Thyroid and Tinnitus

[Neeto]

Hello, I've just been diagnosed with Hypothyroidism and have seen on Thyroid UK's signs and symptoms check list,under Hearing Problems, Tinnitus that I've suffered with for 2 years. I would like to know why it's on the check list? I believe my thyroid probably started playing up around the same time and would like to know what the connection is. Many thanks.

[Lalatoot]

It is on the list because it is one of the clinical symptoms associated with thyroid problems. Tinnitus can also be caused by a low level of B12 so it is a good idea to get vitamin levels checked too.

[Neeto in reply to Lalatoot]

Thanks interesting although my B12 is normal, it was part of full bloods done when checking my thyroid levels. I feel both conditions came about when my sister passed away suddenly, emotional stress and grieving, but the thyroid symptoms I put down to menopausal age until my eyebrows started to fall out. The body is so complex!

[Lalatoot in reply to Neeto]

Sorry about your sister.

For optimum levels our vitamins inc B12 need to be in the top third of their range as a rough guide.

[Neeto in reply to Lalatoot]

Thanks.

Mine are 536 pg/mL, should I be looking to up my intake?

[Lalatoot in reply to Neeto]

It depends what the range is. The range is the numbers in brackets after your result.

[Neeto in reply to Lalatoot]

It says 180 - 1100 so I'm up there. Think it's just something I have to live with unless it miraculously goes..... Thanks for the info though, willing to try anything out!

[Wetsuiter in reply to Neeto]

Your B12 is not 'up there'. its only 38% (a lot less than half way) through that range.

[Neeto in reply to Wetsuiter]

Thanks, maths has never been a strong point! I'll look at my diet with the foods that have it and will buy a supplement.

[SeasideSusie Remembering in reply to Neeto]

B12

Mine are 536 pg/mL(180 - 1100), should I be looking to up my intake?

According to an extract from the book, "Could it be B12?" by Sally M. Pacholok:

"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".

"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."

So according to that you result is on the lowish side.

A more accurate test is the Active B12 test.

Total B12, which is what you have had done, tests both bound and unbound (active) B12, and it's possible to have a decent total B12 amount but poor active B12 level. The Active B12 test only measures the active B12 which is what is available to be taken up by our cells.

The NHS does, as far as I am aware, doesn't routinely test Active B12 but it can be done with a fingerprick test from Medichecks for £39.

[SlowDragon Administrator in reply to SeasideSusie]

You mean “doesn’t routinely” test active B12

[SeasideSusie Remembering in reply to SlowDragon]

Thank you SD, edited my post now. Another example of flying fingers and brain lagging behind! Being a touch typist can be both a blessing and a curse!

[SlowDragon Administrator]

very sorry for your loss

Stress and thyroid is often linked

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

Folate and B-12 work together.

What’s your folate result?

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

Bloods should be retested 6-8 weeks after each dose change (or brand change) in levothyroxine

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

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

If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3 £29 (via NHS private service )

monitormyhealth.org.uk/thyr...

If antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).

About 90% of all primary hypothyroidism in Uk is due to Hashimoto's.

Low vitamins are especially common with Hashimoto's. Food intolerances are very common too, especially gluten.

So it's important to get TPO and TG thyroid antibodies tested at least once .

Link about thyroid blood tests

thyroiduk.org/tuk/testing/t...

Link about antibodies and Hashimoto's

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

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

List of hypothyroid symptoms

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

Link about low B-12

ncbi.nlm.nih.gov/pubmed/186...

There is a high (approx 40%) prevalence of B12 deficiency in hypothyroid patients. Traditional symptoms are not a good guide to determining presence of B12 deficiency. Screening for vitamin B12 levels should be undertaken in all hypothyroid patients, irrespective of their thyroid antibody status. Replacement of B12 leads to improvement in symptoms,

How much levothyroxine have you been started on ?

Levothyroxine should always be taken empty stomach and then nothing apart from water for at least an hour after

Many people take Levothyroxine soon after waking, but it may be more effective taken at bedtime

verywellhealth.com/best-tim...

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. Teva is the only brand that makes 75mcg tablet.

healthunlocked.com/thyroidu...

[Neeto in reply to SlowDragon]

Thank you so much everyone. A lot of good info there to read when I've a quieter moment. I'll cross check with the initial tests I've had done and will discuss with the doctor when I go back in 4 weeks for my follow up, only been on Levothyroxine for just over a week now so early days for me.

The B12 is very interesting to know, will certainly be following that up, to hear silence again would be amazing.

[SlowDragon Administrator in reply to Neeto]

How much levothyroxine were you started on?

healthunlocked.com/thyroidu....

[Neeto in reply to SlowDragon]

I've copied and printed your info SD, had a quick look through, will read properly and refer to the links when I get a chance to at home, am at work but it's gone quiet again for the mo!

I showed no vitamin deficiencies, my diet is pretty good on the whole.

My folate was 5.4 Cholesterol 5.6 LDL Cholesterol 3.5

T4 10.5

TSH 7.41

I've been started on 25mg of Levothyroxine

[SlowDragon Administrator in reply to Neeto]

Unless over 65 years old or heart condition...standard starter dose of levothyroxine is 50mcg

NICE guidelines

cks.nice.org.uk/hypothyroid...

The initial recommended dose is:

For most people: 50–100 micrograms once daily, preferably taken at least 30 minutes before breakfast, caffeine-containing liquids (such as coffee or tea), or other drugs.

This should be adjusted in increments of 25–50 micrograms every 3–4 weeks according to response. The usual maintenance dose is 100–200 micrograms once daily.

Starting too low can make symptoms worse. Levothyroxine doesn’t “top up” your own thyroid outpost. It very quickly switches your own thyroid hormone output down and replaces it

Hence the more recent thinking and guidelines recommended starting on full dose of 1.6mcg per kilo of you weight

gp-update.co.uk/Latest-Upda...

Starting levothyroxine treatment

Traditionally we have tended to start patients on a low dose of levothyroxine and titrate it up over a period of months. RCT evidence suggests that for the majority of patients this is not necessary and may waste resources.

For patients aged >60y or with ischaemic heart disease, start levothyroxine at 25–50μg daily and titrate up every 3 to 6 weeks as tolerated.

For ALL other patients start at full replacement dose. For most this will equate to 1.6 μg/kg/day (approximately 100μg for a 60kg woman and 125μg for a 75kg man).

If you are starting treatment for subclinical hypothyroidism, this article advises starting at a dose close to the full treatment dose on the basis that it is difficult to assess symptom response unless a therapeutic dose has been trialled.

Do you have the range on Folate. This looks like is low ...though not actually deficient

On here we recommend for optimal vitamin levels (helps thyroid hormones work better)

Vitamin D at least over 80nmol

Folate at least over ten

B12 at least over 500

Active B12 (private testing) at least over 70

Ferritin at least half way through range

[Neeto in reply to SlowDragon]

Folate range 3.00 - 13.00ng/ml

Vit D I'm 69, was told anything over 50was good! I did buy drops of this before I had blood tests as we're always being told we don't get enough. I stopped taking it after the results but will start again.

Ferratin I'm 53, range 20.00 - 300.00 ug/L It's got normal by it. Even with my bad maths I can see that's nowhere half way. I'll get a supplement of that too!

Should I be going back to the Doctor straight away then and ask for an increased dose of Levothyroxine?

Thank for your time and all the info.

[SlowDragon Administrator in reply to Neeto]

NHS used to treat vitamin D if under 75nmol. Now they only treat if under 50nmol (budget cuts)

They are supposed to advise self supplementing to bring to 75nmol

ncbi.nlm.nih.gov/pubmed/218...

vitamindsociety.org/pdf/Vit...

Once you Improve level, very likely you will need on going maintenance dose to keep it there, certainly in winter, if not it summer

Test twice yearly via vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function. There’s a version made that also contains vitamin K2 Mk7

It’s trial and error what dose we need, with hashimoto’s we frequently need higher dose than average

ouh.nhs.uk/osteoporosis/use...

Government recommends everyone supplement October to April

gov.uk/government/news/phe-...

Ferritin and iron are complex. You can have normal or high iron and low ferritin

Not recommended to supplement iron unless had full iron panel via GP

However you can look at improving iron rich foods

Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption

dailyiron.net

Links about iron and ferritin

irondisorders.org/Websites/...

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

drhedberg.com/ferritin-hypo...

restartmed.com/hypothyroidi...

[SlowDragon Administrator in reply to Neeto]

See how you get on...getting bloods retested after 6-8 weeks and then get next 25mcg dose increase ....

[Neeto in reply to SlowDragon]

Will do, thanks again. I'll let you know how I get on.....

Will they definitely up the dose or should I ask to have it upped if they don't or will it all depend on the bloods results? Sorry for all the questions!

[SlowDragon Administrator in reply to Neeto]

You will see thousands of posts on here where people really struggle to get dose of levothyroxine increased.....which is madness

Depends on how TSH reacts. As most medics think TSH is God. Whereas it’s actually Ft3 that’s most important (but not tested by NHS)

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 is in top third of range and FT3 at least half way through range

Perhaps this is why new guidelines say patients are better started on full dose.....to stop thousands languishing on totally inadequate dose of 25mcg, 50mcg or 75mcg

Often patients are forced to see specialist thyroid endocrinologist if GP is particularly unhelpful

New NICE guidelines

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

BMJ clear on dose required

bmj.com/content/368/bmj.m41

Post re full starting dose

healthunlocked.com/thyroidu....

How to get TSH as high as possible

thyroidpatients.ca/2020/01/...

[SlowDragon Administrator in reply to Neeto]

Which brand of levothyroxine have you got?

[Neeto in reply to SlowDragon]

Mercury Pharmaceuticals