Gastric problems and thyroxine therapy uptake - Thyroid UK

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Gastric problems and thyroxine therapy uptake

diogenes profile image

Ths paper shows the importance for endocrinologists in considering gastric uptake in patients as part of the investigation of dosage problems and patient response

Front. Endocrinol., 28 January 2021


Levothyroxine Therapy in Gastric Malabsorptive Disorders

Camilla Virili, Nunzia Brusca, Silvia Capriello and Marco Centanni

13 Replies

Thank you -

It seems so logical to a lay person like myself but dismissed by some of those in the medical profession who don't seem able to join up the dots !!

SlowDragon profile image

This paper says similar

jgelliss profile image
jgelliss in reply to SlowDragon

Thank you so much SD for this very interesting and informative article.

shaws profile image

Thanks diogenes,

I think we should send copies to our NHS Endocrinologists.

Thank you for posting this diogenes. My thyroxene requirement has reduced over the past couple of years from 200mcg to 125mcg - this appears to correspond with recent coeliac diagnosis. My weight has remained steady at about 9 1/2 stone for many years. Its a mystery that I need less thyroxene with malabsorption issues. I'm in the process of trying to get history of blood results - might tell me something? Will my requirement increase as my gut heals? - I guess time will tell.

diogenes SlowDragon Than you guys. I am going to print all this information to try and ensure that I get regular, rather than annual testing for my thyroid as well as vits/mins as my gut heals.

SlowDragon profile image
SlowDragonAdministrator in reply to nellie237

Likely to need to test privately

GP won’t test vitamin D more than once every 2 years

You need to test vitamin D twice year when supplementing

B12, folate and ferritin at least annually

What vitamin supplements are you currently taking

Thyroid, needs TSH, Ft4 and Ft3 tested

Both TPO and TG thyroid antibodies

GP Prescribed Ferrous Fumerate 210mg X 2 per day (taking these with orange juice. - 1st after lunch 2nd about 10pm). Folic Acid 5mg per day (taking this with 1st Iron). Vit D 40,000iu pwk (split Sun & Thus with something with a big dollop of cream & 100mcg K2-MK7 (recommended by Seaside Susie) after evening meal. Vit B12 jabs once every 3 wks for 3 months - then every 3 months. Waiting to hear from dietician re adding magnesium. Its going to be an effing slow process - wonderful.

I've already got the blood forms for the next testing - Bone profile in early March, then vits/mins/ TFT early April - then hopefully look at Calcium & Vit D. I asked the GP to refer me for DEXA Scan - but that will be a long wait.

TPO in 2007 was 633 lu/ml. All those years I never ever looked at my TSH results..but told the GP right from the start that I wanted T4 to be in the top 3rd - must have been something I read. I remember the GP trying to broach TSH once, but I was adamant and she didn't push it. Unfortunately she retired during the GP pension fiasco, so this may be a problem going forward.

For the past 2 weeks I have been taking Levo when I first wake up (timing ready for next blood test) - beta blockers & 30mg PPI about 3 hrs later (yes, I used to throw them all down together - I know better now - (stopped night PPI immediately after joining this forum). Can't get bloods done in the mornings due to Covid - path lab only open from lunch-time apart from Mondays. All the patients who have to have fasting tests must be going along with the twirly's then - I don't want to expose myself to that until we are all safer, and I'm not going to get a stable result for a while yet anyway.

I've got a Gastro appointment in early March (just waiting for the letter to drop on the mat telling me this will be by phone). I've done most of his job by getting my vits/mins tested (GP wouldn't have done it if I hadn't asked - neither would the dietician ), got myself referred for Dexa/they didn't biopsy me when my age (61) dictates that they should have - they are not going to get away with sending me away to then be discharged by the dietician - not until I feel ready.

I seem to be an oddity as far as Levo requirement going down with gut issues - or maybe I just don't want to know that my body now thinks it's in its 90's - Oh dear that's why I feel so cr@ppy. I'm aiming to get down to 62 without a face lift next year.


SlowDragon profile image
SlowDragonAdministrator in reply to nellie237

As you are now on strictly gluten free diet absorption of levothyroxine has improved and therefore you need less

When correctly medicated you shouldn’t need PPI

Perhaps suggests levothyroxine dose reduced too much that you now need PPI

Suggest you self supplement magnesium

PPI significantly lowers magnesium levels

Vitamin D

Many of us find Better You vitamin D mouth spray works well as avoids poor gut function

They Also make one that contains vitamin K2

One spray = 1000iu

Likely to need at least 3 sprays per day.....perhaps more in winter

It’s trial and error what dose we need, with hashimoto’s we frequently need higher dose than average

Calculator for working out dose you may need to bring level to 40ng/ml = 100nmol

Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine

Vitamin K2 mk7

2 good videos on magnesium

nellie237 profile image
nellie237 in reply to SlowDragon

Hi SlowDragon,

"As you are now on strictly gluten free diet absorption of levothyroxine has improved and therefore you need less"

I should have made this clearer. The last 25mcg drop in Levo to 125mcg was based on TFT results from same blood draw where Coeliac was picked up - so, not GF. Previous drops in Levo probably over 18mnths - 3 years prior to coeliac diagnosis.

I think your statement is absolutely correct for the period I was taking 200mcg at 9 1/2 stone (It was probably from about 2009 until about 3yrs ago,,,so, about 8yrs).

I was tested for Coeliac at Hashi's diagnosis in 2007. In 2010 I had an endoscopy - all clear, but not specifically looking for coeliac.....

The conundrum for me is - gut issues = higher Levo........ which makes perfect sense, so why has this changed for me - I doubt that I will get an answer.

SlowDragon profile image
SlowDragonAdministrator in reply to nellie237

I had coeliac blood test approx 4 years after hashimoto’s diagnosis in 1990’s (negative) ......tested again in 2016 ...again negative

Endoscopy in 2016 confirmed severe gluten intolerance as if coeliac. DNA coeliac test mixed results, but unlikely coeliac

Complete transformation and reduction in symptoms after going strictly gluten free

No reduction in dose levothyroxine, but did enable getting T3 prescribed alongside levothyroxine (on NHS) a year after endoscopy....after working hard on getting all four vitamins optimal with significant levels supplements

Tested positive for Heterozygous DIO2 gene variation too.

nellie237 profile image
nellie237 in reply to SlowDragon

Thank you for the positive post - working on vits/mins, but taking it slowly. My GP is going to hate me - I'm just about to send an e-consult re advice about stopping PPI - need to take BP meds into account too. I'd like to get this done before seeing gastro, but probably cutting it a bit fine now.

Thank you so much Diogenes for this very important and essential awareness. Most Valuable. Many are not aware why their T4 dose just does not work as well as intended.

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