HRT and Thyroid Meds: Hi guys, haven't posted for... - Thyroid UK

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HRT and Thyroid Meds

Jefner profile image
19 Replies

Hi guys, haven't posted for a while as I have been trialing a different hrt since March. My meno specialist told me to keep an eye on my thyroid levels and from results I have just received, I am not sure what to do in the way of tweaking my meds. Am in need of advice please????

I am still experiencing side effects from the hrt which my meno specialist says is normal but my anxiety and fatigue has increased over the last couple of weeks and I wondered if it might be due to the increase in my tsh.

My tsh has gone up since starting a different hrt (which might be responsible) and I have been on the same thyroid dose ie. 125mg Levo, 10mcg T3 for a while now. Yes I know my T3 levels are low, they have been for a long time but I don't really know what to do about that anymore having tweaked it a few times and not really seeing any positive results in the way I feel. Always been too nervous in upping it too much due to my severe anxiety which is at it's worst the first part of most days so I moved to taking my T3 in the afternoons instead of upon waking.

25th Feb 2019

hs-CRP 0.13 <5.0 mg/L

Ferritin 91.6 (13 - 150 ug/L)

TSH 0.40 (0.27 - 4.20 mIU/L)

T4 Total 113.0 (66 - 181 nmol/L)

T4 19.10 (12.0 - 22.0 pmol/L)

T3 3.58 (3.1 - 6.8 pmol/L)

Anti-Thyroidperoxidase abs H 143.0 <34 kIU/L

Anti-Thyroglobulin Abs H 189 <115 kU/L

Vitamin B12 H 713 Deficient <145 pmol/L Insufficient 145 - 250 Consider reducing dose >569

Serum Folate 41.20 8.83 - 60.8 nmol/L

31st August 2019

hs-CRP 0.18 <5.0 mg/L

Ferritin 69.5 13 - 150 ug/L

TSH 2.41 0.27 - 4.20 mIU/L

T4 Total 108 66 - 181 nmol/L Free

T4 19.10 12.0 - 22.0 pmol/L Free

T3 3.22 3.1 - 6.8 pmol/L

Anti-Thyroidperoxidase abs H 113.0 <34 kIU/L

Anti-Thyroglobulin Abs H 119 <115 kU/L

Vitamin B12 H 676 Deficient <145 pmol/L Insufficient 145 - 250 Consider reducing dose >569

Serum Folate 20.00 8.83 - 60.8 nmol/L

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Jefner
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19 Replies
SlowDragon profile image
SlowDragonAdministrator

Have you tried splitting T3 dose as 2 or 3 doses per day. Many of us find this helpful

5mcg T3 waking and 5mcg T3 about12 hours later if on only two doses

Or 3 x 5mcg at 8 hour intervals- e.g. 7am, 3pm and 11pm

Small dose of T3 before bed can give Improved sleep. Though it doesn't suit everyone

Being under medicated can be cause of anxiety

HRT often means dose of thyroid hormones needs increasing

Are you on strictly gluten free diet?

No vitamin D test?

Your results show you need dose increase. Most likely an increase in T3

Jefner profile image
Jefner in reply to SlowDragon

Hi Slow, thanks so much for your quick response. I am just a complex mess of things and have been since my body crashed 4yrs ago. With the help from people on this site (especially greygoose) I found out by private testing that I had Hashi's but by that time it was too late for my thyroid because when I had an ultrasound about 2yrs ago, my thyroid has pretty much gone with very little detected. I have had anxiety issues for most of my 57yrs which were under control when I started Seroxat about 15yrs ago and it completely vanished but since I crashed, it's been back with me every damn day, some days more severe than others and it no longer works but I refuse to up it as it's the worst one on the planet to come off so I am stuck with it for the rest of my life, so I have a supply of 2mg Diazepam which I have to hand when I feel really bad but only take 1mg at a time.

The weird thing is that some days I feel quite well with no anxiety at all, clear head with energy and am able to go for walks and actually WANT to do things and then BAM, out of the blue, it all comes back and I do not understand why.

I have been totally gluten free since I found out I had Hashi's. I started working with a good FD over a year ago for my Candida overgrowth, SIBO and mold exposure but haven't had a consult with her for many months now because I felt I wanted to trial the HRT and she didn't approve but things did seem to go tits up for me when I went into peri menopause which is when I was diagnosed with under active thyroid. Have always felt my hormones played a big part in things with me hence my wanting to try the hrt (post meno now 5yrs). Also have Reynauds as well now.

My last vit D test was February when it was 77.6 nmol/L

which was reasonable but my FD did want me in at around 120. I have another test kit to do again on Monday as I haven't been taking them as much with the summer weather, although I don't go into the sun much anyway as I cannot tolerate heat and yet I feel the cold lol. Can't win.

I seemed to go right down hill again the day after we had that extreme heat when I sat in my flat with 100degree heat. Then the anxiety hit me very badly again with dizziness, fatigue, nausea, brain fog, I felt so ill mentally and physically I would have shot myself if I had had a gun, and I mean that.

If I add in a little more T3, will that help to bring my TSH down? I thought an increase in T4 would only do that? I have tried splitting my doses but never actually stuck to it, I am my own worst enemy for that. The 10mcg is clearly not enough for me as my T3 levels still remain low on it from previous results. I was thinking of having 5mcg in the morning with my Levo and having another couple of doses as you suggest throughout the day but was never sure of how long a gap to leave inbetween. I am not an early riser and usually have my meds around 9ish.

Funnily enough for the last few months I sleep very well, doesn't take me long to drop off at all but I always wake up feeling the same way, severe anxiety and unrefreshed. Have emailed my GP with my results this morning and asked her advice but as with most GP's they don't really know which is why I always come back to the forum for help from fellow sufferers.

Sorry for the ramblings but I am so very alone with this journey in trying to stabilise my health, no real friends or support or anyone around me that understands. Some days I feel that bad I just don't want to go on. I get agoraphobic and when my anxiety is bad I don't feel safe to drive as I get blurry vision so I stay indoors until it eases and then push myself to go out for a short while. My main problem is that I no longer have a purpose in life. I don't work and just bob around my flat all day with nothing really to do. I have tried to find something to occupy myself but motivation and enthusiasm is so very poor with me and when my anxiety is bad throughout most of the day, that is the time I need a distraction but feel limited in going anywhere. Even my yoga is suffering and I can't be bothered to do that. With no-one around me to help motivate me, I just go downhill because every day is a real struggle when you have to do cope on your own.

in reply to Jefner

Are you on estrogen? Estrogen increases levels of thyroid binding globulin (TBG) which in turn decreases thyroid hormone.

Jefner profile image
Jefner in reply to

yes, estrogen and progesterone

in reply to Jefner

s3.amazonaws.com/site-akiaj...

Jefner profile image
Jefner in reply to

"On a positive note, transdermal estrogen therapy was not found to affect TBG levels and therefore may be the preferred therapy for postmenopausal women who require concomitant treatment with estrogen and thyroid replacement". I have the transdermal gel and the progesterone is taken vaginally rather than orally so to protect my liver

in reply to Jefner

I agree it's good news for those of us on transdermal estrogen as opposed to oral. However, this is the first time I've read it makes a difference when it comes to raising TBG levels so not sure what to make of it...most articles on the subject just refer "estrogen". Maybe it has something to do with the fact that oral estrogen is metabolised by the liver...?

SlowDragon profile image
SlowDragonAdministrator in reply to Jefner

So sorry you are having such a tough time

A short 10-15minute walk or some other gentle exercise might help easy the anxiety

Suggest you try adding 5mcg T3 dose to your Levothyroxine when you wake at 9am

Taking your 10mcg dose about 8 hours later...around 5pm

Or split the 10mcg into two x 5mcg doses - say at 3pm and 9pm

What ever you try you need to stick at for 6-8 weeks and retest

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and fasting. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

Last Levothyroxine dose should be 24 hours prior to test, (taking delayed dose immediately after blood draw).

If/when also on T3, make sure to take last dose 8-12 hours prior to test, even if this means adjusting time or splitting of dose day before test

(This is how/when I discovered, by accident, that taking last dose T3 later in day , for me, gives better sleep )

Jefner profile image
Jefner in reply to SlowDragon

HI, I already moved to splitting the dose from 5mcg in the morning and 5mcg in the afternoon but have been on that dose a long time now and T3 still low so I am going to try 3 doses a day but not sure of the minimum length of time between doses? Will the added 5mcg T3 help bring down my tsh again?

Thanks for the tips but I am old hat at testing so I am aware of how to do lol.

SlowDragon profile image
SlowDragonAdministrator in reply to Jefner

Personally I found significant improvement with 3 doses at equal 8 hour gaps

Jefner profile image
Jefner in reply to SlowDragon

I will try that thanks. How soon did you notice a difference and what dose do you take?

SlowDragon profile image
SlowDragonAdministrator in reply to Jefner

I take 20mcg T3 (always Morningside Healthcare)

10mcg at 7am, 5mcg at 3pm and 5mcg at 11pm

125mcg Levothyroxine- always MP (as split dose - 100mcg at 11pm and 25mcg at 7am)

Only started splitting Levothyroxine dose about 4 months ago.....after suggestion by couple of other members.....astonished that it makes a difference

Hashimoto's, gluten intolerant so strictly gluten free, multiple vitamin deficiencies, Heterozygous DIO2

More on my profile

in reply to SlowDragon

That's interesting to hear as I've always read that T4 meds don't need to be multi dosed due to the long half-life of T4...it's good to hear about other people's experiences tweaking dosages and how it can make a difference:-)

Bluedragon profile image
Bluedragon

Hi, so sorry to hear how bad you are feeling. Sending hugs to you.

You have had some good advice re medication. I would like to talk about the anxiety. I don’t know about your eating habits and little of your lifestyle. Can you add in some oats (soaked overnight or at least 20 minutes beforehand if possible). Make with a plant based milk- oat milk is lovely to make porridge with. Add berries, stewed apple, a little cinnamon, tsp of nut butter and honey if liked. Not all required at once. Flaxseed also good to add. This meal will be great for sugar balancing, energy, mood.

Drink chamomile tea throughout the day- either fresh flowers or teabags - use at least two bags and steep for 20 minutes. You could add a small head of lavender to this (too much and bitter) and a pinch of rosemary (cover or will lose aromatic oils). All three herbs will help with mood and digestion and rosemary also good for memory, focus.

Motherwort would be great for you too - again either fresh, dried and add in tea or get a tincture, take 5 ml 3 x daily. Good for anxiety, heart palpitations. Of course rose - uplifting, loving.

Be careful you don’t pick anything that has been sprayed. Baldwin’s or Fushi will sell tinctures/dried herbs. Or indeed Indigo herbs. Tea drink as often as can. Tinctures you can mix together but don’t take more than 15ml over a day in total - not without working with a herbalist. You can add these herbs to a bath or foot bath too - with Epsom salts.

Are you taking magnesium? Try Biocare’s magnesium taurate.

I’m on same sheet as your FD - no HRT. Do your research and realise why drs do not prescribe any more. There are great herbs to help menopause. Xx

Jefner profile image
Jefner in reply to Bluedragon

thank you, I have done my research and Doctors are not prescribing hrt enough and leaving millions of women to suffer unecessarily. The evidence proves it has changed the lives of the majority of women struggling

Greekchick profile image
Greekchick in reply to Jefner

Hi Jefner,

I was on HRT at the lowest dose for 5 years until the age of 60 which were the current guidelines at that time - I felt great and had no ill effects whatsoever. I felt very unwell prior to that (couldn’t sleep, night sweats, very irritable, and pain all over my body) and I agree with you - it changed my life and that of many women I know. I wish I could have stayed on it longer.

However, I would not impose my views on anyone else. Taking any drug or hormone therapy is a personal decision and everyone has to decide what is right for them either way. Since you have researched it and feel good about it, you are making an informed decision. I hope you feel better soon and sending good wishes your way today.

Bluedragon profile image
Bluedragon in reply to Jefner

Hi, it is obviously your choice whether you use HRT or not, I just was checking you had done research. FYI, I took it for a long time having had a medical menopause. I was in a different place then and research showed HRT to be safe.

I’m sorry my last paragraph overshadowed everything else I said.

FancyPants54 profile image
FancyPants54 in reply to Bluedragon

Herbs do not ever replace oestrogen, which is what we all crave. The modern transdermal oestrogens are gold standard. The fears about cancer are mostly just plain wrong. Poorly conducted trials, misinterpreted by the press and throwing GP's and patients into turmoil back in the '80's. Those findings have been debunked now and apologised for. A woman on oestrogen only therapy (i.e. had a hysterectomy) has no raised risk for breast cancer. A woman taking oestrogen and progesterone has no raised risk for 5 years and after that a tiny risk, that is considered irrelevant it's so low.

The 5 years and off idea is old hat now too. We can stay on the modern HRT's as long as we want. There are ladies in their 80's using the gel. There are some great resources out there now for uptodate HRT advice.

FancyPants54 profile image
FancyPants54 in reply to Jefner

I'm with you there Jefner. HRT all the way. And yes, I researched to the moon and back and experimented with other things first. Now on body identical gel and Mirena coil because the Utrogestan didn't agree with me. Our GP's are rubbish with HRT, not because they have some special scary knowledge about it, but because they are not taught about it and hardly any of them bother to find out! Specialists are the way forward.

I hope you get to the bottom of your anxiety. I split my gel. I'm on 4 pumps a day and apply 2 in the morning and 2 at night to keep my level more balanced. Not sure if you have tried that option.

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