Neck or Thyroid?

[maplewood]

Hi everyone. I have a couple of problems healthwise (one is neck, slipped disc and trapped nerves) and Hypothyroid. I am currently trying to get my TSH and vit's etc to acceptable levels as my last TSH was 6.3. I had to increase my dose to 50mg and have been taking that dose for 4 weeks. However the air hunger which has been a problem since starting med's is still a problem and this last week sweating has become an issue again. Do you think its time to increase med's again? I mentioned my neck because sometimes i am not sure which symptom belongs where neck or thyroid, what do you guy's think?.......Thank you all once again xxx

[Lalatoot]

Yes 50mcg levothyroxine is a starter dose. When on levo tsh should be around 1 or lower with ft4 and Ft3 over halfway through their ranges.

[SlowDragon Administrator]

TSH 6.5 ( 0.35-4.7),

T4 9.4 (7.8-21).

So you need bloods retested again 6-8 weeks after increased up to 50mcg

50mcg is only a standard starter dose

Dose levothyroxine should be increased slowly upwards in 25mcg steps, after each blood test until eventually on FULL REPLACEMENT DOSE

Guidelines on replacement dose is 1.6mcg levothyroxine per kilo of your weight

1.6 x weight in kilo

(Some people need higher dose, very rare to need less)

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

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...

SERUM FERRITIN 21 (20-100),

B12 186 (115-1000),

Last vitamin tests show absolutely DIRE results

B12 is extremely low ...Did you get tested for Pernicious Anaemia. Are you now on B12 injections?

Ferritin - needed full iron panel test for anaemia. Was that done ?

No folate or vitamin D ?

[maplewood in reply to SlowDragon]

Hi, i was on B12 injections years ago and they said i had pernicious anemia then they took me off. I am taking supplements from GP cyanocominn 1mg prolonged release currently. I was wondering myself if i should ask for injections again as i feel it will take me ages to get upto par. No vit D or full iron panel. Actually you have just kind of made me think. I am due to see a nurosurgeon as i keep feeling faint and dizzy. I have been putting it all down to my trapped nerves but clearly it could also be due to B12 deficiency. I am going to ring GP tommorow. Thank you

[SlowDragon Administrator in reply to maplewood]

If you have diagnosis of Pernicious Anaemia you MUST have B12 injections ....

B12 supplements do not work for many people

Sublingual B12 lozenges or B12 mouth spray may work for some, but has limited affects for other people

Ask advice on PAS Healthunlocked

[SlowDragon Administrator]

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

List of iron rich foods

dailyiron.net

Links about iron and ferritin

irondisorders.org/Websites/...

drhedberg.com/ferritin-hypo...

This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.

healthunlocked.com/thyroidu...

Thyroid disease is as much about optimising vitamins as thyroid hormones