Hypothyroidism and High Blood Pressure

I have had hypothyroidism since 2004 and been on 75 mcg of levothyroxine until 1 year ago. A year ago I had been having esophageal spasms and I asked primary doc to decrease my Levothyroxine to 50 mcg hoping that this would help the spasms. The spasms seem better, not sure if its related to the decrease. But for the past few months, my BP has been elevated especially systolic and it increases as the day goes on. Usually by bedtime I am 150-160/70-80, but start the morning off 120ish /70. I asked my primary doc if the decreased levothyroxine was the cause. She says no. I need to exercise more and avoid eating processed foods. I exercise at least 3 times per week, vigorously, already and my diet is very healthy. I am not overweight. The doctor is refusing to increase my levothyroxine dose to what it was previously, says it will make my BP worse. Do I need an endocrinologist? Do you think my levothyroxine should be increased? My TSH was 2.2 on 50 mcg last week. When on 75 mcg my TSH was 1.5 and no high blood pressure. I have read increased systolic BP and a BP that increases as day goes on is due to hypothyroidism....Any advice would be greatly appreciated. Thank you!

[shaws Administrator]

I am not medically qualified but 50mcg of levo is a starting dose. I would think it quite rare for a patient to feel well on 50mcg. Is your GP prescribing? I doubt if people were permanently on 50mcg of levo whether they'd have sufficient hormones to enable the person to function normally on a daily basis.

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

Your doctor states that you need more exercise - that in itself would mean you need more hormones in order for your body to function as normal.

Levothyroxine (T4) is an inactive hormone and it has to convert to liothyronine (T3) and it is T3 that runs our whole body, from head to toe, and we cannot function at all with insufficient.

I think you need a 25mcg increase at the very least until your TSH is 1 or below - not higher. Ask your GP if you can have a Free T3 and Free T4 blood test, following the advice of 'fasting (you can drink water) and allow a gap of 24 hours between last dose of levo and blood test. If the GP refuses, I'd advise to get a private test and there are labs that do home pin-prick tests and a number of members do use these labs.

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

[Hidden in reply to shaws]

Thank you so much! I will talk to primary about the blood work and work on getting a new doctor or an endocrinologist.

[shaws Administrator in reply to Hidden]

You need someone who knows how to treat a hypothyroid patient, not one who only looks at a blood test result whilst ignoring symptoms.

[jgelliss in reply to shaws]

YES YES YES . Someone who really *Gets It* .

[SlowDragon Administrator]

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also extremely important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially if Thyroid antibodies are raised or if under treated for hypothyroidism

Ask your primary doctor to test vitamins and thyroid antibodies now

TSH, FT4 and FT3 will need retesting 6-8 weeks after each dose increase in Levothyroxine

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and fasting. Last Levothyroxine dose should be 24 hours prior to test, (taking delayed dose immediately after blood draw). This gives highest TSH, lowest FT4 and most consistent results.

Always take Levo on empty stomach and then nothing apart from water for at least an hour after.

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

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

Other medication at least 2 hours away, some like HRT, iron, calcium, vitamin D or magnesium at least four hours away from Levothyroxine

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.

Typically most patients eventually need somewhere between 100mcg and 200mcg Levothyroxine

High cholesterol is linked to being hypothyroid too, so might be worth testing levels

nhs.uk/conditions/statins/c...

If you have an underactive thyroid (hypothyroidism), treatment may be delayed until this problem is treated. This is because having an underactive thyroid can lead to an increased cholesterol level, and treating hypothyroidism may cause your cholesterol level to decrease, without the need for statins. Statins are also more likely to cause muscle damage in people with an underactive thyroid.

[Hidden in reply to SlowDragon]

Thank you!

[Aurealis]

I agree with the advice from posts above -

You need to know measured free T3, free T4 and TSH values and ranges

You should adjust the dose until you feel well- that’s the best guide to being optimally treated

Then retest free T3, free T4 and TSH.

If possible it might be helpful to monitor your own blood pressure at home. If your systolic is only being measured at GP surgery you may just have White Coat Hypertension. But I think you are measuring at home?

[Hidden in reply to Aurealis]

Ive been checking at home. Thank you!