Levothyroxine and Gaviscon Advance.

[LFP_]

Hi,👋

I was started on 25mcg Levothyroxine a month ago. At around the same time I was diagnosed with a severely inflamed oesophagus/larynx and told to take Gaviscon Advance after meals and 20mls at bedtime.

I drink coffee, (it’s my vice.....I’m now down to only 2 cups in the morning) so obviously don’t want to take the Levo in the morning.

Secondly the Gaviscon Advance and Levo interact with each other so I can’t take it at night!

Help! I really want to start feeling better.

[SeasideSusie Remembering]

LFP_

Do you get up during the night regularly for the bathroom? If so you could takey our Levo then, that's what I do, somewhere around 4-7am is normal for me to take mine, I don't have breakfast until around 10am.

[LFP_ in reply to SeasideSusie]

Hi Susie,

Thanks for the reply. I’m thinking I’m just going to have to juggle the time of taking the Levo until the inflamed oesophagus resolves in a few months and I can take it at bedtime.

[ThyroQueen in reply to LFP_]

I have been there! It is quite a juggling act. I have benefited a lot from doing the mechanical/lifestyle changes for reflux - buying a ramp for our bed, not eating for three hours before bedtime - to finally get to the point where I could quit the Gaviscon and not have to juggle!

[LFP_ in reply to ThyroQueen]

Hi,👋

That’s what I’m hoping too!🤞I’ve done all the same things as you have. Do you mind if I ask, were you on Gaviscon for a while?

[SlowDragon Administrator]

Acid reflux is common hypothyroid symptom

As dose of levothyroxine is increased upwards gut issues should improve

Standard starter dose of levothyroxine is 50mcg (unless over 60 years old) even aged 60 ....dose is still increased up after starting on 25mcg

Bloods should be retested 6-8 weeks after each dose increase

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

Ask GP to test vitamin levels and thyroid antibodies, if not tested yet

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)

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

Thriva also offer just vitamin testing

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...

If TPO or TG thyroid antibodies are high this is usually due to Hashimoto’s (commonly known in UK as autoimmune thyroid disease).

About 90% of all primary hypothyroidism in Uk is due to Hashimoto’s. Low vitamin levels are particularly common with Hashimoto’s. Gluten intolerance is often a hidden issue to.

Link about thyroid blood tests

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

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

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

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...

[LFP_ in reply to SlowDragon]

Wow! Thank you SlowDragon!😊That’s so helpful, thank you so much.

[topaz1]

Look on Dr Myhill's website about stomach acid and PPI's.

[LFP_ in reply to topaz1]

Thank you so much topaz1. Her site is brilliant.

[Kimkat]

I have suffered with inflamed oeso/larynx for quite a few years and I too am on gaviscon advance and omeprazole, both of which interferes with levo, so on slow dragons advice I now set my alarm for 4am and take it then. I’m hoping for a further increase in levo after having bloods done today. I can only hope that one day I will be free of sore throats and hoarseness 🙏🏼 So good luck and keep us informed.

[LFP_ in reply to Kimkat]

Amen to that Kimkat. It’s so frustrating and annoying, isn’t it. Fingers crossed you get good blood results. The Gaviscon Advance seems to be like a sticking plaster, when I wean down slightly on the dosage the sore throat gets a lot worse. My GP started me on PPI yesterday.

[Kimkat]

I’m exactly the same, having a sore throat every day is no fun and I don’t know about you but I have even been to speech therapy! The ENT consultant has had me there twice now but to no avail, it makes me feel like giving up.