I have had symptoms of internal tremors, dry hair, brittle nails, unusual feeling in neck and sore joints in hands upon waking since March. Bloods as follows:
B12 active 59.4 (37.5-188)
Ferritin 271 (13-150)
Folate 18.8 (8.83-60.8)
FT3 5.03 (3.1-6.8)
TSH 1.93 (0.27-4.2)
TPO 98 (0-34)
FT4 11.9 (12-22)
Vit D 48.9(50-175)
I was put on Levothyroxine 50mg which was good for first 11 days then symptoms massively increased so reduced to 25mg. Still no better.
GP says not Hashimotos as was not hyper before hypo and only prescribed meds as had some symptoms. No advice on vitamins. Also said not to try gluten free as could cause cardiac problems.
Really struggling now and would very much appreciate some advice please
Written by
mondays
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Were these results from BEFORE Starting on levothyroxine?
Folate and B12 and vitamin D all on low side
Improving low vitamin levels can help improve symptoms and enable you to tolerate levothyroxine easier
Ferritin is likely high due to inflammation of Hashimoto’s
Which brand of levothyroxine did you start on
Many people find Levothyroxine brands are not interchangeable.
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
Are you currently taking Teva?
Teva, Aristo and Glenmark are the only lactose free tablets
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
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)
If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test
If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal
Igennus Super B is good quality and cheap vitamin B complex. Contains folate. Full dose is two tablets per day. Many/most people may only need one tablet per day. Certainly only start on one per day (or even half tablet per day for first couple of weeks)
Or Thorne Basic B is another option that contain folate, but is large capsule
If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results
Levothyroxine is, in vast majority of cases, for life
Dose has to be increased slowly upwards in 25mcg steps (retested 6-8 weeks after each dose increase) until on or around full replacement dose. That’s typically 1.6mcg per kilo of your weight
Taking too little, will reduce your own thyroid output, but not offer high enough replacement
Dose levothyroxine is increased slowly upwards in 25mcg steps until TSH is under 2. (Often well under 1 when adequately treated) Most important results are Ft4 and Ft3. Ft3 should be at least 50% through range.
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