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, (itās my vice.....Iām now down to only 2 cups in the morning) so obviously donāt want to take the Levo in the morning.
Secondly the Gaviscon Advance and Levo interact with each other so I canāt take it at night!
Help! I really want to start feeling better.
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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.
Thanks for the reply. Iām thinking Iām 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.
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!
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
If TPO or TG thyroid antibodies are high this is usually due to Hashimotoās (commonly known in UK as autoimmune thyroid disease).
About 90% of all primary hypothyroidism in Uk is due to Hashimotoās. Low vitamin levels are particularly common with Hashimotoās. Gluten intolerance is often a hidden issue to.
Even if we donāt 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
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.
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 25ā50Ī¼g 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 Ī¼g/kg/day (approximately 100Ī¼g for a 60kg woman and 125Ī¼g 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.
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. Iām 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 šš¼ So good luck and keep us informed.
Amen to that Kimkat. Itās so frustrating and annoying, isnāt 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.
Iām exactly the same, having a sore throat every day is no fun and I donāt 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.
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