Conflict between medicines : i have been on... - Thyroid UK

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Conflict between medicines

i have been on levothyroxine for over 40 years. I now take a lot more medication and have recently been told by pharmacist that quite a few of my medicines affect efficiency of thyroxine.I am annoyed that for years nobody has told me this.

Also anastrozole, levothyroxine and amitriptyline are giving me terrible joint pain that I can barely function. I obviously cannot stop my cancer tablet.

Omeprazole I started at Christmas as I am awaiting gallbladder removal which will take months to get done unless I go private.

Omeprazole 20mg

Amitriptyline 10mg

atorvaststin 20mg

calceos 500mg

anastrozole 1mg

Levothyroxine 100microgram

Can anyone advise length of time I should leave between each tablet and what time of day is best taken.

I have been taking levothyroxine before bed but got them taken away in hospital and got told off and was given them 1st thing in morning along with omeprazole.

I am so confused now as the advice given is never consistent.

41 Replies
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I very much doubt the person in hospital that told you you shouldn't take your levo at night knows anything about thyroid. Lot's of people take it at night and do very well. Some people even do better taking it at night. And there is not scientific reason why you should have to take it in the morning.

And taking levo with omeprazole is absolutely wrong. But, pretty much what I would expect in a hospital. One time I was in hospital they gave me my levo with breakfast - breakfast was a large bowl of milky coffee! (I'm in France.) So, no, they know nothing about it.

Now, I am guessing that you are under-medicated on 100 mcg levo. It's not a very high dose, and depression, high cholesterol and acid reflux are symptoms of low T3. So, you probably wouldn't need the Omeprazole, atorvaststin or Amitriptyline if you were optimally medicated - but that's just a guess on my part - and I'm not medically trained - but do you have copies of your latest thyroid blood test that you can post here, with the ranges, and let us have a look?

And, why are you taking calcium? Do you have osteoporosis? Or is it a parathyroid problem? If you absolutely need to take calcium, it should be four hours away from thyroid hormone replacement.

When did they tell you to take the anastrozole? If it has to be the morning, take it in the morning, and go back to taking your levo at night. In any case, you shouldn't take anything with your levo, other medication and supplements should be at least two hours away from thyroid hormone, and some of them four hours away. But, I don't know if the other things can be taken together. :)

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Thank you for quick reply. I don’t have bloods but could try and request print out.

My thyroid meds were only put up to 100 this month. I was on 75/100 alternate days until blood test showed high readings and my gallbladder consultant insisted the GP phone me (I had to send an email to practice manager as I had waited since 23rd January for a phone call)

Calceos was prescribed as I had chemo and radiotherapy for breast cancer in 2012 which affects bones.

Anastrozole again was prescribed for breast cancer as it was hormone related.

I am very depressed and to be honest have thought about stopping thyroid meds to just slip away. I am also exhausted all the time but GP says readings are fine.

The statins were prescribed this month after a cholesterol test done on 23rd January which I think unfair as it’s after Christmas. GP won’t retest me at a later date.

Everybody I know who have thyroid problems get checked every 6 months, I have never been called in for bloods unless I go in and ask.

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Sounds to me as if you have a very bad doctor, there - ignorant and negligent. Is it possible for you to see someone else?

Calceos was prescribed as I had chemo and radiotherapy for breast cancer in 2012 which affects bones.

OK, so how long have you been taking calcium? When did you last have it tested? When taking calcium it should be tested regularly, because excess calcium is a very bad thing. Have you had your vit D tested? I would suggest you join the Bone Health forum on here:

healthunlocked.com/bonehealth

to learn more about it. Calcium isn't even the most important nutrient for bones - magnesium is far more important. And, if you must take calcium, you should also be taking vit K2 - MK7 to make sure it gets into the bones and teeth and doesn't build up in the blood and soft tissues. But, ask them about it, they know more about it than I do.

Anastrozole again was prescribed for breast cancer as it was hormone related.

OK but Anastrozole is also bad for bones, so your really need to find out more about bones.

There is also a breast cancer forum on here, that could doubtless help you with that:

healthunlocked.com/breastca...

and advise you about treatment options.

I am very depressed and to be honest have thought about stopping thyroid meds to just slip away. I am also exhausted all the time but GP says readings are fine.

I'm not surprised you're depressed, you're going through a lot, and it doesn't sound as if your doctors are helping much. But, I really believe that if you were adequately treated for your thyroid, you would be able to cope with it better, and be less depressed - possibly not be depressed at all, and not need antidepressants - depression is not caused by a deficit in anti-depressers, it's far more likely to be caused by a deficit in hormones.

The statins were prescribed this month after a cholesterol test done on 23rd January which I think unfair as it’s after Christmas. GP won’t retest me at a later date.

Frankly, it wouldn't matter what time of the year it was, because cholesterol has little to do with diet. It is made in the liver, and for a reason: you need it. Your brain is made of cholesterol and so are your cell walls, and low cholesterol is far more dangerous than high cholesterol. For one thing, taking statins will lower your sex hormones. And, as you already have problems in that area, it was very unintelligent of your doctor to prescribe you statins! But, I doubt he knows any more about cholesterol than he does about thyroid. Plus he gets financial incentives to prescribe them.

I suggest you do your own research on this to decide whether you want to continue taking them - just because your doctor prescribes them, doesn't mean you have to take them. It's your decision. I would recommend reading Dr Malcolm Kendrick - blog and books -

drmalcolmkendrick.org/

and learn more about it.

It's time to take charge of your own health, and stand up to doctors. No-one has your interests at heart more than you do. And, just because they've been to med school and you haven't, doesn't mean you can't end up knowing more than them! :)

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greygoose Such excellent informed advice. 😀

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Thank you. :)

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It's time you changed your doctor as it seems to me he is treating clinical symptoms of hypothyroidism as nothing to do with needing optimum thyroid hormones. So many people get prescriptions for 'symptoms' instead of increase in dose. The following is a list of clinical symptoms but a higher cholesterol level is due to hypo i.e. low hormones and it reduces as levothyroxine is increased. Can you imagine if they gave us a different medication for all of the symptoms we can develop - if not on an optimum dose. Optimum means we feel well with relief of symptoms.

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

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I would say I have approx 1/2 of those symptoms

Due to have another blood test 1st April.

I have stopped statins and amitriptyline so fingers crossed.

Thank you so much

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I am glad you have stopped and the fact that hypo patients need a good level of T3 and T4 seems unknown to GPs.

It must seem like ages for April to arrive before your next tests.

Why are the medical professionals 'happy' to give us 'extra' prescriptions for the symptoms of hypo rather than making sure both FT4 and FT3 are in the upper part of the ranges, particularly if they state the person is 'depressed.

Also, the stupid guidelines doctors and endocrinologists have to follow are ridiculous, i.e. TSH to read 10 before being diagnosed. These guidelines harm patients and keeps them unwell.

That just shows that they neglect the training of clinical symptoms and leads to consequences the patient has to put up with.

thyroiduk.org.uk/tuk/testin...

everydayhealth.com/columns/...

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Have just noticed this post, so a bit late to respond. How long have you been taking amitriptyline? This is a drug that shouldn't be stopped suddenly. Tapering the dose is recommended. Have you experienced any problems so far?

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Hi thanks for reading my post.

I am still not taking this since my post and seem to be ok. I wake a few times in the night but am going back to sleep.

Can’t say as my joints ache any less.

I am also not taking the statins and don’t intend to

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My joints ached chronically. Then last year my Vit D level was tested and found to be dragging on the ground. Started Vit D3 (first with megadose (50,000 IU)/weekly. prescribed by Endo then switched to daily maintenance 2000.)

Within a month of starting the weekly prescription dose my muscle and joint aches and pains were gone. Something to consider. Chronic aching daily can really wear us down.

I also take K2-MK7 along with Vit D3. Google and read about it. It helps Vit D be absorbed and correctly distributed in the body. Also it's different than Vit K 1 which is something anyone on anticoagulants shouldn't take. AnndVit K1 is the vitamin in leafy greens.

Many doctors don't seem to know even the basics about these supplements. Best to do our own research.

Take care. irina

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I have to say that since stopping amitriptyline approx 6 weeks ago, my joints are definitely a lot better. Maybe coincidence so will keep open mind.

I have had gall bladder removed in the last week so have been lax in picking up emails. My consultant did say that the blood test I had for pre assessment showed T4 was high. I will try and get print out, although, once again, they wouldn’t check T3 when I asked.

Thank you all for such support.

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Did you have a mini lapcholy? I did in 2016. Welcome to the club. Hoping you heal fast and please take it easy. Let all who are willing wait on you. (Cookies on a silken cushion is a good start!LOL.

Take care. irina

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VERY happy to hear you have stopped statins. There is no law that says we have to obey every directive doctors give us. It pays to do our own research and make our own decisions about whether or not we have received appropriate advice.

Sometimes its in our best interest to be the lead dog in the pack.

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Hi, I am new here..Nice posts everyone..I soo agree shaws & greygoose, I am congenital/central hypothyroid.. My endo explained that there is an "axis" with the thyroid .. pituitary and hypothalamus.. in concert.. and since I don't have a thyroid gland the other two don't quite know what to do..I was born w/out a thyroid gland and it has been a challenge getting balanced through the years what with body changes from before menopause to now.. my primary care here in the US kept lowering my dose.. when I first met this primary care.. besides hello.. her first words to me were that I had the most whacked thyroid numbers she'd ever seen.. she was NOT a doc she is a nurse practitioner.. and so after she took me from my normal dose of .150 mcg.. she had me down to .112 mcg.. one more adjustment downward and she'd of possibly killed me.. she Should have recommended an endocrinologist immediately..but she didn't and I suffered for it.. I've been described as too nice by some folks so it took a bit for me to get pissed off enough to call her on her misdiagnosis.. so.. now i have an endo..He, while paying attention to my numbers is also very "pro patient" in other words he goes mostly by what I Feel!!! and also breast cancer and in the process of getting radiation therapy. My oncologist prescribed Anastrozole for 5 years.. after reading the normal side effects of this drug alone I got scared.. so I looked up what could be adverse effects of the two.. levothyroxine and anastrozole together and that scared the c**p outta me.. soo.. I will be having a pow wow with my oncologist post haste!.. and Greygoose.. thank you also for a very informative narative.. :)

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I am very sorry you have congenital hypo so you wont really know how 'normal' really feels. The fact is that we expect professionals dealing with people who've a dysfunctional thyroid gland that they know fully and understand about thyroid hormones and the purpose and it comes as a suprise to know they know little except a TSH. Rarely are the Frees tested, i.e. FT4 and FT3.

If you want to acknowledge a member within your post you have to put an asterisk and beginning of name and a selection will appear - click on the on you want and it will turn blue and they wil be alerted i.e. Larai

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*Shaws* thank you for replying :)

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I agree wholeheartedly with you GG.

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Thank you. :)

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I agree with all of this. A major problem I have when I go to the hospital is the timing of meds. I've talked to supervisors who say the nurses are short-staffed and they don't always give meds on time.

I'm in the US, was a nurse for 40 years and this is a Pi#$ poor excuse.

My solution is I bring my own meds from home in my blue 7 day pill container and take my own-esp thyroid. At home I take them at 5am, go back to sleep and eat about 7.

This drives hospital staff nuts and I'm always told I can't do this. My response is this is my schedule at home and for 2 or 3 days in the hospital I'm not changing it.

Then they want me to give them my meds to be identified and cleared by the pharmacy. Again, no. I keep them locked in my C-Pap zippered case which has a tiny lock.

My doctor is aware of what I do. I am the customer and I'm not taking thyroid meds as my breakfast tray is arriving in my room. Staff can't really do anything. It is my right to have my meds on time.

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I think the problem is they just don't know about thyroid hormones. I did once mention to the ward orderly that I should have my levo an hour before breakfast, when she brought my breakfast tray - politely, if she could just mention it to the nurse, please? When she went away, I heard the nurse screaming at her down the corridor 'she'll get her levo when I b*****y-well give it to her!' I didn't mention it again. :(

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I believe it. I say bring some with you. Sometimes it can be entertaining to watch the staff decompensate!! Tee Hee.

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lol You're wicked, you are! Anyway, I learnt my lesson, the next time I went into hospital, I took my own T3 and kept it in my bag! :)

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You're wicked too lol. Great minds.....

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Indeed! lol

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Can you tell me what readings I need to send. I have got my results but there are 2 full pages of them

Thanks

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TSH

FT4

FT3

TPO antibodies

Tg antibodies

vit D

vit B12

folate

ferritin

Those are the tests that concern the thyroid. So, if you have any of those, post them. :)

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July 2018 reading

FT4. 17.1 pmol/L. 6.30-14.00 pmol/L

TSH. 0.18 mu/L. 0.30-5.60 mu/L

That’s all they tested

9th January 2019 reading

TSH 8.59 mu/L. 0.30-5.60 mu/L

TSH-(SM) speak to GP Plasma TSH level

Ft4 13.9 pmol/L. 6.30-14.00 pool/L

Vict D. 77 nmol/L. 40-250.00 nmol/L

Ferritin. 87 ug/L. 11-307.00 ug/L

B12&Folate there is no reading

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So, the most important question there is: Were both these tests done on the same dose of levo?

Actually, there are quite a few important questions, like: were both these tests done at the same time of day - early morning and fasting?

Also: have you never had your antibodies tested?

There is such a huge difference between the two! What happened?

In the July test one would say you're over-medicated - high FT4. But, not entirely sure because we don't have the FT3.

In the January test, you are grossly under-medicated: high TSH. However, your FT4 is right at the top of the range, so one imagines that your FT3 is low and that you are a poor converter. But, impossible to say for certain without the FT4 and FT3 tested at the same time.

When did you start the Omeprazole?

Your vit d is a bit low, but your ferritin is OK. It would be good to know your serum iron level.

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None of the tests were fasting or early morning. It is impossible to get bloods done early as diabetics go first here I live and normally sit waiting for 2/3 hours.

B12/Folate. It does say on January printout

“The minimum retesting interval for this analyte is 3-6 months (in line with national minimum re testing interval project) and therefore not been completed”

I was on 100 Levothyroxine but after July reading, I was told 75/100 alternate days.

The January reading I wasn’t contacted until 15th February and I started 100 levothyroxine daily.

Never had antibodies tested.

There isn’t FT3 on the blood test form (nurse checked for me years ago)

Omeprazole- I was put on this middle December 2018 when I experienced shoulder and righ hand stomach pain. Got told by GP it was indigestion.

Ended up in A&E over Christmas with a blocked gallbladder and waiting gallbladder operation.

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Yes, I understand, they don't realise the importance of early morning testing, because they don't seem to understand that TSH levels change throughout the day. But, were they done at more or less the same time?

So, given the difference between your July results and your January results, with only 12.5 mcg difference in daily levo dose, I think you must have Hashi's. It's difficult to believe that such a small difference in dose made such a big difference in levels. You don't happen to have results from a previous test on 100 mcg, do you? That might confirm it.

I realise the inadequacies of NHS testing, but you could get these things tested privately, which is what a lot of people do in order to understand exactly what's going on. It's a scandal that people have to do that, but that's the state of endocrinology these days!

Has the omeprazole helped with your pain? You know that it's only supposed to be a temporary quick fix, don't you? You're not supposed to stay on it long-term. Unfortunately, doctors don't seem to know that. It would be better if you could test your stomach acid level to know how to treat it. Try the home test at the bottom of this article:

scdlifestyle.com/2012/03/3-...

The problem is that the symptoms of both high and low acid are the same.

An awful lot of hypos end up losing their gallbladder. It's one of the signs of hypothyroidism.

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As far as I know, I will come off the omeprazole as soon as I have had gallbladder operation. I think it was for stomach acid not the pain. I was on morphing in hospital but they gave me paracetamol for pain (thought about going private to gee it up, but it would be £5892 and no guarantee it wouldn’t be more).

I haven’t taken my statin today and won’t until I have spoken to GP.

I think I will stop amitriptyline as well as they don’t seem to help with the joint pain as well as they did.

I am due to have another thyroid blood test approx 1st April so will post findings on here.

Thanks for help will keep you posted

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You're welcome. :)

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Without adding a lot of thyroid info I was under treated for years for hypo by an EX-PCP/GP (US). In April 2018 finally found a good Endo who checked all recommended lab and Vitamin levels recommended on this site. This had not been done by previous doc. She said it wasn't necessary!

Among other long term hypo symptoms I suffered very bad aches, bone and joint pain which was mis-diagnosed as fibromyalgia. As a retired nurse I thought this was incorrect. I was right. My Vit D was dragging on the ground it was so low.

I was prescribed a weekly dose of 50,000 IU and after 3 weeks my joint pains, etc were completely gone. I now continue on a weekly dose plus a much smaller daily dose of Vit D3.

I also take Vit K2-MK7 in conjunction with the D3 as I understand this helps to avoid Vit D toxicity (rare) and also helps the calcium we already have to go to bones and teeth where it is needed rather than to arteries and soft tissue.

Both my Cardiologist and Endocrinologist are in agreement. It might be interesting to google the rationale behind this as many doctors tell patients they are calcium deficient. Big Pharma promotes this idea of calcium deficiency also. Good sales ploy! This is usually not the case. It's easy to get calcium in the body with food and without supplements. The problem is without enough K2 calcium tends to go to the wrong body areas.

I guess think of the K2 (which is different than K1 and not interchangeable) as a GPS for calcium.

Just my experience. VERY happy to be rid of the aches and pains so easily. My Vit D levels came up quickly and as long as I take my supplements my pain has not returned.

Take care, irina

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I had the same experience! Diagnosed with fibromyalgia! But recently found out , I was not absorbing thyroxine properly due to taking estrogen & lanzaprozole at the same time as thyroxine. Also low vitamin D. Since taking thyroxine thru the night on a completely empty stomach and supplementing with vitamin D3 , B1, selenium and a multi vit. My pain has dimished and energy has returned! I feel like a new person! Doctors never asked the right question: when & how do you take your medication? Also never tested vitamin levels! A simple question and noticing what meds I was taking could have saved me a lot of difficulty over the past 15 years!

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That is very interesting.

I take levothyroxine at 10pm after eating at 6pm

Statins at 6pm

I take anastrozole at 7pm

Amitriptyline at 8pm

Omeprazole before breakfast

Calceos about 11am

Not sure if I’m leaving enough time in between meds? Nobody seems to know

I have been on levothyroxine since 1971 after having the operation that took too much away

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Hi K. I'm really happy you've found what you need to feel better.

One of the reasons I let go of my PCP is I kept asking her to check Vit and mineral levels related to hypo and she refused saying 'Not necessary.'

I hope a lot of people see our posts because I think our symptoms, misdiagnosis re fibromyalgia, and low Vit D are VERY common in people being mismanaged regarding their hypothyroid problems.

Thanks for responding. irina

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It may actually be the statins causing the joint pain - it's a known side effect. You could see about stopping those as there's no real evidence that they help you to live longer or stop heart attacks in women.

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I’ve been on 10mg to relax me at night and not be bothered by arthritic pain. Maybe that’s why your are on it. If so needs taking at night.

Also on Omeprazole and take at night. But having read various comments here makes me really wonder if have alkaline stomach , despite GP telling me that had/have acid reflux and small hiatus hernia and burnt oesophagi. In 1990s told had, and was treated for ,alkaline stomach.

Also on Sertraline but was previously on Citalaprame 20mg. And statins. And six monthly injections for osteoporosis, when I previously had bone strong than others of my age at around 65. Now 74.

Heaven knows what that has all been doing to me!

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Investigate Osteoporosis drugs as from what I've read they are evil, along with Statin drugs.

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Hi hestersimba,

To recap what others have said - to maximise absorption of Levothyroxine:

 Levo needs to be taken on an empty stomach with a full glass of water ***

 1 hour before or 2 hours after food and drink

 2 hours away from other meds or supplements

 4 hours from iron, calcium and vitamin D

 4 hours from tea / coffee (caffeine) or oestrogen

 Taking it at bedtime is fine. Some studies show that ‘Levothyroxine taken at bedtime significantly improved thyroid hormone levels…’ If you take it at bedtime, you must have eaten 2 – 2 ½ hours (some say 4 hours) before going to bed.

As your pharmacist has said, the various drug interactions are leaving you un[der]medicated. You shouldn’t be taking any of them at the same time as your Levo.

1. Omeprazole lowers stomach acid – and as greygoose has said, taking Levo at the same time as Omeprazole is wrong as stomach acid is needed to activate the Levothyroxine.

*** Levothyroxine sodium tablets should be taken on an empty stomach to be effective because stomach acid is needed to cleave off the attached sodium and then it becomes bioidentical thyroxine (T4), the same T4 that a healthy thyroid would produce. Gastric acid is highest on an empty stomach.

A full glass of water ensures the tablet is shlooshed all the way to your stomach otherwise it might stay in you gullet and dissolve there – best to do this with any tablets, if taking with just water.

2. Calceos (Calcium and Vitamin D) would also reduce absorption if you’re taking it at the same time as Levo.

Had a quick look:

3. Amitriptyline (for pain and migraine or for depression) and Levothyroxine should NOT be taken together.

“…Amitriptyline has an active drug interaction with thyroid hormones or thyroid medication. It has been found that when Amitriptyline and Levothyroxine were taken together the absorption of Levothyroxine decreased significantly as Amitriptyline is antidepressant drug and it occupies the major absorption of site of Levothyroxine.

The dose of thyroid hormones may need to be increased when someone is taking Amitriptyline.

“Dose adjustment of Levothyroxine should be done in order to get the required biological effect and to maintain the thyroid hormone levels in the body to regulate the daily activities.” drugsdetails.com/can-i-take...

Side effects:

“It’s usual to take Amitriptyline in the evening or before bedtime because it can make you feel sleepy. If you find that you are still feeling drowsy in the morning you could try taking it earlier in the evening.

Amitriptyline doesn't usually upset the stomach so you can take it with or without food.”

Amitriptaline can cause high cholesterol

If you take it in the evening you’d have to time it so it’s far enough apart from the bedtime Levo.

4. Anastrozole (brand name Arimidex) breast cancer treatment drug, lowers the amount of oestrogen in the body

Side effects include:

Tiredness

Raised cholesterol level

Muscle or joint pain

Someone writes “…I have been on Arimidex and Synthroid since 2006 and asked both my endocrinologist and oncologist about mixing the two.

They told me no problem but to take one at night and one in the morning.”

---

You have been on Levo for over 40 years after you had a (partial) thyroidectomy and were on 100 or 125 daily. You are now on 100mcg. Given the above drug interactions etc., you must be absorbing even less than that – so you could be under-medicated i.e. still hypothyroid ***

Also when ill (i.e. breast cancer) or stressed some people advise greater need for increasing your Levo. Like during your upcoming gallbladder op.

5. Atorvastatin – to lower cholesterol

Amitriptaline and Anastrozole cause high cholesterol, underactive thyroid also leads to high cholesterol.

*** However, statins are CONTRAINDICATED in untreated hypothyroidism as there is an increased risk of certain side effects. Your GP should know this! And should have discussed the risks and side effects with you.

Warning: stop taking Atorvastatin and call a doctor if you get: muscle pain, tenderness, weakness or cramps.

---

Don’t know, perhaps try Magnesium? It’s supposed to help with joint / muscle pain. I like Magnesium citrate powder by Viridian (I take about ¼ tsp rather than ½ tsp) – I think I took it to balance out calcium (I drink a lot of milk), found I also sleep better…more deeply. viridian-nutrition.com/Shop...

I think Vitamin C helps absorption of Levo, since you have low stomach acid. Others on here would know.

I’d make an official complaint regarding your GP – s/he is officially required to prescribe responsibly and safely and knowledgeably, and it’s quite serious offence that s/he hasn’t. And it’ll help (save!!!) other patients.

If you don’t feel up to writing, then perhaps ask see the practice manager and do it in person / verbally. Others on here could advise if that’s do-able.

Perhaps you could also ask to be referred to an endocrinologist – post here to ask for someone to recommended one, or ask your oncologist for one?.

If you post your thyroid and cholesterol / lipid panel results with ranges, others can help you with them.

---

As to - “There isn’t FT3 on the blood test form (nurse checked for me years ago)” – It isn’t actually available to “select from the computer”, the doctor has to handwrite it on the blood form.

---

p.s. I’m not medically qualified!

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