I'm a 61 year old woman- usually fit- good BMI and do strength training. No regular meds until recently.
In spring 2018 I felt tired and rundown ( I have a stressful job and it was over 2 years since my last period so I wondered if this was just post menopause - not on HRT)
The GP tested my bloods and I had TSH 5.27 and ? "Thyroxin" 4.7. She suggested a further test in 3 months. I thought I had one and it was normal again - no data for that- but my GP last week couldn't find anything. I'm going to check again.
I have (like us all) had a super stressy lockdown working long and hard and recently have felt quite unwell.:-
Bad wheezy (asthmaticky) chest and dry cough, fatigue, brain fog, dizziness and vertigo, tinnitus massively ramped up, very low and tearful, acid stomach/indigestion some of the time.
I had begun to think long COVID but I haven't ever been tested positive for COVID and haven't had a period when I think I definitely had it. On researching that doesn't rule it out.I use the Zoe COVID app and my presenting symptoms have initiated 3
requests for me to take a COVID test- all negative including yesterday.
Doctor tested thyroid, iron (not ferritin) and liver and I had a chest Xray. All OK except thyroid.
GP called to say subclinical hypothyroidism- TSH 5.77 and T4 14.2. She said usually it would be do nothing and retest in 2 months but in view of my symptoms she prescribed 75mg levothroxine and I'm to be retested in 8 weeks. She said I could feel much better in 2 weeks- I'm day 8. I was also prescribed a steroid inhaler for 8 weeks to improve my breathing as my peak flow is poor.
I have some auoimmune issues- mild (Lichen )- but we have a fair bit of auto-immune disease in the family. I have never had a test for Hashimoto's. As I say I have been super stressed with work since March without a break .
I have booked a private COVID antibody test on Monday to rule out or potentially rule in long COVID.
I am a total thyroid novice and would be grateful for any observations about what GP is doing and whether there are risks to my thyroid/health in taking this dose for 2 months- if in fact I have a raised TSH because it has been an awful time and my immune system is kicking off. I'm now planning 4 weeks off in the next 8 to try to get myself into a better place.
Could be a coincidence but this afternoon after 8 days of levothyroxine my normal occasional irregular heart- missing beats- is quite bad and persistent and my vertigo is, if anything,worse.
I'm wondering whether I should pay to see an endocrinoligist.
I don't want to go down a medicated path if I don't need to.
Thanks very much.
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Marvdog
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dizziness and vertigo, tinnitus massively ramped up, very low and tearful, acid stomach/indigestion some of the time.
These are typical hypothyroid symptoms.
Tinnitus often low B12
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
Many people find Levothyroxine brands are not interchangeable.
Which brand of levothyroxine have you been started on?
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
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)
Bloods should be retested 6-8 weeks after each dose increase in levothyroxine
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
Lichen often responds well to strictly gluten free diet
Hashimoto’s and gluten intolerance often go hand in hand too
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
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
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
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.
Thanks very much for your prompt reply. I shall read it closely and take it in. Recently I have been taking Metatone, Vit C and D and zinc and Omega 3 and 6. if I'm getting the tests you recommend should I stop any of these ahead of blood tests?
Hi,In the 1st instance you should go and speak to your Pharmacist and explain your symptoms. Ask if there are any contra -indications with your other meds. Arrange to see your GP and ask for referral to an Endocrinologist, lets face it they are said to be the experts???!! Also previous are all relevant too.
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 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.
Good morning. I have been on Levothyroxine for three years. From the start it was made by MercuryPharma. During the course the pharmacy changed to the Teva brand and it wasn't long before I started to feel like ... Well, you know! My GP told the pharmacy to only supply the Mercury brand and all was back to normal. Nothing to do with Teva, but I was experiencing low enthusiasm in anything, and had pretty bad leg and back pains. The endocrinologist ordered a "full blood count" and as a result she immediately increased my Levo does my 50 micro grams. In a week, all pain was gone and I was feeling better and more interested in doing things (enthusiasm). I am not a doctor but I would suggest you arrange an appointment with an endocrinologist. Pretty amazing what they an work out from a few simple tests.
Thank you. I’m nearly 2 weeks in and don’t feel any better. In fact I feel a bit worse. However I think I’m in the middle of something viral/ stressy/ autoimmune so that’s why I’m not sure my SCH is the cause of my symptoms. I’m going to make enquiries to find an endocrinologist.
Hi, when I started on levo 17 years ago I felt worse for a while. It can take weeks or even months to start to feel better. You maybe just need to stick with it for a while and give the levo a chance. Your body has been out of kilter for a while and it can take a while to improve. Jo. Xx
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