Severe Hypertension suspected to be secondary t... - Thyroid UK

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Severe Hypertension suspected to be secondary to hypothyroidism

bhm90503 profile image
13 Replies

I am new, but not yet ready to post a question until obtaining the labs due to be obtained next month. I have been taking many drugs over the years for hypertension. Recently I have realized that I have had sub-clinical hypothyroidism all my life, and suspect that I may be able to relieve myself from hypertension drug side effects by supplementing my thyroid. I feel fine; the criterion for successful thyroid supplementation will be to throw away the hypertension drugs.

I am currently on 100 mcg levothyroxine. I do not have Hashimto's.

So far in googling the literature, I find it odd that I cannot find evidence for clear, systematic studies related to my goal. Any relevant sources would be welcome!

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Heloise profile image
Heloise

There is a similar question just above yours. I posted a video by John Bergman who has many informational videos to help us understand the body's systems.

in reply toHeloise

Thank you.

SlowDragon profile image
SlowDragonAdministrator

What are your most recent results and ranges on 100mcg Levothyroxine?

Have you had ultrasound scan of thyroid to definitely confirm it's not Hashimoto's. 10-20% of Hashimoto's patients never have raised antibodies

For full Thyroid evaluation you need TSH, FT4 and FT3 tested. Also extremely important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially if still under treated for hypothyroidism

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. (Patient to patient tip, best not mentioned to GP or phlebotomist)

Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies or all vitamins

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

Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have special offers, Medichecks usually have offers on Thursdays, Blue Horizon its more random

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. Watch out for brand change when dose is increased or at repeat prescription.

Many patients do NOT get on well with Teva brand of Levothyroxine. Though it is the only one for lactose intolerant patients

bhm90503 profile image
bhm90503 in reply toSlowDragon

Thanks for the info. I should add that I live in the US and get my medical care through an HMO (age: 84). My primary doctor is flexible and will usually prescribe what I request, including an endo who I am now seeing and I think wishes I would just go away. My toolkit is Google, the HMO formulary, and memory of my symptoms over the years. As for Hashimoto's, the Quest labs indicated 0 antibodies which seems consistent with my lack of arthritis. Let's defer more details until after I see the endo in a month with labs. I should not change the levo dose until then, but will try to increase ferritin 60 (20-380)ng/mL and B12 507 (200-1100) pg/mL in the meantime. Is it true that I should get up to the middle of these ranges?

SlowDragon profile image
SlowDragonAdministrator in reply tobhm90503

Ask them to test your vitamin D

Be aware measurement is different in USA to UK

Here in UK we measure vitamin D in nmol - aiming for result around 100nmol as minimum. (Doctors will prescribe if under 50nmol)

In US results are in ng/l

Recommended range 40-80ng/l

vitamindcouncil.org/for-hea...

Folate is rarely tested in USA. No idea why

sciencedaily.com/releases/2...

B12 frequently low as we get older

healthline.com/nutrition/vi...

aplaceformom.com/blog/4-16-...

bhm90503 profile image
bhm90503 in reply toSlowDragon

At my insistence here are some recent labs:

Ordering: Nguyen MD, Hung Performing #: QuestDiag Location: TMPN Endocrinology

Tests Ordered : T3 FREE (34429), T4 FREE (866), TSH 3RD GENERATION (899), THYROGLOBULIN PANEL (30278), THYROID

PEROXIDASE ANTIBODIES (5081), VITAMIN D 25-HYDROXY LC/MS/MS (17306), Iron, TIBC and Ferritin Panel (5616), Vitamin B12

(Cobalamin) and Folate Panel, Serum (7065)

VITAMIN B12/FOLATE, SERUM PANEL (Collection Date: 11/05/2018 10:12, Status: Final)

Component Result Units Flag Range Comment

FOLATE, SERUM 20.1 ng/mL

Reference Range

Low: <3.4

Borderline: 3.4-5.4

Normal: >5.4

VITAMIN B12 507 pg/mL 200-1100

THYROGLOBULIN PANEL (Collection Date: 11/05/2018 10:12, Status: Final)

Component Result Units Flag Range Comment

THYROGLOBULIN 13.4 ng/mL

Reference Range:

Intact Thyroid 2.8-40.9

Athyrotic <0.1

Note: Abnormal flagging is based

on the reference interval for

patients with intact thyroid.

This test was performed using the Beckman Coulter

chemiluminescent method. Values obtained from

different assay methods cannot be used

interchangeably. Thyroglobulin levels, regardless

of value, should not be interpreted as absolute

evidence of the presence or absence of disease.

THYROGLOBULIN ANTIBODIES <1 IU/mL < or = 1

THYROID PEROXIDASE ANTIBODIES (Collection Date: 11/05/2018 10:12, Status: Final)

Component Result Units Flag Range Comment

THYROID PEROXIDASE ANTIBODIES 1 IU/mL <9

T3, FREE (Collection Date: 11/05/2018 10:12, Status: Final)

Component Result Units Flag Range Comment

T3, FREE 8.4 pg/mL H 2.3-4.2

T4, FREE (Collection Date: 11/05/2018 10:12, Status: Final)

Component Result Units Flag Range Comment

T4, FREE 1.8 ng/dL 0.8-1.8

TSH (Collection Date: 11/05/2018 10:12, Status: Final)

Component Result Units Flag Range Comment

TSH 0.01 mIU/L L 0.40-4.50

VITAMIN D,25-OH,TOTAL,IA (Collection Date: 11/05/2018 10:12, Status: Final)

Component Result Units Flag Range Comment

VITAMIN D,25-OH,TOTAL,IA 79 ng/mL 30-100 Vitamin D Status 25-OH Vitamin D:

Deficiency: <20 ng/mL

Insufficiency: 20 - 29 ng/mL

Optimal: > or = 30 ng/mL

For 25-OH Vitamin D testing on patients on

D2-supplementation and patients for whom quantitation

of D2 and D3 fractions is required, the QuestAssureD(TM)

25-OH VIT D, (D2,D3), LC/MS/MS is recommended: order

code 92888 (patients >2yrs).

11/7/2018 Your Medical Home on the Web - Patient Portal

nextmd.com/ud2/Documents/Do... 2/2

For more information on this test, go to:

education.questdiagnostics....

(This link is being provided for

informational/educational purposes only.)

IRON, TIBC AND FERRITIN PANEL (Collection Date: 11/05/2018 10:12, Status: Final)

Component Result Units Flag Range Comment

FERRITIN 60 ng/mL 20-380

IRON, TIBC AND FERRITIN PANEL (Collection Date: 11/05/2018 10:12, Status: Final)

Component Result Units Flag Range Comment

% SATURATION 33 % (calc) 15-60

IRON BINDING CAPACITY 250 mcg/dL (calc) 250-425

IRON, TOTAL 82 mcg/dL 50-180

Patient:

I think I am maybe OK on most of it.

Back to my first questiion: Is it important that I increase ferritin and B12 to midrange? And is anything sub-optimal?

SlowDragon profile image
SlowDragonAdministrator in reply tobhm90503

First - I just edited your post to remove personal details of name and DOB

Your FT3 result appears to be significantly above range

You need to discuss this with your doctor urgently

FT3 result- 8.4 (2.3 - 4.2)

FT4 - right at top of range

FT4 result - 1.8 (0.8-1.8)

TSH very low

TSH result - 0.01 (0.4 -5.0)

bhm90503 profile image
bhm90503 in reply toSlowDragon

I was in a hurry and forgot about the personal references - I apologize. But in addition I forgot that these were previous labs when I was taking too much ndt -hence the low tsh. I switched to levo.

The most recent labs with levo (75mcg):

Free T3 (Collection Date: 01/23/2019 07:34, Status: Final)

Component Result Units Flag Range Comment

Triiodothyronine (T3) Free [Mass/volume] in Serum or

Plasma 2.6 pg/mL 2.3-

4.2

Free T4 (Collection Date: 01/23/2019 07:34, Status: Final)

Component Result Units Flag Range Comment

Thyroxine (T4) free [Mass/volume] in Serum or Plasma 1.3 ng/dL 0.8-1.8

TSH (Collection Date: 01/23/2019 07:34, Status: Final)

Component Result Units Flag Range Comment

Thyrotropin [Units/volume] in Serum or Plasma 0.39 mIU/L L 0.40-4.50

I then pushed to 100 mcg, risking an over range in t4 and hoping to bring t3 to the upper half of range. A debatable choice!

My typing is very slow - I am recovering from an operation on my hands. I will try to practice a voice dictation system by next month so as to be more verbally fluent.

Thanks again for your time.

SlowDragon profile image
SlowDragonAdministrator in reply tobhm90503

So your body is adapting to a huge change in levels from very over range FT3 on NDT

You will need perhaps at 3-4 months to see where levels settle

Retesting again in say another 8 weeks

bhm90503 profile image
bhm90503 in reply toSlowDragon

My next apt with my endo will be 6 weeks after the last adjustment from 75mcg to 100mcg levothyroxine. I am pushing a little fast, but the sooner I can drop Minoxidil from my regimen the better - my vision is blurred. I am controlling the hypertension but the BP is not as low as it was a few weeks ago; I suspect I might have passed the sweet spot. Let's resume the discussion after my next labs. Thanks again for your concern.

Mouse profile image
Mouse

I had essential hypertension before I was diagnosed with hypothyroidism but the funny things is that if I am on a low dose of Levothyroxine then my blood pressure is fine but if I try and increase my dose my blood pressure goes up.

humanbean profile image
humanbean

This link may be of some interest :

stopthethyroidmadness.com/b...

bhm90503 profile image
bhm90503 in reply tohumanbean

Thanks for this reference - actually I have returned to this website often and experimented with ndt. I learned much by (too) rapidly varying the dosage and finding temporary sweet spots which yielded relief from an amazing number of annoyances thru out my life (post-nasal drip, headaches,cold hands and feet, loss of the lower register in my singing voice, etc). However deciding on how to deal with t3 and the shutdown of tsh (which some commentators claim might not recover if =0 for long enough) convinced me to make a fresh start with levo and proceed more cautiously by making sure the vitamins and minerals are optimized for conversion. Then introduce t3 if necessary. I think this website maybe advocates ndt before levo has been tried. Easy for me to say; I have no pain.

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