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Thyroid UK
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Can you have HRT if on Levothyroxine?

I’ve been peri menopausal for 7 years. Since last November joint pain has increased and I’ve developed shoulder instability (that’s what it feels like).

Recently I was finally, after years, put on treatment for Thyroid. I’m on Levothyroxine 50mcg and up to now I’ve had some benefits so I’d like to stay on it.

I’m in so much pain with shoulders at the moment that I’m thinking it may be peri menopausal arthritis? It so restrictive, I can’t go on like this. It seems worse around menstruation, like ligaments become loose/slack.

Can you have HRT with Levothyroxine?

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Yes, I am on both Levothyroxine and Liothyronine, plus an oestrogen HRT patch. I do not need progesterone (no ovaries) and do not know whether it makes a difference if you do but I doubt it.

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Thanks. That’s good to know.

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Yes you can but sometimes your thyroxine needs can go up with HRT so keep an eye on it.

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Thanks, I was wondering about that.

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Agree

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I think it sounds like hypothyroid symptoms. Are they dosing you based on TSh or do they check Ft3 and 4 too? Is your shoulder pain both sides?

People usually feel better when Ft3 and Ft4 are mid range or slightly above.

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Me too. They go off TSH. Yes shoulder pain both sides.

Thanks.

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I’m pretty sure it’s hypo symptoms (shoulder pain both sides)

I would ask them to test Ft3 and Ft4, I suspect they will be very low on the range. They shouldn’t be dosing based on tsh alone.

I feel much better when mine are slightly above the mid Range. I think most people do.

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I’ll ask for those at next labs. Thanks.

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Hi yes you can take HRT and thyroxine - I did for about 15 years. After my partial thyroidectomy in 1996 I went into premature menopause and started taking HRT around 2002 - only stopped about 18 months ago - since when my symptoms have become unbearable and I'm trying to get myself healthy again - so yes you can take both - check with doctor as to which type.

Good luck

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Thanks for that. Hope you get yourself healthy again, soon. It’s awful.

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I have combined thyroid treatment (natural desiccated thyroid) and HRT for years. They can be combined, but some drugs should not be taken together. I only use transdermal estrogen so no problem there, and natural progesterone to be taken at night (I take NDT in the morning). But if you take oral HRT, you'd better find out if it can interfere with the uptake of thyroxine and, if so, they should be taken a few hours apart.

How often do you have labs to determine if you are optimally treated? 50 mcg of thyroxine is considered a starting dose and often needs to be raised after 6-8 weeks. Many doctors are frighteningly clueless when it comes to the treatment of hypothyroidism and too often settle for hormone levels "anywhere in range", hence my question.

Also, does your doctor test your free T4 and free T3 levels, as well as thyroid antibodies, or just your TSH?

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That’s very interesting, thanks for that.

I have only had one lot of labs done since starting on T4, been on it around 8 weeks now. My GP was saying she’d check again in a year! My Nurse was off sick, she knows to check labs 6-8 weeks for a few months and check symptoms etc. I’m gonna see nurse next time.

They’ll only check TSH and T4

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A year?! That's crazy!!! You need to be checked every 6-8 weeks until optimally dosed (symptom-free).

Ideally, you should have your free T3 levels measured as well as T3 is the truly active hormone carrying out all metabolic activity on cellular level. There are private labs in the UK where you can order FT3 and other tests (UK members will have to provide you with details as I'm not in the UK but it's often mentioned here on the forum).

If your FT3 levels are suboptimal, you will remain hypothyroid, no matter how much T4 your take or how "good" your TSH looks. If you have problems converting T4 to T3 (many do), taking T4 won't be enough.

If you can have your FT3 levels tested by a private lab, you can then post results here for members to comment on. If your FT3 levels are low and you seem to have a conversion problem, you can order T3 online without a prescription if your doctor won't prescribe it.

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Thanks very much. I’m going to see if Nurse Clinician will include T3 next time. They’ve done it once before, years ago.

Yeah, GP just said TSH is fine now and that I’ll stay on 50mcg Levothyroxine. She was gonna check in a year but hubby said it should be sooner, she changed her mind to 3 months. I’m waiting a few weeks then I’ll see Nurse Clinician.

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You know your stuff!

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Yes I was on both forca long time but made sure well apart. Thyroid meds in morning and HRT in the evening but check your levels as they can change and the same when you come off it.

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Thanks for that.

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I’m on HRT patches, levo and T3. No issues.

Just a suggestion, have you tried magnesium? I find that magnesium lotion (especially sleep lotion for BetterYou) helps my shoulders to relax a good amount.

You could ask for your vitamin D levels to be checked. Taking vitD with k2 (if not on blood thinning meds) and magnesium might help you with thyroid and menopause issues. Ask for the results and ranges. VitD needs to be around 100, but your GP will say “normal” even if it’s 55 (range 50-199).

(See posts by seaside susie, slow dragon etc for excellent advice).

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Thanks.

I have tried magnesium spray a while ago. I think I still have it. I’ll have a go with that, thanks.

My Vit D was around 50 . I take supplements.

Thanks very much for tip re Vit D, K2 & magnesium- I’ll try that.

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I didn’t absorb vitamin D tablets well. I now use spray.

Liquid capsules are good too.

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I’ve oredered the magnesium spray and a Vit D K2 spray.

Thanks very much.

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Hope they help ☺️

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Me too, thanks.

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I have tried HRT twice. Only managed 3 nights both times trying it. Woke up soaked each time with puddles in my chest. Soaked back and legs. I have disrupted sleep and hot flushes anyway in bed but this was 100 times worse. So stopped taking it. Then took weeks for me to feel better. Just does not agree with me.

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Yeah, that’s what I’m afraid of. And as I’ve only just started on Levothyroxine I’m wondering if it’d be a good idea to add HRT.

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I was diagnosed with low estrogen levels 40 years ago and started on HRT. Twenty years later, some of the same symptoms were attributed to hypothyroidism, which I had tried to tell my doctors I had back then. Anyhow, I am on both. I take my thyroid meds in the morning and my female hormones at night.

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Thanks. That’s really good to know. I want to know my options, just in case.

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Make sure you take the HRT and your thyroxine several hours apart as they can interfere with one another. I take levothyroxine in early morning first thing on an empty stomach for best absorption and HRT at bedtime. 50mcg is a low dosage, maybe need higher dosage. Also agree with others, magnesium helps muscle pain, I find putting in a bath helps along with oral meds. Vitamin D really helped my bone and joint pain. All the best on your thyroid journey!

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Thanks. It’s sounding very much like I need to go see Nurse Clinician. She had indicated I was starting on a small dose with a view to increasing based on symptoms.

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This is a good article about managing pain:

thyroidpharmacist.com/artic...

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Thanks very much.

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Brilliant Article! I also am cutting out gluten and taking omega 3 . I was diagnosed with Fibromyalgia but since changing diet and taking Vit D , magnesium orally and topically and omega 3. My pain levels have diminished to almost nil.

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That's great to hear:-)

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Taking estrogen+progesterone HRT does affect the way that thyroid therapy works. So if you want to do that, you should be prepared to monitor your thyroid therapy at the same time, so that you retain reasonable FT3 and FT4 levels. You should try to keep your FT3 about mid-range.

Having said that, my spouse is on HRT and thinks it is great. She doses using "bioidentical" hormones in the form of a waxy troche. However I have been unable to get her to go on thyroid therapy, which I have urged her to do because her FT3 has fallen almost to bottom of range.

I cannot tell you how the female body responds to thyroid, since I am male. However, I should mention that thyroid therapy in males has a *major* effect on increasing testosterone level. There are some males (like me) whose MD will tell them that their testosterone production has shutdown, when in fact, returning the male body to euthyroid status will result in testosterone level going back up into the normal range. I have heard of females who have found that normalizing thyroid levels, and making sure that whole-body iodine level is sufficient, reduces symptoms that are usually blamed on low estrogen.

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That’s really helpful & very interesting, thank you very much.

Yeah, I think I really need T3 check don’t I . I reckon I’ll hold off HRT for now and use the magnesium, D3, K2 & calcium. Then, ask Nurse Clinician to do T3 and T4 as well as TSH at next appointment. If she won’t then I think it’s going to be time to get them done myself.

Thanks.

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As far as I'm concerned, the most important thyroid test is FT3. The second most important test is for either TPO or TG antibodies.

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I’ll definitely ask for that, they’re always reluctant but I’ll ask.

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Modern allopathic medicine is definitely stupid enough to allow thyroid destruction to continue, unabated. Possibly because they think there is nothing that can be done about antibodies. So they are both ignorant AND stupid.

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Hello I take both but I would get your thyroxin levels and vitamin levels optimal first and then go on to hrt if you are still not feeling good. Might take 6-12 months to tweak it. Also consider yoga or Pilates classes three times a week before embarking on hormones for your shoulders. Test for vit d, b12, folate, ferritin. Magnesium supplement good idea. I love the high potency Viridian one. Helps me sleep and v calming. And if you do go onto HRT then be sure to take them far apart. Consider nature identical hormones. Good luck.

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Hello, thanks very much for your input.

Sounds a good plan. Yeah, I’ve only been on Levothyroxine a short time haven’t I .

I’ve had the other things tested...Ferritin, folate etc.

Thanks.

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Hi! I developed Phantosmia whilst taking combined HRT tablet form. Swapped to HRT patches as safer and doesn’t effect the liver.

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Thanks. That’s good to know.

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Yes I’m on 125mcg levothyroxine and take Livial (tibolone) and have done for many years.

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Thanks, that’s very helpful.

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Hello, thanks very much for your input.

Sounds a good plan. Yeah, I’ve only been on Levothyroxine a short time haven’t I .

I’ve had the other things tested...Ferritin, folate etc.

Thanks.

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Hi ..your thyroxine is still low but you can only increase in increments to get to your optimal level. I ended up on 175 mcg then came down to 150 which I was on for 30 years and now making a few tweaks. Shoulder stuff and aches and pains def hypo symptom but should ease up in time ...I needed osteopathy and acupuncture as was very hypo for a while but did recover. Also was on HRT 10 years no problem - best thing I coukd have done and made me human and stopped the overwhelming tiredness within days, but you would have to discuss with doc. Some doc's a bit cautious and emphasise risks but it's up to you. Life is risky. I would advise sorting thyroid out first though as you may find you do not need HRT?

Good luck and hope you get some balance and relief in the near future though it can be a slow process.

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Hi, thanks for replying.

It’s good to know that things can ease in time, it’s awful isn’t it. Really good to hear that you got improvements with increases in thyroxine.

Also good to know how HRT was for you. I agree, it’s looking like it may well be down to thyroid so I’ll sort that out first.

Thanks very much. I hope you’re levels stay good.

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Ask your Consultant to arrange for an MRI scan to find out if you have Avascular Necrosis.

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Hi yes! I’m on 125 mcgs of Levothyroxine and have a transdermal patch 2 x a week and oestradiol vaginal pessaries 3 x a week to help. My endocrinologist has recommended that as I still have ovaries I can’t take just oestrogen, I must have progesterone as well (Evorel Conti) patch. Shoulder arthritis he said was common with Hypothyroidism and I also have 3 partial tears in my rotator cuff tendon right shoulder and arthritic osteophytes so not good. Try going gluten free with your diet as gluten is a known inflammatory and a GF diet can help with Hashimoto’s Hypothyroidism (the most common form of Hypothyroidism which is an auto immune condition). You May need to up your Levothyroxine dose once you start HRT and in any event you should have blood tests every 6-8 weeks until you get your TSH, T4 & T3 levels right. This can take up to or longer than a year. The GP who suggested waiting a year after a starter dose should be struck off! Blood tests need to be carried out every 6-8 weeks especially in the 1st year. See a different GP if you can.... good luck with it all!

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Hi,

Thanks for your reply. That’s really good to know. The tears must be painful too. Ouch. Yes, my Nurse Clinician knows about the tests every 6-8 weeks yet the GP was oblivious! Thanks.

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As the HRT I have is through transdermal patches & pessaries, it won’t affect Levothyroxine uptake unlike HRT taken orally in tablet form. However, I still separate the doses by administering Levothyroxine in the morning half to one hour before eating breakfast and use the patches and pessaries at night before bed. Also the regime I follow is Sunday & Thursday patches every alternate side and pessaries on Monday Wednesday & Friday’s to get good coverage through the week. Try to get at least 8 hours sleep a night if you can. I’ve been sleep deprived for 18 years due to my disabled son. I’m sure being sleep deprived can make things much worse...

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I've been on HRT and Levo for 12 years. 5 years ago I stopped taking my HRT tab everyday and have cut it to 1 tab every 3 or 4 days. If I dont take it at all my hot flushes hit about 35 in a 24 hour period. I took times etc for a week and went back on the HRT after sleep deprivation and almost feeling depressed. So I don't see why you cannot take the two. As other comments have suggested take at different times to the Levo.

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Thanks for your reply. That’s really interesting and good to know.

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