I have been under the hospital for several years for foot pain, had 2 injections and recently had an mri scan to see if bone fusion will help. Result from todays consultation not got arthritis discharged as bone structure OK. Does anyone else have any foot pain problems
foot pain: I have been under the hospital for... - Thyroid UK
foot pain
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Raf063
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SlowDragonAdministrator
Plantar fasciitis is common hypothyroid symptom
Usually linked to low Ft3 and/or low vitamin D
How much levothyroxine are you currently taking
When were levels last tested
What vitamin supplements are you currently taking
When were vitamins last tested
As you have Hashimoto’s are you on strictly gluten free diet
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 as you have 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)
If/when also on T3 or NDT make sure to take last half or third of daily dose 8-12 hours prior to test, even if this means adjusting time or splitting of dose day before test
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...
Thriva Thyroid plus vitamins
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...
Medichecks - JUST vitamin testing including folate - DIY finger prick test
medichecks.com/products/nut...
Medichecks often have special offers, if order on Thursdays
Add results and ranges if you have any
Or come back with new post once you get results
Levels within range just
Vitamin D low, now on tablets
All rest not had checked
Not been told that I should be gluten free
How low was vitamin D?
How much vitamin D are you prescribed
Vitamin D
GP will often only prescribe to bring levels to 50nmol.
Some areas will prescribe to bring levels to 75nmol
leedsformulary.nhs.uk/docs/...
GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)
mm.wirral.nhs.uk/document_u...
NHS Guidelines on dose vitamin D required
ouh.nhs.uk/osteoporosis/use...
But with Hashimoto’s, improving to around 80nmol or 100nmol by self supplementing may be better
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.
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
Calculator for working out dose you may need
40ng/ml = 100nmol
grassrootshealth.net/projec...
Government recommends everyone supplement October to April
gov.uk/government/news/phe-...
Also read up on importance of magnesium and vitamin K2 Mk7 supplements when taking vitamin D
betterbones.com/bone-nutrit...
medicalnewstoday.com/articl...
livescience.com/61866-magne...
sciencedaily.com/releases/2...
Vitamin K2 mk7
betterbones.com/bone-nutrit...
healthline.com/nutrition/vi...
Vitamin D was 20
Not prescribed had to buy vitamin d3
1 tab a day 1000iu
Vitamin D of 20nmol is Deficient and requires LOADING dose prescribed by GP
That’s 300,000iu over 6-8 weeks
That’s 5000iu per day for 8 weeks or 7000iu per day for 6 weeks
So 1000iu vitamin D per day is woefully inadequate
ouh.nhs.uk/osteoporosis/use...
Essential to retest vitamin D at end of the course ....you may need to do so privately
With Hashimoto’s we frequently need at least 2000-3000iu per day just as maintenance dose
See different GP and insist on getting B12, folate and ferritin tested.....plus thyroid levels INCLUDING Ft4 and Ft3
What do you weigh in kilo
Guidelines on dose levothyroxine by weight = 1.6mcg Levothyroxine per kilo of your weight
I will up the dose my gp hasn't got a clue
How long since you last had thyroid levels tested?
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)
Add results and ranges if you have any
Obviously you need a new prescription before increasing dose of levothyroxine
80kg 100thyroxine
So likely to need at least 125mcg daily.....possibly higher
Suggest you print out these guidelines ready to push for dose increase in levothyroxine
See/contact GP for thyroid and vitamin testing
Make sure to get blood test done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test
Do you always get same brand of levothyroxine at each prescription?
Come back with new post once you get results
Already shown guidelines to gp , they are not interested
Tried to get all test done same again they refused
New gp did vit d test after I pushed for it, then didn't want to do anything about it until I pointed it out how low I was, she said I was borderline
So like thousands of members on here, you need to get your own private testing done
Only do test on Monday or Tuesday morning and post back via tracked 24 hour postal service
List of private testing options
thyroiduk.org/getting-a-dia...
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...
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...
Medichecks - JUST vitamin testing including folate - DIY finger prick test
medichecks.com/products/nut...
Medichecks often have special offers, if order on Thursdays
Come back with new post once you get results
If vitamin results are deficient take results to GP. If vitamins low self supplement to improve
Perhaps test vitamins first. Then test thyroid levels after improving low vitamin levels
Examples of Posts mentioning Medichecks results
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
healthcheckshop.co.uk/store...?
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
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.
I agree with SlowDragon . Plantar fasciitis is very common, and it was one of my hypothyroid symptoms for years - although I had no idea at the time what was causing it.
en.wikipedia.org/wiki/Plant...
Doctors think that exercise will fix the problem, but I used to have a dog many years ago (before thyroid treatment and optimising nutrients and before some other health-related issues cropped up) and walked her for miles every day. Despite all this exercise I suffered excruciating pain in my heels and ankles first thing in the morning. Putting my feet to the floor was agony. My ankles wouldn't bend and going downstairs would be excruciating as a result. The problems wore off every day after an hour or two but always came back.
In my case the problem went away with no other treatment when I started treating my thyroid and optimised as many nutrients as I could.
I saw a “new to me” GP when we moved areas......shortly before I was prescribed T3 ....he nearly fell off his chair laughing when I said my plantar fasciitis was linked to my Hashimoto’s and was primarily due to low Ft3
I have never had the slightest issue with heels or joints since started on T3 alongside levothyroxine
Typical doctor then?
Did you ever seen him again after your T3 eliminated your foot problems?
No .....definitely not someone who would consider changing his views
I see I much more enlightened female GP who understands the gut connection to thyroid
Foot pain and numb/tingling toes is a big problem for me now. My right foot is probably plantar fasciitis, my left foot, goodness knows. Stiff ankles on stairs. Swollen feet. It sort of wears off with use, so if I'm up and about I get a bit better feeling, but after I stop it's agony to stand up again. My whole leg/s feel stiff and painful. My gait is wrong. I am under medicated for various reasons making it hard to increase. It was one of my first actual symptoms and I've had more than enough of it.
SlowDragonAdministrator
Looking at previous posts you have had Hashimoto’s confirmed
Strongly recommended getting FULL thyroid and vitamin testing.....privately if GP won’t
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 if you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies
Ask GP to test B12, folate and ferritin levels
How long since you have had thyroid test?
Are you still only on 100mcg levothyroxine?
Always get same brand of levothyroxine?
Please add actual results and ranges
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...
Thriva Thyroid plus vitamins
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...
Medichecks - JUST vitamin testing including folate - DIY finger prick test
medichecks.com/products/nut...
Medichecks often have special offers, if order on Thursdays
Come back with new post once you get results
SlowDragonAdministrator
guidelines on dose levothyroxine by weight
Even if we don’t start on full replacement dose, most people need to increase levothyroxine 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
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