Insulin and Thyroxin - why has my appetite increased so much?

[SheDavis4]

I've been on twice daily insulin for 10 months and Thyroxin 25mg fur a month. My hunger pangs are so extreme at times making me feel quite ill. I'm trying to watch my weight so feel I cannot just reach for food when this happens.

Can anyone help?

[SlowDragon Administrator]

Standard starter dose of levothyroxine is 50mcg unless over 65

What were your thyroid and vitamin results before starting on levothyroxine

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 been tested yet

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

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 antibodies and vitamins

medichecks.com/products/adv...

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 down to £26.10 if go on thyroid uk for code

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

monitormyhealth.org.uk/thyr...

Or

Vitamin D NHS

vitamindtest.org.uk

When under medicated, body can crave food to try to raise levels

[Anthea55]

Kenneth R. Blanchard in his book 'The Functional Approach to Hypothyroidism' mentions patients with food cravings. He thought that these cravings may be related to T4 coming into direct contact with the stomach walls. He got these patients to take their T4 with food and most of them reported that "the hungries are gone".

So it's worth a try for you to take your thyroxine (T4) with food and see if it helps. I do it and find that it's so much easier than all the hassle of taking it between meals and counting the hours, etc etc.

I don't know anything about your insulin, so can't help with that.

Best wishes.

[tattybogle in reply to Anthea55]

This might not be wise advice for someone who is on such a low dose , and having blood tests to titrate dose upwards. Different foods, etc would have a different effect on the amount of thyroxine that was absorbed from each tablet each day , and so the dose taken would end up a a random amount less than 25mcg, which is not enough yet anyway.

At the very least if you were to try this , it should be with exactly the same food each day, and keep doing it forever.

Caffeine , calcuim and iron have been shown to reduce the amount of thyroxine that is absorbed from Levo tablets, and probably many, many other things have an effect too.

In order to find the right dose of Levo for someone , they do need to be taking the same amount daily , for at least 6 weeks, or else the blood test will be misleading, and the doctor will get the next dose wrong.... and they don't need any help to get it wrong, they get it wrong too often anyway.

[Anthea55 in reply to tattybogle]

Dr Blanchard goes on to say that a few of his patients taking T4 with food needed more T4 because of reduced absorption due to mixing with food, but he says 'this effect is surprisingly uncommon'.

I was first told to take thyroid medication with food by Dr Peatfield and since then I have also seen that it is suggested by Dr Myhill.

drmyhill.co.uk/wiki/Thyroid...

You suggest that you need to take the same amount of T4 daily for at least 6 weeks; but T4 is a storage hormone (a bit like your petrol tank) so that if you miss a dose you can make up for it another day, or even take it all weekly. It's the total amount which matters, your body uses it as it needs it. It's a bit like suggesting that you need to put the same amount of petrol in the tank each time you fill up - you don't. Many years ago if I wanted to know how many miles to the gallon I was getting in my old car I kept a notebook and kept a record of mileage and fuel added each time. After some time I calculated my petrol consumption over several refills. To improve the accuracy it could be worth making sure that the first and last fills were to the top and ideally at the same pump if it was on an incline, but even that became insignificant if you measured over a long enough distance.

[tattybogle in reply to Anthea55]

Yes.. i understand the storage/half life/alternate dosing qualities of T4 Just didn't explain myself very well... I was trying to keep my reply simple. and to make the point that because the 25mcg dose is stupidly low, it might not be wise to risk reducing it further by loosing any to varied absorption.

Once settled on a full dose ,it's easier to experiment on ourselves with how we take it and if need be increase dose a smidge to compensate.

I have my Levo in the morning with a cuppa which breaks all the rules , but i do the same every day , so any effect on absorption is consistent. and so my regular dose of 112.5mcg accommodates this.(or 100/125 alternating , but i prefer the same each day , it's easier to remember, and i think my body prefers the consistency)

[Zazbag in reply to Anthea55]

My experience doesn't fit with this hypothesis. I had insane hunger before I was diagnosed, I think for some people it's a symptom of hypothyroidism itself. I become crazy hungry again when I'm undermedicated. When I'm taking the right medication at the right dose level my hunger levels become normal again. I never take my medication with food. My guess would be that the OP is simply on too low a dose, which makes sense since she's only on 25mcg. She should try increasing that dose before fiddling around with the timing of her dose around food.

[SlowDragon Administrator]

Being started on very low dose can make you more hypothyroid

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, 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...

[humanbean]

Your doctor is not doing you any favours by keeping your Levo dose so low. When people take thyroid hormones they aren't "topping up" a dysfunctional thyroid, they are replacing what they produce with what comes in the tablet. If their dose is too low then they can end up with less thyroid hormone than their own thyroid was producing.

On the subject of your weight you might find this link of interest :

healthunlocked.com/thyroidu...

You would need proper testing to see if your iron and/or ferritin (iron stores) was low.

[SheDavis4 in reply to humanbean]

Wow thanks, this makes a lot of sense.

I'm under an Endocrinologist for this treatment not the docs.

Had to ring 111 today as feel so bad.

I won't be having a telephone consultation with the specialist til Feb - not sure I can last like this.

[jrbarnes]

HI there, I suffer terrible insulin resistance from low thyroid hormone. Did you have diabetes prior to being diagnosed with hypothyroidism? Your situation may be more complicated since you take insulin and having low thyroid levels, specifically low T3 levels can really aggravate it further. Do you drink coffee?

[SheDavis4 in reply to jrbarnes]

I am a type 2 diabetic of 11 years. Started insulin in Feb and gradually increased the amounts to reach OK levels but the Thyroxin has sent my bloods into double figures. I gather from the call back from 111 that when the Thyroxin is increased my blood levels will vary again.

Would have been good if the specialist could have warned me about this.

[jrbarnes in reply to SheDavis4]

I don't know much about diabetes and Thyroid but I understand it can complicate things. My endo didn't bother to tell me that I'd need thyroid medication after my hemi thyroidectomy so it doesn't surprise me they didn't warn you.