Thyroid UK

Unsure what is happening to me

Hi I am new, I have symptoms such as my salivary glands being blocked and feeling sore, constipation every day, periods abruptly stopping, losing hair, tiredness, dry skin all over face and body, cold hands and feet, easy bruising, poor circulation, pins and needles, aching in between my finger knuckles (carpal tunnel?) eyebrow loss, dry eyes. Am I possibly undermedicated? Taking 50mcg Levothyroxine diagnosed 2011.

Thanks

TSH 6.3 (0.2 - 4.2)

Free T4 13.8 (12 - 22)

Free T3 4.0 (3.1 - 6.8)

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Alexxis,

You are undermedicated on 50mcg to have TSH 6.3 and FT4 low in range. Most of the symptoms you complain of will be due to undermedication. Ask your GP to increase dose.

The goal of Levothyroxine is to restore the patient to euthyroid status. For most patients that will be when TSH is 0.3 - 1.0 with FT4 in the upper range. FT4 needs to be in the upper range in order that sufficient T3 is converted. Read Treatment Options in thyroiduk.org.uk/tuk/about_... Email dionne.fulcher@thyroiduk.org if you would like a copy of the Pulse article to show your GP.

For maximum absorption Levothyroxine should be taken with water 1 hour before, or 2 hours after, food and drink, 2 hours away from other medication and supplements, and 4 hours away from calcium, iron, vitamin D supplements, magnesium and oestrogen.

It takes 7-10 days for a dose increase to be absorbed before it starts working and it will take up to six weeks to feel the full impact of the dose. Symptoms may lag behind good biochemistry by several months.

You should have a follow up thyroid test 6-8 weeks after increasing Levothyroxine dose. Arrange an early morning and fasting (water only) blood draw when TSH is highest, and take Levothyroxine after your blood draw.

thyroiduk.org.uk/tuk/about_...

Blocked saliva glands are nothing to do with thyroid undermedication. Try gargling with lemon juice to stimulate saliva. If the blockage persists your GP should arrange an x-ray to investigate. nhs.uk/conditions/salivary-...

Pins and needles are often due to low B12. If you have symptoms of B12 deficiency in b12deficiency.info/signs-an... ask your GP to check B12 and folate. It is worth asking for ferritin and vitamin D to be checked to as all four are commonly low in hypothyroid patients.

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GP won't increase. Thanks

Ferritin 5 (15 - 150)

Folate 1.4 (4.6 - 18.7)

Vitamin B12 132 (190 - 900)

Vitamin D 16.1

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Alexxis,

You need a dose increase. Show your GP the Pulse article, see another GP in the practice or change practice.

If your GP has seen the thyroid and vitamin and mineral results and isn't treating you I would write a formal complaint to the practice manager or senior partner and change GP.

Your vitamins and minerals are all severely deficient.

Vitamin D is severely deficient. Your GP should refer to local guidelines or the NICE CKS recommendations for treating vitamin D deficient adults cks.nice.org.uk/vitamin-d-d... Do not accept a prescription for 800iu which is to be taken as a maintenance dose after deficiency is corrected. My GP prescribed 40,000iu daily x 14 followed by 2,000iu daily x 8 weeks which raised vitD from <10 to 107. Vitamin D should be taken 4 hours away from Levothyroxine.

Ferritin is severely deficient and this may indicate iron deficiency anaemia. Your GP should do an iron panel and full blood count to check. If you are prescribed iron it should be taken 4 hours away from Levothyroxine.

B12 and folate are severely deficient. Symptoms of B12 deficiency are in b12deficiency.info/signs-an... B12 injections should be initiated immediately and 48 hours prior to prescribing 5mg folic acid. Your GP should also be checking whether you have pernicious anaemia causing B12 and folate deficiency. healthunlocked.com/pasoc are the experts on PA, B12 and folate deficiency.

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