Which form of Hrt works well with thyroid replacement hormones.

[Angelic69]

Hi all, went back on a different type of HRT after the hair loss, and thirteen days since I started the new stuff I am losing an excessive amount of hair again accompanied by a burning scalp and not wanting to get out of bed. Has anyone got any experience in which forms or brands of HRT do not interfere with thyroid replacement? I've sent an email to my endocrinologist's secretary too to ask if they have a solution or a brand or method which causes less interference.

[SlowDragon Administrator]

Extremely common to need dose increase in levothyroxine on HRT

[Angelic69 in reply to SlowDragon]

Just recieved some progress, its only the oral HRT which alters TBG.

pubmed.ncbi.nlm.nih.gov/151...

Is this a good source.

[SlowDragon Administrator in reply to Angelic69]

No experience of HRT ...other than regularly seeing members need dose increase after starting

As I understand it ..it’s extra hormones in blood that affects thyroid levels as changes the way thyroid hormones are transported

[Angelic69 in reply to SlowDragon]

I went on HRT seven months ago TSH has rose to 2.39 from 0.. FT3 looks ok but i had only just taken it about an hour prior to blood test and hadn't taken HRT tablet until mid afternoon approx nine hours after.

[SlowDragon Administrator in reply to Angelic69]

TSH for most people on levothyroxine needs to be under one

[Angelic69 in reply to SlowDragon]

Yes thats what i thought but no medication changes were made? I have a strange feeling the receptionist or nurse may have replied no medication changes going off only that it was still in range, I can tell you A tsh OF 2.39 Is a nightmare on my joints and motivation, would that cause an immune responses as my head is burning and my hair is excessively falling?

[SlowDragon Administrator in reply to Angelic69]

Highly likely

Obviously need to get full thyroid and vitamin testing

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

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...

Medichecks Thyroid plus vitamins including folate (private blood draw required)

medichecks.com/products/thy...

Thriva Thyroid plus antibodies and vitamins By DIY fingerpick test

thriva.co/tests/thyroid-test

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins and antibodies 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

[Angelic69 in reply to SlowDragon]

They have tested my bloods, they just need to evaluate the result for my best interest.

[SlowDragon Administrator in reply to Angelic69]

Please add actual results and ranges once you get them

The best person to evaluate what levels suit you best ....is you ...

[Angelic69 in reply to SlowDragon]

I did post results are they not on this feed.

Sodium

143 mmol/L

133-146

Potassium

4.5 mmol/L

3.5-5.3

Urea

3.8 mmol/L

2.5-7.8

Creatinine

65 umol/L

50-90

8 Liver Function Tests, (LFT)

Total Protein

78 g/L

60-80

Albumin

48 g/L

35-50

Bilirubin (Total)

12 umol/L

4-20

Alkaline Phosphatase

57 U/L

35-105

ALT

24 U/L

5-38

. Bone, (BNE)

Calcium

2.48 mmol/L

2.10-2.58

Adjusted Calcium

2.32 mmol/L

2.10-2.58

Albumin

48 g/L

35-50

Alkaline Phosphatase

57 U/L

35-105

on 02/07/2020 15:28. Full Blood Count, (FBC)

WBC

6.28 x10^9/l

4.00-11.00

Rbc

4.54 x10^12/l

4.10-5.10

Hb

138 g/L

120-150

Hct

0.430 l/l

0.360-0.460

MCV

94.7 fl

80.0-100.0

MCH

30.4 pg

27.0-32.0

MCHC

321 g/L

315-345

Plt

247 x10^9/l

140-400

Neut

3.99 x10^9/l

2.00-7.00

Lymp

1.71 x10^9/l

1.00-3.00

Mono

0.43 x10^9/l

0.20-1.00

Eos

0.11 x10^9/l

0.02-0.50

Baso

0.04 x10^9/l

0.01-0.10

02/07/2020 15:28. Thyroid Stimulating Hormone, (TSH)

TSH

2.39 mU/L

0.27-4.20

N.B. Please note the new TSH reference range from 1st April 2015

02/07/2020 15:28. Free T4, (T4)

Free T4

18.0 pmol/L

9.0-26.0

N.B. Please note the new TSH reference range from 1st April 2015

02/07/2020 15:28. Free T3, (T3)

Free T3

4.4 pmol/L

2.8-7.1

N.B. Please note the new TSH reference range from 1st April 2015

02/07/2020 15:28. Estimated Glomerular Filtration Rate, (GFR)

eGFR

> 60 mL/min/1.73m2

Creatinine

65 umol/L

50-90

Normal kidney if no proteinuria, haematuria, or abnormal kidneys on USS.

UK CKD guidelines are available at renal.org/CKDguide/ckd.html

EGFR calculated using parameters for white female. (If black multiply

result by 1.21)

02/07/2020 15:28. Short FBC, (SFC)

Interim Report: Please check Full Blood Count (listed separately) before making clinical decisions.

WBC

6.28 x10^9/l

4.00-11.00

Hb

138 g/L

120-150

Hct

0.430 l/l

0.360-0.460

MCV

94.7 fl

80.0-100.0

Plt

247 x10^9/l

140-400

Neut

3.99 x10^9/l

2.00-7.00

Warning: These results are provisional, and

[SlowDragon Administrator in reply to Angelic69]

02/07/2020 15:28.

Thyroid Stimulating Hormone, (TSH)

TSH 2.39 mU/L 0.27-4.20

Free T4, (T4) 18.0 pmol/L 9.0-26.0

Free T3 4.4 pmol/L 2.8-7.1

All thyroid tests should be done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

This looks like test was 3.30pm

Ft4 is 53% through range

Ft3 is only 38% through range

Most people on levothyroxine need TSH under 2....many need TSH under 1 and Ft4 in top third of range and Ft3 at least half way through range

What were TSH, Ft4 and Ft3 BEFORE starting HRT

[Angelic69 in reply to SlowDragon]

Will try and obtain and get back to you asap. xx Thanks.

[SarahJLD in reply to SlowDragon]

Oh thank you for that information. Started HRT 10 days ago, some menopause symptoms improved already but shoulder/neck stiffness and pain suddenly off scale having been just an inconvenience until 48 hours ago. Somehow had missed I may need to increase thyroxine.

[Hidden]

Are you on oral estrogen? That increases TBG (thyroid-binding globulin) which in turn decreases thyroid hormone levels. It´s common to need an increase in thyroid meds after starting oral estrogen.

If you are on oral estrogen, have you considered transdermal bio-identical estrogen combined with bio-identical progesterone? Synthetic hormones do not have the same structure as the hormones naturally produced by the body.

[Angelic69 in reply to Hidden]

I was, twice, on oral estrogen but after just thirteen days back on them same burning scalp, painful joints, fatigue symptoms developed again so immediately stopped.

I have been given a transdermal version of the estrogen in a low dose which is body identicle but they didnt give any progesterone to accompany it. When i enquired about the perscription being estrogen only to the receptionist she spoke to the prescribing GP and came back saying the GP had said she had wrote a prescription for both estrogen and progesterone. I explained that the medication delivered was estrogen-only. The receptionist did not go back into talk to the GP but told me i would get a call back from the GP later on in the day. I did not get a call back but later the pharmacist delivered another prescription containing another oral version of combined HRT like the one i just stopped taking because of side effects, in fact exactly the same as the one i just stopped taking, Crazy stuff. I thought maybe its different. It mentioned on the patient information leaflet that no hair loss had been associated with this product so i thought it must be ok. Unfortunately no it wasnt ok.

[milkwoman]

I didn’t do well on oral progesterone and estrogen patches (could not get menopause symptoms and breakthrough bleeding under control and oral progesterone caused rapid weight gain). I’m now on a custom compounded transdermal cream which contains two forms of estrogen (estriol and estradiol) along with progesterone. Cream is applied am and pm. (I make enough testosterone so no need to supplement).

I did find that I needed to increase my levothyroxine due to HRT.

[Angelic69 in reply to milkwoman]

The company that make your HRT are they UK based, can you post details or private message me with details and expected costs.

Also how long was you taking your HRT before thyroid problems started, which symptoms did you notice first as a warning there was an issue.

sorry for the extra questions.

[milkwoman in reply to Angelic69]

I’m in the US. When I google Compounding Pharmacy UK, a whole list pops up. Maybe there is one located near you that you can contact?

[Angelic69 in reply to milkwoman]

Ive read mixed things about thesze guys and after reading some articles on Lupus type flare-ups with estrogen in none lupus sufferes and then thinking I'm hashis and could be at risk of other auto immune diseases, i am now thinking for me it might be the estrogen that is causing my issues. I can find two types, one is less potent than the other but is more expensive by a few pounds. I tried estrogen only patches but i had an increase in hair loss and an increase in joint pains and burning scalp so for me although testosterone derived progestins have been identified as a cause mine i think is something else which i doubt using a compound pharmacy would be helpful. I have been tested for lupus by my Endo a while back and test came back negative but i read this article which mentions lupus flare up but negative test for disease so i have the symptoms each time i try to use HRT so not sure what i can do.

[FancyPants54 in reply to Angelic69]

Angelica, you don't need compounded HRT, it costs a lot of money in the UK and isn't regulated.

You will need a dose increase in Levo now you are on HRT. They have said that only oral oestrogen causes a drop in thyroid hormone, but it's not true, transdermal does it too. I know, it's done it to me and I'm very in tune with my hormones as actively trying to get on top of both thyroid and meno. It's really noticeable and instant. I had been using 125mcg patch (I have the Mirena coil for progesterone) and increased it to 150mcg at menopause clinic recommendation. It only took about 2 days to affect my thyroid hormone levels. She told me to hold on for 6 weeks as hopefully things would settle down, but they haven't. I'm doing new bloods this week and will then hopefully add some T3 to my Levo as I am a poor converter. I am not alone. It's common to need to increase your thyroid meds when on HRT and it's not just tablet form.

The burning is weird though. You might do better on a transdermal gel or patch, but still expect to increase your Levo.

[Angelic69 in reply to FancyPants54]

I totally agree transdermal has same effect for me too. I tried estrogen only and still same effect and yes it does not take very long to see an increase in symptoms. I came across an article which talks about lupus flare ups with estrogen, i already have hashi and have previously been tested for lupus which came back negative. The symptoms i get with HRT were painful joints and inflammation which is how the article described the effects of estrogen replacement associated lupus fares. Ive found a less potent form of estrogen which i am going to ask to trail and see if symptoms persist. Funny enough though the latest batch the GPs have prescribed are transdermal sequi patches still with the same testosterone derived progesterone??? I dont understand the logic? I have sent them another email with a list of testosterone derived progesterones so hopefully next time they will join the dots and prescribe a different form which is a least progesterone derived if it has to be synthetic.

[Hidden in reply to milkwoman]

Can I ask which brand of oral progesterone you were on, as I understand there is a difference between bio-identical P (Utrogestan) and progestins?

[Angelic69 in reply to Hidden]

Yes it was a progestin, Estradiol hemihydrate + norethisterone acetate. Two different brands but same ingredients? Elleste Duet Conti and Kliofem both same dose too.

[Hidden in reply to Angelic69]

There is only one (prescription) oral bio-identical progesterone that I know of in Europe: Utrogestan. Natural/functional/alternative doctors claim that progestins don´t mimic the progesterone produced by our bodies so will wreak havoc on our endocrine system...as will oral estrogen...the natural doctors I know of in Europe prescribe Oestrogel/Lenzetto (transdermal bio-identical estradiol) and Utrogestan.

[Angelic69 in reply to Hidden]

Thanks

[Angelic69 in reply to Hidden]

Progestins can be derived from testosterone and increase androgens which can cause hair loss, i have posted some links to a newer post.

[FancyPants54 in reply to Angelic69]

You probably need to try Utrogestan and insert the caps into your vagina at bedtime rather than swallow them. Way less side effects that way. It's not licensed for that use in the UK so GPs don't know about it, but it's common on the continent and works just fine.

[milkwoman in reply to Hidden]

My oral progesterone was Prometrium (progestin). At first I was on the generic form then asked to be switched to the name brand thinking it would be better (it was actually worse). Although I’m not sure, I’m guessing my compounded cream is bio-identical.

[Hidden in reply to milkwoman]

As far as I know, Prometrium is the same as Utrogestan in Europe so bio-identical (whereas progestins are synthetic progesterone with a different structure). But interestingly enough, I recently read about someone on thyroid hormone feeling worse on it, so just because it´s bio-identical does not mean right for everyone...

I have been experimenting with Utrogestan, taking it both cyclically and continuously, and the former definitely works best for me. It´s often said that we tend to be progesterone deficient (some alternative doctors even recommend taking 300 mg of Prometrium/Utrogestan daily with no estogen), but I have found low estrogen levels to affect me much more.

[Angelic69 in reply to Hidden]

Hi, can you take progesterone without estrogen safely?

[Hidden in reply to Angelic69]

Yes, women in their mid 30s are prescribed progesterone by functional doctors because that’s when P production starts to decline relative to estrogen.

[Angelic69 in reply to Hidden]

I will ask to trail that, thank you. xx

[Angelic69 in reply to Hidden]

Ive read about lupus flare ups on HRT, could it be worse if you already have hashis?

[Hidden in reply to Angelic69]

No idea, sorry. Hope someone else knows!