Hello. I've been hypothyroid for 4 years and take 50mcg Levothyroxine daily.
In the last 12 - 18 months I've noticed that after some meals I'm left feeling drunk; slurred speech, brain fog, delirium its so horrible, the only relief is sleep.
I've noticed a pattern particularly after chocolate, the Dairy Milk brand is poison to me, carb heavy meals too, sometimes I cannot guess at it at all.
I want to maintain a balanced diet and do not want to eliminate carbs, what advice can you give me?
Good grief....50mcg levothyroxine is only a STARTER dose
When were thyroid levels last tested
You are likely extremely under medicated
Bloods should be retested 6-8 weeks after each dose increase in levothyroxine
Typically dose is increased slowly upwards in 25mcg steps until TSH is well under one
Most important results are ALWAYS ft3 followed by Ft4. Aiming for Ft3 at least 60% through range
Extremely common to have very low vitamin levels when under medicated
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
Have you had thyroid antibodies tested
Ask GP to test vitamin levels
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 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...
NHS easy postal kit vitamin D test £29 via
vitamindtest.org.uk
guidelines on dose levothyroxine by weight
Even if we frequently 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 eventually 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.
BMJ also clear on dose required
I agree with SlowDragon and it wont surprise you to know that few GPs actually know how to treat patients who have dysfunctional thyroid glands and I have no idea how you've managed to get through 4 years on a miserably low dose.
It may come as a shock that few, if any, doctors know much about how to treat patients who have a dysfunctional thyroid gland and know nothing about problems/symptoms
You will get more information and assistance on this forum and it is learning curve for us, the patients.
Thyroid hormones run our whole metabolism, from head to toe and the brain and heart have the most T3 receptor cells. T4 (levothyroxine) is inactive and is supposed to convert to T3.
Hi -
That sounds scary!
There is - in my mind - a connection between being under medicated or undiagnosed and digestive issues. Every cell in the body needs enough thyroid hormone to function properly, including the digestive system. Additionally 20% of conversion from T4 (the hormone in levo thyroxine) to fT3, the hormone which all the cells in our bodies need so that we are not hypo, happens in the gut. My understanding- and I am a little too new to this to put it well, I suspect - is that the gut gets damaged when you are not medicated properly, because it isn’t getting what it needs.
So, in terms of what to do for the best:
- get an increase in levo from the GP as soon as possible, emergency appointment.
- think about gut healing:
- cut out gluten and aim to repair the gut a little (I know! I resisted cutting out gluten for years but it honestly does help so many people with thyroid issues if you do it properly.
- if you are not vegetarian then stock (I hate saying bone broth, it’s home made stock, surely?!) particularly chicken - and you can get bones for free from the butcher - is hugely beneficial, if you have the time and energy... or an instapot!
- cut out as much processed food, particularly sugars, as you possibly can.
- some of us do better without dairy as well... I really struggle with Dairy Milk chocolate, can just about handle ordinary milk, but I’m better without that too and planning on ditching it again very soon! The Halo brand dark chocolate is dairy and soy free as a nice alternative treat
- I find turmeric and cicumin supplements very soothing on the tummy. They reduce inflammation and you get a far bigger whack than through diet, plus the black pepper aids absorption.
- I also find tablets for healthy stomach bacteria very helpful -available reasonably priced online.
That sounds like a lot all at once, doesn’t it? In terms of priorities, 1. levo as it is no good being under medicated - it will heap on the issues and 2. cutting gluten, 3. Lowering sugar intake. Essentially, if you eat a GF whole food diet - i.e. “real” food in its natural form as far as possible, this should help repair the gut. High fibre foods should help to build good gut bacteria too. Sugar helps the bad gut bacteria, unfortunately. If it sounds overwhelming, then one thing at a time and aim to get the diet “better”, rather than “perfect”. I confess to a GF biscuit and cup of tea with milk problem mid afternoon, so I want to be clear that whilst I am committed to being GF, some times I allow myself some leeway! That’s OK - better not perfect!
Lotika
About 90% of primary hypothyroidism is autoimmune thyroid disease, so it’s likely your hypothyroidism is autoimmune
Dairy and gluten intolerance often develop, especially if under medicated as you almost certainly are
Levothyroxine doesn’t top up failing thyroid, it replaces it. Hence why it’s almost always the case of increasing dose slowly upwards in 25mcg steps until on, or near full replacement dose.
Lactose Intolerance 
Food intolerance testing?
Histamine intolerance?
Help!!! Please. Trying to work out when to take split dose along with food and other tablets.
