Thyroid UK
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Carbimazole

HI I am new

Based on below bloods my GP wants to start me on Carbimazole

Thyroid perox. antibodies 4595 kIU/L (<34)

Thyroglobulin antibodies 283.5 kIU/L (<115)

TSH 0.36 mIU/L (0.2 - 4.2)

Free T4 20.3 pmol/L (12 - 22)

Free T3 4.1 pmol/L (3.1 - 6.8)

Just seen new bloods and they are

TSH 9.3 mIU/L (0.2 - 4.2)

Free T4 11.7 pmol/L (12 - 22)

Free T3 3.0 pmol/L (3.1 - 6.8)

So I need increase now

I am to start on 5mg Carbimazole a day, diagnosed hypothyroid 5 years ago. I do have hypo symptoms of constipation, fatigue, puffy eyes and ankles, feeling cold, eyebrow and eyelash loss.

Thanks for support/advice

37 Replies
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Are you taking or have you been taking thyroid medication or levothyroxine?

TSH 0.36 mIU/L (0.2 - 4.2) TSH is low but it's a pituitary hormone. If FT3 and FT4 are within range then it simply indicates you have enough thyroid hormone for your body's needs and so the pituitary gland is not signalling the thyroid to produce more hormone.

Free T4 20.3 pmol/L (12 - 22) Your FT4 is within range indicating a comfortable level of T4 available for use.

Free T3 4.1 pmol/L (3.1 - 6.8) The active thyroid homone FT3 is in range and in fact it's low in range indicating that you are converting FT4 to FT3 but your conversion is not that good so you may be slightly deficient. FT3 is best in the top third of the range.

Your low FT3 may be why you have some symptoms or symptoms could be due to low vitamin levels which are common with thyroid conditions.

You have elevated thyroid antibodies showing that you have Hashimotos, autoimmune thyroiditis.

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Thanks I take 200mcg levothyroxine. No idea what to do about my vitamin and mineral levels, supplementing doesn't seem to help

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If you post your vitamin levels and the amount of supplements you're taking people here might be able to help. Often doctors do not prescribe high enough doses and sometimes there are coexisting conditions your doctor needs to investigate. We might be able to help if you can post your results along with the laboratory ranges and supplements.

Absorption can also be a problem if taking levothyroxine and having antibodies. There are people on this forum who can advise. If you are taking any other medication, please also include that information as it can be relevant.

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Ok I would like to include some background to each one just so that people know just how much my levels have decreased by? GPs aren't being very helpful. Thanks

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Sorry site won't let me edit the post

Ferritin *33 ug/L (30 - 400) taking 3 ferrous fumarate

MCV *70.5 fL (80 - 98)

MCHC *377 (310 - 350)

Haemoglobin estimation *110 (115 - 150)

Folate *2.3 ug/L (2.5 - 19.5) taking 5mg folic acid once a day

Vitamin B12 194 pg/L (190 - 900) taking B12 injections every 3 months

Vitamin D total 35.2 nmol/L (25 - 50 DEFICIENT) taking 800iu since 2012

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As Clutter has suggested, it might be an idea to change your GP because some of these need investigating further. Is there another GP in your practice you could see?

Even though B12 is in range, it's only just in range and it's possible you've got anaemia caused by low B12.

Have you got symptoms of B12 deficiency because if so, I advise you to post your B12 and folate results along with an outline of your thyroid condition and symptoms, low ferritin etc on the HealthUnlocked Pernicious Anaemia forum healthunlocked.com/pasoc and ask their advice about what your GP should be doing. Really, it looks like you need further investigations to rule out pernicious anaemia. Your GP should check for intrinsic factor antibodies.

B12 symptoms of deficiency

b12deficiency.info/signs-an...

B12 The Guidelines Doctors follow

onlinelibrary.wiley.com/doi...

Ferritin is dire. You need ferritin to be at least 70 or mid-range for your own thyroid to function properly.

Iron deficiency anaemia NICE guidelines

cks.nice.org.uk/anaemia-iro...

You can help raise your iron level by a maximum 200g per week of liver, no more, due to its high Vit A content, and include lots of iron rich foods in your diet, weblink posted by SeasideSusie below.

apjcn.nhri.org.tw/server/in...

Helping iron levels with diet - post on HealthUnlocked.

healthunlocked.com/thyroidu...

The importance of vitamins and thyroid function

americannutritionassociatio...

SlowDragon has lots of advice on improving gut function

If you get a referral to endocrinology then ask Thyroid UK for their list of 'good' endocrinologists.

Just seen the bit you've added about B12 injections. Did your GP check for pernicious anaemia before ordering B12 injections?

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Chla,

Change your GP. Your GP clearly doesn't know what s/he is doing. Carbimazole is prescribed for hyperthyroidism, not for hypothyroidism and patients taking high doses of Levothyroxine. You are not overmedicated on 200mcg but if you were the correct action would be to reduce Levothyroxine dose not prescribe Carbimazole. Carbimazole will reduce your FT4 and FT3 and as FT3 is low in range is likely to increase any hypothyroid symptoms you have.

If you are feeling hypothyroid on 200mcg Levothyroxine you should be referred to endocrinology for management.

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Just seen new bloods and they are

TSH 9.3 (0.2 - 4.2)

FREE T4 11.7 (12 - 22)

FREE T3 3.0 (3.1 - 6.8)

So I need increase now

Reply

Chla,

Yes, you need Levothyroxine dose increases until TSH is 0.2 - 1.0. Had you taken the Carbimazole your GP prescribed your TSH would have risen higher and FT4 and FT3 dropped further below range. Please do see another GP and advise your practice manager that your GP needs retraining as s/he has prescribed inappropriately.

The goal of Levothyroxine is to restore the patient to euthyroid status. For most patients that will be when TSH is 0.2 - 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. The Thyroid UK office opens on 3rd January.

Thyroid peroxidase and thyroglobulin antibodies are positive for autoimmune thyroid disease (Hashimoto's). There is no cure for Hashimoto's which causes 90% of hypothyroidism. Levothyroxine treatment is for the low thyroid levels it causes. Many people have found that 100% gluten-free diet is helpful in reducing Hashi flares, symptoms and eventually antibodies.

chriskresser.com/the-gluten...

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

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Welcome to the forum, Chla

That doesn't sound right. I really wouldn't take the Carbimazole until you've got more info from others here. I wonder what your doctor is trying to achieve. I understand that people don't usually change from hypo to hyper.

It looks to me that you are still hypo and with the high antibodies that would make it Hashimotos. Those readings aren't too bad.

Have you been taking medication over the last 5 years, since being diagnosed as hypothyroid? If so what and how much?

Have you had any vitamins and minerals tested? These need to be well in range for thyroid medication to work and will help your other symptoms.

Gluten free is good for Hashi's.

How have your regular blood tests gone?

Sorry, it's all questions at this stage. The more you can tell us, the more we can help you.

All the best.

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Thanks I take 200mcg levothyroxine. No idea what to do about my vitamin and mineral levels, supplementing doesn't seem to help

and vitamins last tested a week ago. Regular bloods have gone up and down and they are every 6 - 8 weeks

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With Hashimotos thyroiditis, hormone levels can fluctuate as a result of the autoimmune activity. As the autoimmune disease attacks the thyroid, the dying cells release a lot of hormone. You can readd more about Hashimotos on Thyroid UK's website.

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

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Just seen new bloods and they are

TSH 9.3 (0.2 - 4.2)

FREE T4 11.7 (12 - 22)

FREE T3 3.0 (3.1 - 6.8)

So I need increase now

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How do you take your levo? Do you take it on an empty stomach, leaving at least an hour before eating or drinking anything other than water? Are you taking any other supplements or medication with it?

To have a TSH of 9.3 on 200 mcg levo would suggest that either you don't take it regularly/correctly, or you have an absorption problem, in which case, you need to see a gastroenterologist.

But Carbimazole is definitely the wrong treatment for you and will make you very ill. Change your doctor, and then report this one for incompetence. S/he is dangerous!

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I take the levothyroxine on an empty stomach and I leave 4 hours before eating and drink anything other than water. I take supplements but leave 4 hours between them and levothyroxine

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Ok, well, everything that we've said on here applies then. YOu've likely got an absorption issue.

You definitely should NOT take carbimazole.

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Yes, you need an increase by 25 mcg and retest in 6 weeks and then adjust and so on. Are you still on 200mcg of levothyroxine? If so, that is quite a high dose and it's possible that you've got absorption problems that are interfering with your absorption of levothyrxoine and vitamins. If you can post your vitamins results it might give a clue.

Do you always take your levothryoxine on an empty stomach, with a glass of water, leaving an hour before eating or drinking anything except for water?

Do you leave 4 hours until taking any other medicines including supplements?

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I take the levothyroxine on an empty stomach and I leave 4 hours before eating and drink anything other than water. I take supplements but leave 4 hours between them and levothyroxine

Still on 200mcg

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The fact you are on relatively high dose yet still have high TSH strongly suggests that you have very poor gut function and poor uptake

Presumably you know to take Levo on empty stomach and then nothing apart from water for at least an hour after.

Many take on waking, but it may be more convenient and possibly more effective taken at bedtime

verywell.com/should-i-take-...

Many people find Levothyroxine brands are not interchangeable. Once you find a brand that suits you, best to make sure to only get that one at each prescription.

Taking vitamin C at same time as Levothyroxine might help improve uptake

ncbi.nlm.nih.gov/pubmed/246...

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I take the levothyroxine on an empty stomach and I leave 4 hours before eating and drink anything other than water. I take supplements but leave 4 hours between them and levothyroxine

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Your blood tests do NOT show you are over medicated. You have Hashimoto's and almost certainly dire vitamin levels

Who wants to prescribe carbimazole? If it's GP they obviously have little idea of what they are doing

Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels

Low vitamin levels stop Thyroid hormone working

See this typical post with endo saying over medicated, but follow up post shows that vitamins are so dire that thyroid hormones are not able to work

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

But don't be surprised that GP or endo never mention gut, gluten or low vitamins. Hashimoto's is very poorly understood

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

thyroidpharmacist.com/artic...

thyroidpharmacist.com/artic...

amymyersmd.com/2017/02/3-im...

chriskresser.com/the-gluten...

scdlifestyle.com/2014/08/th...

drknews.com/changing-your-d...

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Just seen new bloods and they are

TSH 9.3 (0.2 - 4.2)

FREE T4 11.7 (12 - 22)

FREE T3 3.0 (3.1 - 6.8)

So I need increase now

Vitamins and minerals can post in new post if need be as they have a lot of background

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Yes put on new post with some background info

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I agree with Anthea55, something isn't right with you being prescribed Carbimazole. Is there another GP in your practice from whom you could seek a second opinion? Your antibodies demonstrate you have Hashimoto's, not Graves, and your TSH/FT3/FT4 are all within range; so there appears to be no clinical need (or logic) to use an anthi-thyroid drug to reduce your production of T3/T4 hormones. Even "if" your FT3/FT4 had been shown to be above range, the answer would have been to reduce your Levo, not add in carbimazole.

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Just seen new bloods and they are

TSH 9.3 mIU/L (0.2 - 4.2)

Free T4 11.7 pmol/L (12 - 22)

Free T3 3.0 pmol/L (3.1 - 6.8)

So I need increase now

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GP says I don't look like a hypo patient

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Well GP's should make evidence based decisions. They should examine all the evidence including blood tests and symptoms. Your GP has ignored the biochemical evidence and your symptoms and proposed a course of action that is in contradiction with your blood test results.

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Chia

Oh, so tempted

"GP says I don't look like a hypo patient"

Reply "And you don't look like a jerk"

I assume you might be slim? There is no rule that Hypos have to be overweight.

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Yes I am slim

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And GP is a jerk.

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What??? Please change your GP.

We all look different.

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Will do this thank you

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Oh goodness me?

Maybe you don't look like you are hypo but your blood test results should give your doctor a clue or two.

Carbimazole is for people who are hyper, in my case with Graves Disease - I took it when my TSH was <0.03 (0.35-5.5) below low reference level and my T4 was 28.6 (10.0-19.8) and I think those results are pretty average for hyper patients. They are nothing like your results.

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Does the GP look like a GP?

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Please listern to these people your gp is a idiot and you should not take carbimazole.😨😨

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NOOOOOOOO!! Don't do it. You are hypo not hyper with Hashimotos (akak autoimmune thyroiditis). If you take carbi you will be very ill and could even die. You possibly had a Hashi flare when the first set of bloods were taken, but your Free T4 was in range and your free T3 was low in range, so no way overactive. That doctor is dangerous.

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This is one of the scariest posts I've read about medical incompetence!

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