Morning Tum Discomfort

[Lizf1006]

Hi, does anyone have morning bloat and discomfort with fluttery heart palps? This happens before I eat or drink anything.

Liz

[SlowDragon Administrator]

Perhaps it's time to get thyroid and vitamin levels tested

When was dose reduced to 100mcg/75mcg from 100mcg?

That's quite a low dose for someone who's had thyroidectomy

When were bloods last tested?

Poor gut function and bloating is sign of being hypothyroid

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 under treated

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)

Is this how you do your tests?

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

Add any recent results and ranges if you have them and members can advise

Or come back with new post once you get new results

[Lizf1006 in reply to SlowDragon]

No I haven’t had surgery, but had radioiodine treatment seven years ago. My last blood test was five weeks ago, tsh 2.9. Ferritin and folate ok, b12 very high 1340 so i’ve stopped supplementing. Not sure if I can afford private testing, i’ll look it up.

Thanks for the info.

[SlowDragon Administrator in reply to Lizf1006]

TSH of over 2 is too high on levothyroxine

Many people need TSH under one

Just testing TSH is inadequate

You need FT4 and FT3 tested at same time as TSH

Testing should be done as early as possible in morning and fasting and last levothyroxine 24 hours prior to test

[Lizf1006 in reply to SlowDragon]

I take my Levo last thing at night. What time should I ask for a blood test?

[SlowDragon Administrator in reply to Lizf1006]

Many of us take Levothyroxine at bedtime, it may be more effective

It's still important to get bloods tested as early as possible in morning and fasting

You need to adjust dose timing day before

If, for example, testing Monday morning 9am

Saturday evening delay dose of Levothyroxine until Sunday morning (around 8-9am)

Sunday evening dose delay Levothyroxine until immediately after blood draw on Monday morning

Monday evening take Levothyroxine dose as per normal

New NHS England Liothyronine guidelines November 2018 clearly state on pages 8 & 12 that TSH should be between 0.4-1.5 when treated with just Levothyroxine

Note that it says test should be in morning BEFORE taking Levothyroxine

Also to test vitamin D, folate, B12 and ferritin

sps.nhs.uk/wp-content/uploa...

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 at

[e-mail]

Professor Toft recent article saying, T3 may be necessary for many otherwise we need high FT4 and suppressed TSH in order to have high enough FT3

rcpe.ac.uk/sites/default/fi...

Ask you GP to retest thyroid and to test vitamin levels

Come back with new post once you get results and ranges

Being under treated and therefore hypothyroid frequently causes poor gut function, bloating, IBS etc

Low vitamins often direct result. Frequently necessary to supplement some or all four vitamins to maintain at optimal levels. Otherwise low vitamins tend to lower TSH

[Lizf1006 in reply to SlowDragon]

Many thanks for all your help. I have looked through all my test result copies and not once in 7 years have I been given a thyroid fasting blood test! Also blood taken various times of the day! My FT3 has only been tested 3 times and was low each time. My next test is due end of May after my hols so I will now be more prepared what to ask for.

Thanks Liz