I am confused and hope someone can help. Should I be taking omeprazole with hashimottos? Posts saying lack of acid, In stomach yet omezorapole stops acid. I have stopped smoking too. Always feel like I have a cold and nose blocked esp in morning. Throat always swollen just a bit of help would be great. Just so confused.
Help: I am confused and hope someone can help... - Thyroid UK
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Hypos tend to suffer from low stomach acid. The symptoms of low stomach acid and too much stomach acid are almost the same so difficult to tell them apart.
For low stomach acid diluted apple cider vinegar is recommended.
Maybe silly question, how do you know if low or high. Just at wits end. Dr's brush it aside. Absolute nightmare. No life for over 4 years. Thyroid "functioning* normal but on 50mg levothyroxine but neck throat always swollen, never a good day, just some worse than others. Had brown tongue, brushed it better, had helicobacter always something in throat feeling. Thyroid UK and this my only help. Bloods last week showed "normal" so I hope if upped to 75 it will help but I have no idea. Due to virus not seen specialist or anything as said at wits end
Type stomach acid in the search on this site. It will find discussions and one will have the technique - it is to do with drinking bicarb and burping.
How long have you been left on 50mcg levothyroxine
When were thyroid levels last tested?
50mcg is only a starter dose of levothyroxine
The aim of Levothyroxine is to increase the dose slowly in 25mcg steps upwards until TSH is under 2 (many patients 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
NHS guidelines on Levothyroxine including that most patients eventually need somewhere between 100mcg and 200mcg Levothyroxine.
nhs.uk/medicines/levothyrox...
guidelines by weight might help push for dose increase
Even if we don’t start on full replacement dose, most people need to increase dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until on full replacement dose
NICE guidelines on full replacement dose
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.
gp-update.co.uk/Latest-Upda...
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.
A small Dutch double-blind cross-over study (ArchIntMed 2010;170:1996) demonstrated that night time rather than morning dosing improved TSH suppression and free T4 measurements, but made no difference to subjective wellbeing. It is reasonable to take levothyroxine at night rather than in the morning, especially for individuals who do not eat late at night.
BMJ also clear on dose required
bestpractice.bmj.com/topics...
Also note what foods to avoid (eg recommended to avoid calcium rich foods at least four hours from taking Levo)
ESSENTIAL to regularly retest vitamin D, folate , ferritin and B12 frequently these are very low when under medicated and often need supplementing to maintain optimal levels
SlowDragonAdministrator
Low stomach acid can be a common hypothyroid issue
Thousands of posts on here about low stomach acid
healthunlocked.com/search/p...
Articles
nutritionjersey.com/high-or...
articles.mercola.com/sites/...
thyroidpharmacist.com/artic...
stopthethyroidmadness.com/s...
How to test for low stomach acid
healthygut.com/articles/3-t...
naturalendocrinesolutions.c...
Ppi like omeprazole tend to lower vitamin levels
pulsetoday.co.uk/clinical/m...
gov.uk/drug-safety-update/p...
Bloods done last week as resting heart went to 114 bpm and temp 34.4. All I got was bloods were fine . I have not a clue on anything. Dr never says anything. All I know is I have hashimottos, thyroid functioning as normal. Yet always drained, throat swollen, sometimes struggle to swallow and feeling something in throat all the time. Been on 50mg for 5/6 weeks was on 25mg for 4 weeks. I just don't know and love the help on here from people who know things as I am clueless in regards to it, just been ill with it, for at least we know of, 4.5 years probably more
You are legally entitled to printed copies of your blood test results and ranges.
The best way to get access to current and historic blood test results is to register for online access to your medical record and blood test results
UK GP practices are supposed to offer everyone 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.
Important to see exactly what has been tested and equally important what hasn’t been tested yet
Come back with new post once you get results
Did you get test done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test?
Ask GP for vitamins tested
Thank you
So you have high antibodies.... this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).
Hashimoto's frequently affects the gut and leads to low stomach acid and then low vitamin levels
Low vitamin levels affect Thyroid hormone working
Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common.
According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps, sometimes significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)
Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies
While still eating high gluten diet ask GP for coeliac blood test first or buy test online for under £20, just to rule it out first
Assuming test is negative you can immediately go on strictly gluten free diet
(If test is positive you will need to remain on high gluten diet until endoscopy, maximum 6 weeks wait officially)
Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse
chriskresser.com/the-gluten...
amymyersmd.com/2018/04/3-re...
thyroidpharmacist.com/artic...
drknews.com/changing-your-d...
restartmed.com/hashimotos-g...
Non Coeliac Gluten sensitivity (NCGS) and autoimmune disease
ncbi.nlm.nih.gov/pubmed/296...
The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported
ncbi.nlm.nih.gov/pubmed/300...
The obtained results suggest that the gluten-free diet may bring clinical benefits to women with autoimmune thyroid disease
nuclmed.gr/wp/wp-content/up...
In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned
restartmed.com/hashimotos-g...
Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.
Did you or anyone else show, thyroid functioning as "normal" it's such a confusing thing esp if not clued up at all on it. Sometimes just wish wouldn't wake up when it's so bad like last week. I don't know if going up to 75 is good or is it the acid giving the probs I don't know omeprazole and gavis on advance no help at all either the now. I though stop smoking would help massively too
You are likely very under medicated...important to get dose increase as fast as tolerated
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. Teva contains mannitol as a filler, which seems to be possible cause of problems. Teva is the only brand that makes 75mcg tablet. So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half
Teva and Aristo are the only lactose free tablets
healthunlocked.com/thyroidu...
Teva poll
healthunlocked.com/thyroidu...
academic.oup.com/jcem/artic...
Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).
Levothyroxine is an extremely fussy hormone and should always be taken on an 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 convenient and perhaps more effective taken at bedtime
verywellhealth.com/best-tim...
No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap. Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away
(Time gap doesn't apply to Vitamin D mouth spray)
Improving low vitamin levels can significantly improve symptoms
As can strictly gluten free diet
Can I just say, the help on here is amazing and I cannot thank you enough. When you have no clue and you get this aid it's so reassuring. I have so many un answered question from Dr's etc and just feel so alone and left so 🙏🙏🙏
Work on improving things one step at a time
Get hold of your recent thyroid results and come back with new post
Likely shows you need dose increase in levothyroxine
Ring/see Gp and ask for vitamin and coeliac blood tests
And come back with new post once you get results
Members can advise on next steps once we see results
I have to go get all this years blood results at 12. Will I be able to take a pic or just write out the info to post? If I need last year's I will ask to get them for Monday if you want them too
26/2/20
TSH - 2.98
FREE T4 - 13.1
TPOAb - 149.4
TPOAb not tested since
15/6/20
TSH - 1.69
FREE T4 - 16.4
14/7/20
TSH - 1.36
FREE T4 - 20.8
UREA - 3.8
CREATINE - 100
SODIUM - 137
POTASSIUM - 3.7
CHLORIDE - 101
eGFR result/1.73m2 - >60
BILIRUBIN - 11
ALP - 95
AST - 18
ALT - 23
CALCIUM - 2.26
ADJUSTED CALCIUM - 2.18
PHOSPHATE - 0.93
TOTAL PROTEIN - 74
ALBUMIN - 44
GLOBULIN - 30
GLUCOSE - 6.0
CRP - <5
CHOLESTEROL - 5.9
TRIGLYCERIDE - 3.40
LDL CHOLESTEROL - 3.53
HDL CHOLESTEROL - 0.82
HAEMOGLOBIN A1c - 6.0
HAEMOGLOBIN A1c (IFCC) - 42
ESR - 6
Bloods taken after February I was taking Levothyroxine since approx June. Any more info, if on tests let me know. Hope this can aid me by yourself
All results need ranges added (figures in brackets after each result)
26/2/20
TSH - 2.98
FREE T4 - 13.1
TPOAb - 149.4
The high TPO antibodies confirms Hashimoto’s
Not on medication?
Ft4 looks likely low in range
14/7/20
TSH - 1.36
FREE T4 - 20.8
On 50mcg levothyroxine?
Just testing TSH and Ft4 is completely inadequate
Did you take levothyroxine before blood test?
You need TSH, Ft4 and Ft3 tested together
Plus vitamin D, folate, ferritin and B12
What’s range on calcium and adjusted calcium results?
Cholesterol is high - suggests you are not on high enough dose of levothyroxine
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 as you have Hashimoto’s
Ask GP to test vitamin levels
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)
Is this how you did last test?
Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins
List of private testing options
thyroiduk.org/getting-a-dia...
Medichecks Thyroid plus ultra vitamin (doesn’t include folate)
medichecks.com/products/thy...
Thyroid plus vitamins including folate (private blood draw required)
medichecks.com/products/thy...
Medichecks - JUST vitamin testing including folate - DIY finger prick test
medichecks.com/products/nut...
Medichecks often have special offers, if order on Thursdays
Thriva Thyroid plus vitamins
Blue Horizon Thyroid Premium Gold includes vitamins and cortisol
bluehorizonbloodtests.co.uk...
If you can get GP to test vitamins then cheapest option for just TSH, FT4 and FT3
£29 (via NHS private service ) and 10% off if go on thyroid uk for code
Any of these results highlighted as being out of range?
Not really. Cholesterol high a bit 5.9. On 50mg levothyroxine. Lyn from thyroid UK called me today. Suggesting few things. Gluten free diet, taking pills at night changing brand from North star as mannitol in it and few other things. Keep diary of it all. Test on vitamins, coaliac few more
STRONGLY recommend getting full thyroid and vitamin testing
Suspect vitamin levels are low
Get Coeliac blood test BEFORE cutting out gluten
Teva brand of levothyroxine upsets many people
If you are taking Northstar 50mcg tablets these are made by Accord and don’t contain mannitol
Only 25mcg Northstar is Teva brand
Maguc info as usual
Come back with new post once you get results
Hi.
Free t4 19.8. Range 10.0 - 22.0
Tsh 1.36. Range 0.27 - 4.20
Free T3 range 3.1 - 6.8
T4 went up from 13.1
Tsh down from 2.98
Cealoiac test not returned!!
Follate low 3.1.. Range 3.9 - 26.8
B12. 232. Range 197-771
Ferritin 163. Range 30-400
White cell count 10.0. Range 3.7 - 9.5
Hope this is all OK.
Free t4 19.8. Range 10.0 - 22.0
Tsh 1.36. Range 0.27 - 4.20
Free T3 range 3.1 - 6.8
T4 went up from 13.1
Tsh down from 2.98
Cealoiac test not returned!!
Follate low 3.1.. Range 3.9 - 26.8
B12. 232. Range 197-771
Ferritin 163. Range 30-400
White cell count 10.0. Range 3.7 - 9.5
Is this new test?
Done Privately or by GP ?
Was test done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test ?
Ft4 - looks like you took levothyroxine before test?
TSH - probably too high on levothyroxine -
suggests you need dose increase in levothyroxine
Ft3 - no result?
No vitamin D test results?
Folate and B12 both EXTREMELY low
See GP for full testing for Pernicious Anaemia before starting any B vitamins
Likely to need B12 injections
GP should prescribe folic acid as folate BELOW range
However Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid.
thyroidpharmacist.com/artic...
Rather than supplementing folic acid prescribed by GP
You may do better Supplementing a good quality daily vitamin B complex, one with folate in not folic acid may be beneficial.
chriskresser.com/folate-vs-...
B vitamins best taken after breakfast
Igennus Super B is good quality and cheap vitamin B complex. Contains folate. Full dose is two tablets per day. Many/most people may only need one tablet per day. Certainly only start on one per day (or even half tablet per day for first couple of weeks)
Or Thorne Basic B or jarrow B-right are other options that contain folate, but both are large capsules
If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before any blood tests, as biotin can falsely affect test results
endo.confex.com/endo/2016en...
endocrinenews.endocrine.org...
Low B12 symptoms
b12deficiency.info/signs-an...
Omeprazole lowers B12
Likely to need either regular B12 injections or daily sublingual B12 supplement (as well as vitamin B complex)
Done Tues at 11am. Nothing to eat and no meds. The last one was 2 weeks ago I sent you. That's why put up /down next to level results
So how much levothyroxine were you taking when this test was done
75mcg ?
Did you get 25mcg tablets changed from Teva?
How long have you been on this dose?
Bloods should be retested 6-8 weeks after each dose increase in levothyroxine
Dr calling on Monday at 9am. Still on 50mg. But remember you told me you thought I had infection, due to white thick saliva, well think thrush so on nystatin but hope not helicobacter again. So bloated, feel sick after eating full of wind. 6 weeks on 50mg now and I don't understand tsh free T4 etc going up or down if that's good etc. Just all so new to me
Can you add Ft3 result...if it was tested
See GP for Pernicious Anaemia test and starting B12 injection
Also request vitamin D test
Vit d was meant to have been done along with cealoiac. Do you think I need b12?
Yes and folate
See my first reply today
Folate is deficient
B12 extremely low
Have you missed off Ft3 results?
You need vitamin D tested
Ask GP or test here
Ft3 result 4.6 range 3.5 to 6.4
Ft4 is 82% through range
Ft3 only 38% through range
What time was last dose of levothyroxine before test?
Helpful calculator for working out percentage through range
11.10am without meds. Thank you
Hi. Read that reply again and a little confused. You said I am too high on levo then I need more levo below the comment. I didn't have any meds before bloods that day, well over 24 hours without meds. Tsh too high on levo then below it says need an increase. Just confused soz
So you did leave 24 hours between last dose levothyroxine and test
So Ft4 is high in range ...but Ft3 is low
This is poor conversion of Ft4 to Ft3 .
Low vitamins badly affect conversion
It’s chicken and egg....vitamins are low because you are under medicated...but conversion of levothyroxine (Ft4) into active hormone (Ft3) is poor because vitamins are low
Very very common scenario
Getting all four vitamins OPTIMAL by supplementing helps improve conversion
Folate is deficient
B12 extremely low
No vitamin D result..yet
Ferritin is good
Frequently strictly gluten free diet helps too...obviously you are still waiting for coeliac blood test result. If test is positive you have to stay on high gluten diet until endoscopy (supposed to be max 6 week wait)
If Coeliac test is negative then you can immediately trial strictly gluten free diet for 3-6 months ...
Thanx. Will get folic acid today and Dr on Monday. Yes more than 24 hour without meds
SlowDragonAdministrator
Stopping smoking can often lead to hypothyroidism becoming apparent, or getting worse
Thyroid levels should be tested more frequently in the two years after quitting
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
Have you had thyroid antibodies tested?
Ask GP to test vitamin levels and thyroid levels
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 as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins
List of private testing options
thyroiduk.org/getting-a-dia...
Possibly cheapest option for getting all tested via DIY finger prick test
TSH, FT4 and FT3
£29 (via NHS private service ) and 10% off if go on thyroid uk for code
thyroiduk.org/getting-a-dia...
monitormyhealth.org.uk/thyr...
Medichecks - JUST vitamin testing including folate - DIY finger prick test
medichecks.com/products/nut...
Medichecks often have special offers, if order on Thursdays
Or other options
Medichecks Thyroid plus ultra vitamin (doesn’t include folate)
medichecks.com/products/thy...
Thyroid plus vitamins including folate (private blood draw required)
medichecks.com/products/thy...
Thriva Thyroid plus vitamins
Blue Horizon Thyroid Premium Gold includes vitamins
bluehorizonbloodtests.co.uk...
Add any results you have already
Or come back with new post once you get results
in reply to SlowDragon
Hi SlowDragon,
I was wondering if you could elaborate on how stopping smoking effects hypothyroidism. I quit 5 years ago after being a heavy smoker for a decade and my interest has been piqued!
Thank you. 🙂
Many members developed or, more accurately were diagnosed as Hashimoto’s, or needing increase in levothyroxine in year or so after quitting smoking
ncbi.nlm.nih.gov/pmc/articl...
thyroid.org/patient-thyroid...
verywellhealth.com/cigarett...
Hi, I was given omeprazole also, I felt like it caused more discomfort than it was worth. If you're having throat discomfort you could try Manuka honey it has helped me.
Your welcome. I hope it helps. Manuka honey has been used to treat h-pylori. Wishing you all the best
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