What are these ‘flare ups’?

[Winniepoo15]

Hi everyone. I’m not sure what’s going on but this is the third flare up I’ve had since August. I’ve got just about everything wrong with me at the mo, but past week the joint pain has spread & the niggly neck pain I had has now become painful & right side of my thyroid gland hurts. I’m taking paracetamol to ease the headache & pain. I had a blue horizon thyroid test done last week so I’ve added results for some kind person to check for me. I’m hoping all I need is to tweak my meds & these pains will be gone. I doubt it will be that simple. At present I’m on levo 50mcg 4 days & 75mcg for 3. Earlier in year gp would not increase my meds even though I felt unwell. Thanking you in advance.

[SlowDragon Administrator]

Do you always get same brand of levothyroxine

Which brand?

That’s a very small dose of levothyroxine

guidelines on dose levothyroxine by weight might help push GP to increase dose

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, or near 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.

Also here

cks.nice.org.uk/topics/hypo...

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...

[SlowDragon Administrator]

What vitamin supplements are you currently taking?

Vitamin D doesn’t want to get any higher

Folate is on low side

Antibodies are negative for autoimmune thyroid disease

But have you ever had ultrasound scan of thyroid?

20% of Hashimoto's patients never have raised antibodies

healthunlocked.com/thyroidu...

Paul Robson on atrophied thyroid - especially if no TPO antibodies

paulrobinsonthyroid.com/cou...

Are you on strictly gluten free diet...or tried it

[Winniepoo15 in reply to SlowDragon]

Hi. Thank you for all the information you’ve given. I’ll have a read & try to understand this complicated thyroid of ours. I always have same brand of levo-Mercury pharma, & seem to be ok on that brand. I’ve been gluten & dairy free for eighteen months. I have awful gut issues but they haven’t really been resolved by doing so. I take Doctors Best d3, & Herbology magnesium glycinate until near optimum. I did take ferrous fumerate for couple weeks when my ferritin was low-at around 30 & was very surprised at how quickly it rose. Gp was against me doing so but I could not raise my ferritin levels, even after eating chicken & lambs liver for six months. I just didn’t absorb the iron. I stopped all b12 vits four months ago as thought I may be deficient, but it’s not looking like it with these results. Do you only need to take folate when you supplement with b12? And, no, I have never had a scan on my thyroid. I’m not sure if this is thyroid related, but when laying down, Ive been having coughing & choking episodes which can be very scary & unpleasant? I’m hoping all I need is an increase in meds to feel better than I have in the past three months. X