Hi, I am here on behalf of my daughter. She is 32 years old and she has become very withdrawn, apathetic, short, snappy, irritable, low, depressed, anxious, tense and I am wondering if it's to do with her bloods? She is meant to be taking 150mcg levothyroxine but she has been taking 50mcg levothyroxine; I am worried she is going to end up very ill. Her GP and endocrinologist do not know about the dose reduction and when I asked her why she is taking a tiny amount she has said if she takes any more than a 50mcg tablet she gets very bad digestive symptoms of bloating, nausea, abdominal cramps. She went to the GP before about this problem and the GP said it was either stress or irritable bowel, she doesn't fully support either diagnosis. She was diagnosed 6 years ago.
Any help would be appreciated, thank you in advance.
DEC 2017 (50mcg levothyroxine)
TSH 4.8 (0.2 - 4.2)
FT4 14.4 (12 - 22)
FT3 3.3 (3.1 - 6.8)
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Your daughter is undermedicated and needs to increase her levothyroxine dose.
Taking levothryoxine and having thyroid antibodies and Hashimotos disease can contribute to gut bacteria imbalance, knocking out good bacteria and causing other problems. It's thought that hypothyroidism may contribute to low stomach acid which can cause bloating and other problems too. Taking a desertspoonful of organic apple cider vinegar (with the mother) in a glass of water before the main meal may reduce bloating and improve digestion. Some people find they need something stronger like HCL Betain with Pepsin.
Your daughter could do the simple stomach acid test in this link
Has your daughter had thyroid antibodies tested? If not, she needs TPO Thyroid Peroxidase antibodies and TgAb Thyroglobulin antibodies tested. If they are positive it will confirm Hashimotos thyroiditis. It's helpful to know because there is a lot she can do to help restore balance for intestinal health and reduce antibodies activity.
SlowDragon has great links to how to heal the gut.
A dessertspoon of vinegar in water may be rather a high starting dose. I would suggest starting with a teaspoon of apple cider vinegar in a small glass of water - sipping it before and during a meal. Every week or 10 days increase the amount of vinegar by 1/2 a teaspoon until it stops helping then reduce the dose back to what did help.
When people talk about vinegar "with the mother" this link describes what they are talking about :
If apple cider vinegar doesn't help there are alternatives - for example, digestive bitters are supposed to help the stomach produce its own acid, or betaine HCL + pepsin :
Yes she definitely does have Hashimoto's. It's also more commonly called autoimmune thyroid disease here in UK
Suggest you see different GP, this underlines how little current one knows
Your daughter is very under medicated to have TSH so high. 50mcg is standard starter dose and should be retested 6-8 weeks after starting or and dose change, and dose increased by 25mcgs Steps until TSH is around one and FT4 towards top of range and FT3 at least half way in range.
She is highly likely to have very low vitamin levels as result of under medication
Have you got test results and ranges for vitamin D, folate, ferritin and B12? These need to be optimal, not just in range. Post results here or on new post for advice
Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels
Low vitamin levels impair how Thyroid hormones work
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 (despite it being extremely common disease)
Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies
Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,
"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.
In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l.
Most patients will feel well in that circumstance. But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.
This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."
You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctor please email Dionne: tukadmin@thyroiduk.org
Going strictly gluten free should help gut. She may also need to consider dairy free.
She was quite possibly under medicated on 150mcg as gut was causing problems.
Low stomach acid can be an issue
Lots of posts on here about how to improve with Apple cider vinegar or Betaine HCL
Getting TSH right down low, healing gut and getting vitamin levels optimal are key. If FT3 still remains low then she may, like many with Hashimoto's need the addition of small dose of T3. But other steps must be done first
Prof Toft - article just published now saying T3 is likely essential for many
These will be worse now if your daughter cut dose recently
Ferritin she needs full iron panel done and then likely ferrous fumerate 3 x daily. Needs to be above 70
Push for B12 injections urgently and make sure to get them at least every 3 months. If she has low B12 symptoms she should have several injections close together
I used to get the same symptoms because I was reacting to the fillers in certain brands of levothyroxine (i.e., acacia, lactose, wheat/gluten, petroleum/aluminum based colorants, etc.)
It went on for years that way before I finally made the connection.
Of course, in the US, we have very few truly hypoallergenic medicine choices available, especially for thyroid.
But, you may have better formula options as far as allergens go.
This may not be what is causing the digestive upset, but it is something to keep in mind just in case. Hope you can get it all sorted out soon
Thank you, she is on Teva levothyroxine. Her endo says her thyroid levels improved on this. Before that she was on Actavis, Mercury and Wcokhardt all of which did not improve her levels.
Perhaps your daughter is lactose or dairy intolerant?
Many are
See The Thyroid Pharmacist website for lots of info. She is dairy intolerant.
You don't have to have obvious, or in fact any, gut symptoms to still be seriously intolerant. (I found that out with gluten. Was absolutely stunned at the difference going gluten free. Subsequently confirmed by endoscopy as severely gluten intolerant, never had any gut symptoms.)
Also, if there are any gluten intolerance issues, I would make it a point to request the strength that contains no dyes. The dosage can be worked out, alternating doses on different days, halving/quartering pills (that is what I do). There can easily be a gluten component to the dyes that are used depending on where they are sourced; and generally, no one is the wiser, unless you have a sensitivity. At least that's the way it is in the US. I found that one out the hard way.
Hopefully, this does not apply to your daughter, but it was worth a mention just in case
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