Hashimoto treatment

[Lilly12255]

Hi,

I have Hashimoto. I wanted to compare treatment with other ladies with the same condition. Could you please share your treatment?

Thank you

Xx

[Hidden]

In my experience, people with Hashimoto´s are very different so no two people are going to react the same way to the same treatment. Some do fine on levo only (usually when permitted to take high enough doses regardless of the TSH), some need T3 added to levo (mostly T4 with a little T3, or mostly T3 with a little T4 depending on the person), some do great on NDT, others combine NDT with T4 or T3, and some do best on T3 only. Levothyroxine only will of course only work if you are a good converter. Conversion can be improved by correcting mineral and vitamin deficiencies (vitB12, vit D, selenium, zinc, iron...there are many good posts about this).

So it´s all about trial and error.

Although most conventional doctors won´t know it, I have found adrenal status to play a role. But, since adrenal fatigue is not a recognised condition by mainstream medicine, you have to order tests yourself (24 h saliva test or DUTCH - dried urine). Both are available from UK labs. I ordered them when I developed hyper symptoms after adding T3 to T4, although labs showed I was a poor converter even on high doses of T4 (so basically still hypothyroid on levo, yet unable to handle T3 without developing hyper symptoms - a typical symptom of adrenal fatigue according to websites dedicated to the condition, and also described in books like "Your thyroid and how to keep it healthy" by Dr. Peatfield). The results showed adrenal fatigue which I treated myself (since I could not find a knowledgeable doctor), and I was then able to slowly add T3 to levo.

Unfortunately, many patients are left to deal with their problems on their own, due to the incredible ignorance and yes, sometimes incompetence, of most mainstream doctors. Many don´t know there are other treatments than levothyoxine available, they go by the TSH alone, they have no idea about the importance of adequate T3 levels at cellular levels, they have never heard of adrenal fatigue, they ignore the role menopause plays when it comes to messing up your hormones even more...I could go on forever.

[Hidden]

PS. I find this article does a great job at explaining why individualised treatment is so important:

thyroidpatients.ca/2019/09/...

[Lilly12255]

Thank you so much for the explanation!

[SlowDragon Administrator]

Looking at previous posts....a month ago you had dose increased to 75mcg levothyroxine

healthunlocked.com/thyroidu...

You will need FULL thyroid and vitamin testing 6-8 weeks after EACH dose increase

75mcg is only one step up from starter dose...

What vitamin supplements are you currently taking?

Have vitamin levels been tested previously...please add results and ranges

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)

As you have Hashimoto’s are you on strictly gluten free diet?

If not, you might want to consider trying this

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.

[SlowDragon Administrator]

Can see you are TTC

Obviously vitamin levels are especially important before TTC

Folate and B12 in particular. These are Goldilocks vitamins you don’t want too much or too little

Testing 6-8 weeks after each dose increase....you need TSH, FT4 and FT3 tested. Also EXTREMELY important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common when hypothyroid, but especially with Hashimoto’s

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 do your tests?

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...

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

thriva.co/tests/thyroid-test

Blue Horizon Thyroid Premium Gold includes vitamins

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

thyroiduk.org/getting-a-dia...

monitormyhealth.org.uk/thyr...

Before TTC thyroid levels need to be stable

verywellhealth.com/infertil...

Pregnancy guidelines

thyroiduk.org/having-a-baby-2/

gp-update.co.uk/files/docs/...

Very important info on when to increase dose once pregnancy confirmed..see pages 7&8

btf-thyroid.org/Handlers/Do...

[greygoose]

You do realise there's no treatment for the actual Hashi's, don't you? There's nothing that can be done about that. What is treated is the lack of thyroid hormones, due to the damaged thyroid. And you can only replace a hormone with a hormone. So, as Hidden explains so beautifully, it has to be one of, or a combination of, the two main thyroid hormones, in one form or another. There may be things you can do to ease symptoms - like going gluten-free, for example - but there are no other treatments.