Levothyroxine and St Johns wort

[Emilym4444]

Has anyone ever tried to take St Johns wort when on Levothyroxine? Are there any adverse effects if I do so? I am currently on 50mcg Levo.

If you do take it, how long do you wait after taking your levo to have the St Johns wort?

Thanks,

Emily

[shaws Administrator]

Your dose of 50mcg is a starting dose and should be increased every six weeks by 25mcg until you feel well. or until TSH is 1 or lower.

This is an excerpt from the following link:-

"St. John’s wort is also an enzyme inducer. One study found that it may increase levothyroxine metabolism. Taking the two drugs should be avoided, but if you decide to use the combination, you should tell your doctor and be on the alert for any symptoms of hypothyroidism (e.g., low energy, fatigue, depression, dizziness, weight gain and anemia)."

worstpills.org/public/page....

[Emilym4444 in reply to shaws]

Thanks for your response.

I have been on 50mcg for a year and a half now, apparently my bloods are fine, but still find myself feeling low sometimes. This is why I was considering taking St John's wort, but obviously I won't do so if it negatively affects my thyroxine levels.

[shaws Administrator in reply to Emilym4444]

50mcg of levothyroxine is a starting dose and the fact that doctor is ignoring your clinical symptoms because your (probably) TSH is 'somewhere in range'.

What you have to day is to get a new blood test. I don't know if you follow this procedure - if not it is advisable:-

The earliest possible appointment, fasting (you can drink water) and allow 24 hour gap between last dose and test and take it afterwards.

Always get a print-out of your results with the ranges and post for comments. Ideally you should get a Full Thyroid Function Test - rarely done on the NHS. You can get a postal private one which is an early a.m. blood draw, following above advice. This is:-

TSH, T4, T3, Free T4, Free T3 and thyroid antibodies.

If you decide to do a private test, make sure you are well hydrated a couple of days before blood draw. These are home finger pin-prick tests.

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

[RedApple Administrator]

Welcome to the forum Emilym4444,

St John's Wort is contra-indicated for people on thyroxine. Here's the info from a Holland&Barrett SJWort product:

Do not take St. John’s Wort if you are using any of the following medicines: A thyroid hormone - Thyroxine

You can view the full list of contra-indicated medicines on their product info leaflets. Here's a link to one of them images.hollandandbarrettima...

[Emilym4444 in reply to RedApple]

I appreciate that, thanks RedApple

[Greml1n]

Try looking at Drugs.com - an American website, but super useful esp as the Americans are so quick to sue everyone.

[SlowDragon Administrator]

Can you add your most recent blood test results and ranges

50mcg Levothyroxine is only a starter dose

You are legally entitled to printed copies of your blood test results and ranges.

UK GP practices are supposed to offer online access for blood test results. Ring and ask if this is available and apply to do so if possible, if it is you may need "enhanced access" to see blood results.

In reality many GP surgeries do not have blood test results online yet

Alternatively ring receptionist and request printed copies of results. Allow couple of days and then go and pick up.

The aim of Levothyroxine is to increase the dose slowly in 25mcg steps upwards until TSH is under 2 (many need TSH significantly under one) and most important is that FT4 in top third of range and FT3 at least half way in range

NHS guidelines on Levothyroxine including that most patients eventually need somewhere between 100mcg and 200mcg Levothyroxine.

nhs.uk/medicines/levothyrox...

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 you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies

Ask GP to test vitamin levels And thyroid antibodies

You may need to get full Thyroid testing privately as NHS refuses to test TG antibodies if TPO antibodies are negative

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .

Last dose of Levothyroxine 24 hours prior to blood 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

Cheapest option for just TSH, FT4 and FT3 £29 (via NHS private service )

monitormyhealth.org.uk/thyr...

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

For thyroid including antibodies and vitamins

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

[Emilym4444 in reply to SlowDragon]

Thanks for this detailed response. I will definitely get my bloods checked privately. I miscarried at 6 weeks in September as well, and I'm wondering if the reason was that my dosage of levo was wrong. They only increased it to 75mcg. I'm going to have to try and be more informed, my Dr never seems to care.

[salsapixie]

There is conflicting information from different sources. Obviously nobody wants to get sued if there is an interaction. So I’m not sure if this is why certain suppliers tell you to avoid it. I’ve started St. John’s Wort having looked up lots of conflicting research on taking it with levothyroxine. I don’t want to go back on SSRI’s because starting and withdrawals get worse every time for me. I tend to take fluoxetine. There is some research to suggest St John’s Wort can help in the mild to moderate end of depression. I’ve taken it a few days. My sleep has improved so far, which helps. I’ve had some mild dizziness (wore off after two days) and slight anxiety. I guess I’ll wait and see how it goes. There isn’t much research that suggests 5-HTP is effective.

I’d never discourage anyone from taking anti-depressants. They have helped me a lot in the past. I just want to try something else this time.

I’m on 150micrograms of levothyroxine. I’ve been stable for about 18 months after seeing an endocrinologist who increased my dose. Within two months I felt “normal” for the first time in about 15 years! My past TSH was 0.25 with free T4 being about 19.5 (top of range).

[Sailing14]

Hello, I know this post is an old but I wondered if you could advise if you managed to continue on St John’s wort, as I was thinking of commencing it. I am on thyroxine at present.

Thank you

[Emilym4444 in reply to Sailing14]

Hi, I never continued taking it to be honest, I was worried it would interact negatively with my levothyroxine.