is just unknown to doctors who don't keep up with the times. That describes most conventional doctors, unfortunately.


I'm living proof it happens. I've had A-Fib all my life and no one seemed to worry about it because, "I've had it all my life." So they interpreted my A-Fib as being "normal" for me. There's nothing "normal" about A-Fib. It is perfectly understandable result of hypothyroidism. When the thyroid cannot function properly, just about any dysfunction in the body can occur. Especially with the heartbeat. The regulator of the heart beat is not able to do its job -- therefore dysfunction occurs.

As conventional doctors blindly repeat, "We don't know what causes A-Fib..." I just roll my eyes in total disgust at their ignorance.

Most likely, the A-Fib has surfaced because your hypothyroidism is not being effectively addressed. Nutritional deficiencies that keep your thyroid from functioning optimally are no doubt at the core of the issue. Lack of nutrients prohibits thyroid hormone conversion from the inactive thyroid hormone Levothyroxine (T4) you take, into the active thyroid hormone Triiodothyronine (T3) -- It is the T3 that will regulate your heartbeat properly.

If you cannot convert the Levo (T4), then your hypothyroidism (and A-Fib) will not improve. Your doctor would do well to address your issues by switching you to a Natural Desiccated Thyroid (NDT) product that contains both T4 and T3 in conjunction with addressing your nutrient deficiencies. Doing so will give some of the T3 you need to get by on a day-to-day basis until conversion can take place.

Your nutrient deficiencies can be exacerbated by the lack of sufficient stomach acid, which also keeps nutrients from being absorbed. If you are taking anything for acid reflux, that would surely be a contributor to keeping you from adequate absorption of nutrients.

The article below covers this is exceptional detail. Even if you don't think you have a lack of stomach acid, remember that hypothyroidism can cause this to occur as well. Hypothyroidism eventually slows down all systems of the body -- including the regulation of receiving adequate stomach acid for digestion and absorption of nutrients.


Your doctor is missing the possibility that your hypothyroidism is not in check. He thinks it is fine and therefore the A-Fib is caused by something else. This happens perhaps a million times day somewhere in the world. Or more often. If he knew the greater possibility of the A-Fib being caused by hypothyroidism that is not under control (a glaring reminder to him that he has not done his job very well) -- then he's do some more testing.

He should test both Free T3 and Free T4. When comparing them, it will likely be evident that you're not converting T4 into T3 at an optimal rate (good Free T4 levels and low Free T3). Most conventional doctors only test Free T3 if they suspect hyperthyroidism. It's how they are taught. This is why most don't ever do the proper testing that's necessary for a patient to have optimal thyroid function. That makes for patients who rarely feel as they wish they could. They have all kinds of issues as a result of low thyroid function. But most conventional doctors completely miss it. They still rely on TSH for guidance -- which makes no sense.

After diagnosing hypothyroidism and getting TSH down to 1.5, the use of TSH as a measure of function becomes counterproductive. At that point, it is how the patient feels. If you feel good, have energy and are enjoying life: your thyroid is not holding you back. No need to test for that. TSH lowers when thyroid hormone is ingested. This is regardless of how little thyroid hormone you're converting or getting into your cells.

Healthy people have a TSH of 1.0 As TSH gets lower, most doctors panic and lower thyroid hormone. Big mistake. They should just stop using it and use Free T3 and Free T4 to guide them -- as well as feedback from the patient. (That would mean they'd have to actually listen for a change!). Functional doctors have this figured out and it's so wonderful.


You can imagine the heart wondering when it will get the right regulation so that it doesn't have to sometimes beat as if a winning slot machine on the Las Vegas strip. Or slow down and then catch up with a huge, hard beat that makes you gasp. You see, the heart is just the heart. It doesn't regulate itself. It needs the thyroid to tell it what to do. If the regulator is not getting what it needs to service all systems, then dysfunction in other systems occurs.

Without adequate T3 in all the cells of your body, you will have dysfunction. It's not rocket science, but conventional doctors usually think it is far simpler than it really is. It's not just about TSH. It's really more about correcting nutritional deficiencies. With that said, please have your iodine levels checked. Many initially become hypothyroid because of low iodine levels that keep the thyroid from functioning optimally. It is perhaps the most important nutrient to the thyroid, second only to selenium.

If your doctor scratches his head with any of this; please do all you can to find a doctor of functional medicine who can help you restore your health.

Healing Hugs!


Thank you so much for your reply. I am having yet another blood test today as I feel so dreadful. Have even stopped one beta-blocker. Can see where you are coming from with nutrient deficiencies, take metoclopramide to address digestion problems. Di


Hey there Di,

You don't need a beta-blocker. Conventional doctors are very robotic, in general. They see something ("A-Fib! Irregular heart beat!") and then respond in the same manner -- and with the same drugs -- no matter the root cause of the dysfunction. In fact, they make their living by not finding the root cause of dysfunction throughout the body. Instead, they are trained to slap a band-aid on it in the form of some unnecessary pharmaceutical that causes even worse issues while not making a dent in the problem, but instead making it far worse. Those pills mask symptoms but they create other issues as the dysfunction is not corrected. Your dysfunction is your thyroid not getting enough nutrients and beating on your door to get your attention to the problem! You need more thyroid hormone.

Giving you a beta-blocker is among the worst things a doctor could do to you.

Beta-blockers are for subduing hyperthyroidism (hyper) -- they are very bad for just about anybody. There are better ways to handle such things, but beta-blockers are big money. They block the stress hormones that occur when your heart beats too fast. So instead of addressing just why you have A-Fib, they'll just try to add a beta-blocker as an automatic reply to it -- even though it blocks conversion of T4 to T3. No wonder your heart is having a hissy fit! It is sending out a loud message for others to heed, and they instead give it something that makes it all even worse!

Self-serving conventional medicine at its best. When are they calling the cardiologist? Trust me, you don't need one. It's not that kind of heart issue. It's just low thyroid hormone and not enough T3 in all the cells of your body.

Just imagine what its doing to your already slowed down hypothyroidism state. They are the opposite of what you need. That also means interference with the Thyroxine (T4) thyroid hormones you take as Beta-blockers interrupt conversion of T4 to the active thyroid hormone T3.

So you're in a Push-Me/Pull-You state between the beta-blocker and your thyroid hormones. It's a disaster. In the meantime, you aren't getting the very thing that will help you: T3.

Beta-blockers interfere with your progress to control hypothyroidism. The only thing you need to address the A-Fib is ample thyroid hormone and of the right kind that you need.

That can be determined by comparing Free T3 to Free T4. If your doctor is using TSH as a guide for maintenance of your thyroid hormone, kick him to the curb. You really need to kick him to the curb anyway. He's playing Marcus Welby, M.D. and he's doing a poor job of it.

You're being given the opposite of what you need and your doctor thinks that is the right thing to do! He couldn't be more wrong. There is a reason for your A-Fib. It's called hypothyroidism. He's just ignorant that hypothyroidism (as well as hyperthyroidism) is known to also cause A-Fib.

Okay. I hope you truly understand what I'm telling you. It's your life, but this type of Three Stooges medical treatment has got to stop. I went though it for decades, as at the time I knew no better. But now I do. I get it. I had to figure it out inside and out on my own with my own research and diligence for truth. Else I wouldn't be here. Conventional medicine was killing me.

Now... about your stomach and that other medicine you're taking (metoclopramide):

Your stomach empties slowly because hypothyroidism causes all the systems of the body to slow down. It just keeps on in that manner, but with more systems being effected until you get the thyroid hormone T3 into all the cells of your body. At a minimum, you probably need a thyroid hormone that contains T3 to help you immediately. Replacing your lack of adequate stomach acid (caused by hypothyroidism and keeps your gut in big trouble as there is not enough acid to control the overgrowth of all kinds of bacteria). It's a vicious cycle. Replace the stomach acid and you'll begin to absorb nutrients. It's natural, it's what your body uses. You don't need anything else.

What is happening to you is that hypothyroidism has over 300 symptoms. That's the type of dysfunction throughout the body that occurs when the thyroid is not getting all the nutrients it needs in order to carry out its functions optimally. Conventional doctors know little of this. The reason they are in the dark is because their profession would rather prescribe drugs for any one and all of those 300+ symptoms to make big money and recurring revenue for the medical industry and the pharmaceutical industry. Terrible, conflict-of-interest marriage that keeps so many people sick.

Conventional medicine has never claimed they "cure" anything. We just thought that was what they do. They do not. They will never own up to the fact that dysfunction of the thyroid (the regulator of the entire body) is their bread and butter. It pays the bills and keeps us coming back for more of the same inadequate treatment -- because we don't know better. And we get sicker with all kinds of illness. All thyroid dysfunction related. Not the fault of the thyroid at all and never was. Yet the thyroid is treated most times as the villain that must be subdued. Rubbish.

We need to simply give the thyroid what it needs in order to function properly and for all of its peripheral conversions to take place. It's just nutrients. Vitamins and minerals and sometimes hormonal balance. But conventional medicine used to call taking vitamins and minerals, "Throwing your money down the toilet." Many still do repeat that silliness. There is a reason they used to say it -- they were taught to do so -- and it keeps money pouring in. Conventional medicine is set up to exploit those who don't recognize the con that is being run on them.

Hypothyroidism is a known result of what happens when the body doesn't get adequate nutrients necessary for good thyroid health and functioning. It can happen for many reasons. But it happens -- and its cause is not a mystery at all -- nor is its remedy. One and the same: Nutrients. Get the nutrients while fixing the stomach and gut issues that couldn't absorb those nutrients so your body could use them to ensure full thyroid function.

That also means dietary changes and the use of replacement stomach acid, probiotics, and digestive enzymes to get your gut back in balance and healthy.

The GPs of the world will never understand that there are real cures for hypothyroidism. The body can return to normal because where lack of nutrients have caused an issue, the replacement of those nutrients can cure it. Some are on thyroid hormone temporarily along with getting the nutrients they need optimized. They then no longer need thyroid hormone.

But this is not what conventional medicine tells you. Because it is not how they keep us coming back for another spin on that carnival ride called the "Let's-see-what-prescription-we-can-write-you-today," merry-go-round.

The will never admit that dysfunction of the body's regulator (the thyroid) is the main cause of most of the maladies known to us today. Without T3 in all our cells, we will eventually become just a shadow of ourselves waiting to fade away -- while having 30 different unnecessary prescription medications on the dresser when we do.

It's pretty simple. The thyroid cannot keep producing thyroid hormone without adequate nutrients. Conversion of T4 to T3 will not take place without nutrients. Without adequate stomach acid and a healthy gut, you will not absorb the nutrients from your foods or supplements. 'Round and 'Round we go! But we don't have to -- not anymore.

If your doctor has no clue, then find someone who does. Your health demands it. You don't need beta-blockers that block your thyroid function and make you sicker as you are sent to more doctors with prescription pads biting at the bit to give you more of what you don't need.

What you need is more T3 in all your cells. Doing the blood tests I mentioned will prove it. Also, check your iodine. Most hypothyroidism comes about with a foothold brought on by iodine deficiency. It can start so long ago, you'd be surprised. Yet conventional medicine tells us that there is no iodine deficiency problem in western civilization. They are wrong. Very self-serving that they are wrong.

Find yourself a doctor of functional medicine or do the research yourself and discover what you need and how to get it. However you do it, you will get well if you do what your body needs for you to do.

Healing Hugs!


Thank you so much for taking the trouble to reply. What you say makes so much sense. I have had Afib for for years and pottered along quite happily on Pradaxa, 125 Levothyroxine and a statin. A quick trip to A&E with a pulse of 150-170 for four hours resulted in a beta blocker being added, a calcium channel blocker too. Since then the strength of both have been doubled and the Levothyroxine reduced to 100. And now I feel rubbish! Tomorrow I see the doctor, yet another one at our surgery, and we'll go from there as I go armed with a list and a demand for a copy of my blood test results.

Thank you once again


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You are so welcome, Hylda. I appreciate your reply and am grateful for it.

Are you still taking the statin as well? Cholesterol is needed in order for hormone functions (including those of the thyroid) to take place. Statins work like many other conventional pharmaceuticals: they stop all cholesterol. That couldn't be more unhealthy for optimal thyroid function.

In fact, most who are intolerant of statins have been proven to be hypothyroid. It's as if the body is saying it doesn't need them to heal. And it doesn't, as all the body needs is sufficient active thyroid hormone Triiodothyronine (T3) to have ample amounts of it in all the cells of the body. Then the dysfunction of your heart rate, blood pressure, and cholesterol (among many other things) will be handled perfectly by the thyroid. It just has to have the nutrients in place that it needs in order to help you. Until you get your thyroid optimized again, it will need some help. A combination thyroid hormone of T4 and T3 should help. If not, more T3 can be added to get the A-Fib to stop.

Most doctors cringe at thinking about giving a patient with A-Fib thyroid hormone. They think it will make the A-Fib worse! What they do not see if that thyroid dysfunction is more often the cause of the A-Fib than anything else. They were not taught this in med school. They were too busy learning about pharmaceuticals. Not their fault, mind you... but after they learn what to do... then it is their fault if they don't do for their patients what is necessary to regain their health. Most don't even think at all. They follow protocol and that's it.

The article below is excellent in showing why doctors should test the thyroid when it comes to matter of irregularities with the heart. The fact that a doctor in the article states, "more than half the people who have normal thyroid function have hypothyroid symptoms," makes it prudent for doctors to check all thyroid tests and make sure they are reading them correctly. It shows how much conventional doctors are "winging it" when it comes to treatment of thyroid problems. The vast majority are simply uneducated in that regard. Perhaps print it out for your doctors to read:


When conventional doctors realize that thyroid dysfunction (which they call "disease") causes many issues throughout the body -- including heart dysfunction (which they also call "disease"), they will throw in the towel and become doctors of functional medicine. Real doctors... not "play" doctors.

If your conventional doctors don't have a clue after being informed of information that should have them excited about being able to help you... then find yourself a true doctor of functional medicine.

Let me know if I can be of further help to you.

Healing Hugs!



I do still take the statin. Think taking myself off the beta blocker and the calcium channel blocker enough to start with!!

Will be interested to see what this new doctor is like tomorrow. Have got to get sorted, resembling a ball on legs more each day



Read up on statins and the problems they cause, Hylda. The issue is that it is hypothyroidism that causes high cholesterol. The high cholesterol is telling us we have hypothyroidism.

Statins turn off the production of cholesterol. Cholesterol is needed for making thyroid hormones (among other hormones). Statins are counterproductive to good thyroid health and function.

Bad stuff as we need cholesterol to perform functions in our body. So much so, that cholesterol is vital to our health:

"Cholesterol is found in every cell of the body and is essential for proper cell membrane fluidity and necessary for steroid hormone production and bile production in the body. The liver, intestines and skin produce most of the body’s cholesterol (60-80%) with only a fraction being obtained through diet."


We're finding out that the claims made against "bad" cholesterol are proving to be untruths. Rather, statins are a multi-billion dollar business that feeds the pharmaceutical coffers.

We don't need statins. What is needed instead of statins is a correction of the deficient nutrients of the body (especially iodine, among others) so that proper thyroid function can take place.

Even the NHS knows this:

"If you have an underactive thyroid (hypothyroidism), treatment may be delayed until this problem is treated. This is because having an underactive thyroid can lead to an increased cholesterol level, and treating hypothyroidism may cause your cholesterol level to decrease, without the need for statins. Statins are also more likely to cause muscle damage in people with an underactive thyroid."


Your health will improve when you stop taking the poisons that keep your body from performing all its functions. Whatever those are, they all have to go. Some you wean off of as they are addicting (that tells you something), others you can simply stop taking. Find a doctor who will treat your hypothyroidism optimally and you will have no need for drugs that are prescribed to combat what hypothyroidism does to the body. It just makes sense to take only what you need -- and enough of the right kind/s to restore your health.

"You don't have to posit malfeasance on the part of big pharma here. All you have to do is think past the disease-specific mind-set of modern-day medicine. We are much more than our cholesterol level. A statin drug, like so many drugs that block enzyme pathways far upstream in major cellular pathways, is going to have much more biologic action than just moving an easily measured cholesterol level.

When you step back and look at medications as chemical modifiers of cellular processes in complex biologic systems like our body, it's easy to understand that health comes not from pills. Not even statins."

Remember, the medical definition of "disease" is "dysfunction." Suddenly, disease is not so scary at all. Restore the function instead of throwing the baby out with the bathwater!


The Statins you take are hurting you, not helping you.

Healing Hugs!


Will see how I get on as I have taken myself of my heart tablets, will think about the statin next. Thank you for your kind concern


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You're so welcome, sweet Di.

The thing to remember is that heart "dysfunction" aka "disease" as defined by conventional medicine is a very common dysfunction (or "disease") caused by hypothyroidism. Hypothyroidism can cause dysfunction ("disease") throughout the entire body.

Most doctors overlook these blatantly hypothyroid issues because when they check TSH and use it as their only method to asess thyroid function, TSH fails them in that regard. Without checking both Free T3 along with Free T4 (at a minimum), the doctor is making an unproven assessment. If not converting thyroid hormone or not able to get thyroid hormone into your cells, your symptoms will worsen over time.

Many doctors use their errors in testing and subsequent assessment as proof that something else is yet needed to improve your condition.

In the meantime, they do nothing more to help you get the thyroid hormones needed for to regain your overall health and quality of life. They spend far too much time on the "diseases" aka dysfunction that crop up because of the hypothyroidism. It's what makes conventional medicine the sham it is. They only treat symptoms instead of getting down to the root causes of the symptoms. In this case, we know it's hypothyroidism. They must focus on the hypothyroidism and stop treating each of its symptoms as if a different matter. They are one and the same. But conventional doctors are not trained in this manner. It's very confusing to them when they're caught in the middle of how they've been trained and what suddenly appears as if they have treated a patient improperly all along.

Quite sincerely, my concern for you is genuine. I've been there and have been mistreated by doctors who knew not what they were doing.

I wouldn't wish that one anyone.

So, now that I've regained my health by learning how to reverse what conventional medicine's failures have caused -- and caused me to endure -- I feel compelled to share my knowledge with those whose doctors are unaware of why their conventional medicine doesn't keep the vast majority of hypothyroid individuals on a healthy track back to full well-being; and why the medicines of their profession are actually causing hypothyroidism.

When we know what is needed to improve our health, we can then fight for gaining that which will heal us and others.

I truly thank you for reading and keeping an open mind. I appreciate your reply and am genuinely very happy to see it.

Wishing you a myriad of wonderful, completely healthy days to come...

Healing Hugs to you!


In my case pins and needles are a sure sign of undermedication...


Me too. And low B12 as well.

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Essential to get your vitamin D, folate, ferritin and B12 levels checked. Always get actual results and ranges

Pins and needles can be low B12 - very common when hypo.

Might also be low calcium if your vitamin D is very low

Or low B vitamins can result from low vitamin D


Low magnesium is very common when hypo too and essential for hearts


What beta blocker are you taking? Hopefully not propranolol. As well as slowing thyroid uptake/conversion (commonly used treatment for hyperthyroidism) propranolol also lowers magnesium

If you have Hashimoto's then highly likely to to have poor gut function and malabsorption. Changing to strictly gluten free diet has helped very many.


You obviously have some gut issues going on, which suggests unresolved hypo and or low stomach acid. Metroclopramide is at least NOT a PPI

Metoclopramide is the main promotility agent currently on the market. It works by increasing muscle contractions in the upper digestive tract, which in turn speeds the rate with which stomach contents move into the intestines".


I rattle with pills. I take Levothyroxine, Frusemide, Pradaxa, Amlodipine, Atorvastatin and should be on Bisoprolol but have stopped for the time being. Just wish somebody would treat me as a whole and not play chess with my drugs.


Levothyroxine should always be taken on empty stomach and nothing else at same time. No food or drink for an hour after


I take Levothyroxine on waking, about one hour before breakfast, then start on the rest. D


Have you ever had your stomach acid measured? It is very likely that you have low stomach acid - most hypos do - and if you raised your stomach acid, that would get rid of a lot of your problems. Have a look at this article, there is a home test you can do at the end :


If you have low stomach acid, that will cause malabsorption of B12, which will cause pins and needles. Obviously your doctor can't deal with more than one problem at a time, poor soul, but I think that testing B12 should be your top priority at the moment, because it will affect everything else.

Statins really aren't recommended when you are hypo - they shouldn't be taken by anyone at anytime, actually, but that's another story. Cholesterol is not going to hurt your heart. Quite the opposite. Cholesterol is needed to make hormones. You already have a hormonal imbalance by being hypo, blocking cholesterol production in your body is going to make that worse, and that will have an adverse effect on your heart.

Why is your dose of levo being reduced? Were you over-medicated? That is to say, was your FT3 over-range? Or did you just have a low TSH? Being hypo can cause your condition, paroxysmal Atrial fibrillation, so seems to me that the first thing your doctor should be doing is sorting out your thyroid problems. And that includes testing your FT3. Has he done that? I have the distinct impression that he doesn't really know what he's doing. I think you need to do some research on your thyroid problem and your heart problem, and see how the two fit together, and have a serious discussion with your doctor about your treatment. And get comprehensive labs done :






vit D

vit B12



When you have the results of all those, you'll be in a better position to make decisions about your health and how to treat it. If your doctor won't do them all - and I doubt he has - you can have them done privately. I do understand what this is like, I've been in this position myself. Doctors find a problem with your heart and panic, go into over-drive prescribing one drug after another, without looking at the bigger picture, and get nowhere. Best to take things in hand, now. :)


Thank you so much for your reply. Have been on statins before Afib was ever thought of. Was running at 7.6, then 4.3 with statins. Tried coming off them but back up to 7.6 within 3 weeks. As I've said before, locums are moving my tablets around like a chess game, meanwhile I look 9 months pregnant, continually flush, have noticed change in breathing and still have a pulse of 169-170 on a short walk. 45-50 at rest


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I started getting heart pains in my 30's along with other vague symptoms they were investigated in my 40's and I was told there were abnormalities with the function of one chamber of the heart but it was just a hormonal "thing" women sometimes get and that is was it. So I have no idea which chamber or what name it had (menopausal crazy woman heart I suspect!) In my 50's I was finally diagnosed with overt hypothyroidism by now the heart pains were chronic. They did not greatly improve on Levothyroxine but after 2 years on it I swapped to NDT and the heart pains plus many other symptoms greatly reduced and some stopped completely. I still get bouts of heart pain but not as bad as what I had before. I am quite sure it was caused by hypothyrodism and inadequate thyroxine that levothyroxine did not properly address. I can only assume the T3 in NDT is the reason for the improvement.

I think reducing your medication is only going to increase the heart problems as you need to be properly optimised for the heart to fuction as it was made to by nature - you would not give a car watered down fuel and expect it to run well and water it down even more when it started doing bucking broncos down the road. It never ceases to amaze me how supposedly intelligent and qualified people can apply such obviously flawed logic to this problem.

Good luck in getting it sorted out I know it can be improved upon but not by making you more hypothyroid than you already are.

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My doctors comment was 100 of Levothyroxine enough for a woman your age!! 73. D

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Dear god the nasty incompetent ageist & sexist monster- should be struck off for saying that to a patient. I would probably exploded with fury and given him a piece of my mind, or said I beg your pardon what did you just say? How dare you speak to me in that manner and reported him. Mind you my reptilian brain would have landed me in the clinker for assault!!

Can you see a different doctor he sounds absolutely awful and has no interest in getting you as well as possible with prejudices like that - you need the amount of levothyroxine that renders you fully optimised. So he doesn't even Bother with a TSH or other blood test results - old women they can have 100mcg max - it beggars belief.


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