Thyroid UK

Hypothyroid with Hashi

Hello

I am new here, 31 years old.

I was diagnosed hypothyroid after going to A and E in Aug 2017 with joint pain causing limping.

11 Aug 2017

TSH 30.9 (0.2 - 4.2)

T4 11.4 (12 - 22)

10 Oct 2017 (started 50mcg for a week and 2 weeks 100mcg)

TSH 0.03 (0.2 - 4.2)

T4 26.3 (12 - 22)

T3 4.1 (3.1 - 6.8)

I was asked to stop levo for a month and became hypo again

22 Dec 2017

TSH 50.2 (0.2 - 4.2)

FT4 11.3 (12 - 22)

ANTI TPO 900 (<34)

Have been told I have Hashi and ultrasound has confirmed this with thyroid enlargement. My questions are: are the feelings of anxiety and on edge normal or a Hashi flare? Also how are the high thyroid antibodies treated? Thank you in advance

8 Replies
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Anxiety can be caused by undermedication, ovetmedication or rapid or dramatic changes in thyroid hormone. The best way to alleviate anxiety feelings is with hormonal stability. Levothyroxine should not be altered more than 25mcgs at a time.

When you were told to stop taking levo your FT3 was in range so you were not overmedicated. Stopping levo could have made anxiety worse, triggered or prolonged it.

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Violet885,

You were a little overmedicated to have TSH suppressed at 0.03 and FT4 26.3 but your dose should have been reduced to 75mcg not stopped. Your GP was totally wrong to stop your Levothyroxine as your subsequent thyroid test 22nd Dec showed. How much Levothyroxine are you prescribed now?

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_...

Thyroid peroxidase 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_...

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 Levothyroxine 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 starting Levothyroxine. 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_...

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Thanks I am on no levothyroxine at all

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Violet885,

Why on earth not? Your TSH is now higher than when you were originally prescribed Levothyroxine? You should see your GP or another GP as soon as possible. An appropriate starting dose would be 75mcg with a follow up test in 6 weeks to see whether dose needs increasing to 100mcg.

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After October results They should not have stopped your Levothyroxine, but simply reduced dose to 75mcg.

The dose was increased too quickly in the first place. Yes, we start on 50mcg, but increase after that in 25mcg steps. Retesting 6-8 weeks after each dose increase

All thyroid tests should be done as early as possible in morning and fasting and don't take Levo in the 24 hours prior to test, delay and take straight after. This gives highest TSH, lowest FT4 and most consistent results

Your GP obviously doesn't understand Hashimoto's

So how much are you taking now? 50mcg? Or 75mcg?

Always 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.

Your antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).

About 90% of all hypothyroidism in Uk is due to Hashimoto's

Essential to test vitamin D, folate, ferritin and B12.

Always get actual results and ranges. Post results when you have them, members can advise

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

Low vitamin levels stop Thyroid hormone working

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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I am on no levothyroxine now.

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Then you need to make an urgent appointment with any GP at the practice to agree starting back on 50mcg Levothyroxine dose ASAP

Retesting after 6-8 weeks

Increase dose only in 25mcgs steps

Get vitamins tested ASAP and ask for Coeliac blood test too

Always 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.

Reply

I haven't checked my ferritin nor my folate. My GP didn't test for any of these indicators. Would try to ask it for my next lab check.

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