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Increasing dose of levothyroxine to treat subclinical hypothyroidism before IVF

RollyPoll profile image
12 Replies

Hi, I'm new here. I was diagnosed with subclinical hypothyroidism ~2.5 years and have since increased levothyroxine from 25 to 50 ug, which lowered TSH to 3.8 mU/L (T4 has always been ok: >10 pmol/L ), but my TSH recently increased again to 8.2 mU/L. My levothyroxine prescription has been raised to 75 ug, but I am concerned it's not enough, especially because I'm >40 and would like to try IVF, so time is running out... I want to avoid having to increase the dose yet again and having to wait for another 8 weeks before blood test confirmation. Can anyone advise? Would it be better to immediately try for a higher dose of levothyroxine, and if so, how much?

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RollyPoll
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Lalatoot profile image
Lalatoot

I can understand your wish to speed things along but with thyroid you need to go slowly. Dose increases of 25mcg every 6- 8 weeks.Levothyroxine isn't an immediate fix. Once the hormones are into your system it takes time for the body to settle and for all the bodily functions to readjust to the increase in hormones. Its all about the body adapting and this takes time.

RollyPoll profile image
RollyPoll in reply to Lalatoot

Thank you for your quick response - that's much appreciated!

SlowDragon profile image
SlowDragonAdministrator

What brand levothyroxine are you currently taking

Do you always get same brand?

Essential to regularly retest vitamin D, folate, ferritin and B12

When were these last tested

What vitamin supplements are you currently taking

Have you had thyroid antibodies tested

Vast majority of primary hypothyroidism is autoimmune thyroid disease also called Hashimoto’s diagnosed by high thyroid antibodies

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)

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/

NHS easy postal kit vitamin D test £29 via

vitamindtest.org.uk

RollyPoll profile image
RollyPoll in reply to SlowDragon

Thank you very much for your response - that's very helpful.

The brands have changed in the past (Northstar and Wockhardt at the moment) - can the same brand be requested via the GP/NHS? Can this make a big difference?

I will check up regarding the other tests.

Is there anything one would do differently depending on whether the raised TSH is connected with an antibody-positive or -negative result?

SlowDragon profile image
SlowDragonAdministrator in reply to RollyPoll

Northstar 25mcg is Teva brand

Northstar 50mcg and 100mcg tablets are Accord

Many people find Levothyroxine brands are not interchangeable.

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

But for some people (usually if lactose intolerant, Teva is by far the best option)

Teva, Aristo and Glenmark are the only lactose free tablets

Most easily available (and often most easily tolerated) are Mercury Pharma or Accord

Accord is also boxed as Almus via Boots, and Northstar 50mcg and 100mcg via Lloyds ....but doesn’t make 25mcg tablets

As already mentioned...beware 25mcg Northstar is Teva

List of different brands available in U.K.

thyroiduk.org/medications-f...

Teva poll

healthunlocked.com/thyroidu...

Once you find a brand that suits you, best to make sure to only get that one at each prescription.

Watch out for brand change when dose is increased or at repeat prescription.

New guidelines for GP if you find it difficult/impossible to change brands

healthunlocked.com/thyroidu...

academic.oup.com/jcem/artic...

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

verywellhealth.com/best-tim...

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)

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

REMEMBER.....very important....stop taking any supplements that contain biotin a week before ALL BLOOD TESTS as biotin can falsely affect test results - eg vitamin B complex

SlowDragon profile image
SlowDragonAdministrator in reply to RollyPoll

Have you had thyroid antibodies tested?

If you have either high TPO and TG antibodies this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).

Hashimoto's frequently affects the gut and leads to low stomach acid and then low vitamin levels

Low vitamin levels affect Thyroid hormone working

Poor gut function with Hashimoto’s 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

healthcheckshop.co.uk/store...?

Assuming test is negative you can immediately go on strictly gluten free diet

(If test is positive you will need to remain on high gluten diet until endoscopy, maximum 6 weeks wait officially)

Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse

chriskresser.com/the-gluten...

amymyersmd.com/2018/04/3-re...

thyroidpharmacist.com/artic...

drknews.com/changing-your-d...

restartmed.com/hashimotos-g...

Non Coeliac Gluten sensitivity (NCGS) and autoimmune disease

ncbi.nlm.nih.gov/pubmed/296...

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

ncbi.nlm.nih.gov/pubmed/300...

The obtained results suggest that the gluten-free diet may bring clinical benefits to women with autoimmune thyroid disease

nuclmed.gr/wp/wp-content/up...

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

restartmed.com/hashimotos-g...

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.

RollyPoll profile image
RollyPoll

Thank you SlowDragon - I have lots of reading to do!

Pnw2020 profile image
Pnw2020

Hi. IVF clinics generally want TSH <2.5. ( Although I have learnt from this excellent forum that this is likely too high if you are on treatment and that TSH is not the whole picture!) Best of luck x

RollyPoll profile image
RollyPoll

AH, very interesting indeed - thanks Pnw2020 - any chance you can you point me to the IVF-related discussions on here (or elsewhere)?

Pnw2020 profile image
Pnw2020 in reply to RollyPoll

Hi.

Have a look a the fertility network UK - there are a few threads on there that might help. To be honest it seems like you have to get external advice ie from an Endocrinologist as IVF clinics won't necessarily investigate the things mentioned here. The other thing to say is that there is nothing stopping you having an initial consultation with an IVF clinic. I have been surprised by the waiting times for private treatment! PM me if you want any more info x

humanbean profile image
humanbean

One important point you need to consider and should start dealing with now before you start IVF.

Other things to consider are that hypothyroidism damages the gut, mainly by reducing stomach acid and making it difficult for the body to metabolise food and extract nutrients from it. So levels of basic minerals and vitamins are often quite low or are frankly deficient.

The nutrients that get mentioned most often on this forum are vitamin D, vitamin B12, folate, and ferritin (iron stores). These are particularly important for us because they are needed in converting T4 (the storage form of thyroid hormone) to T3 (the active thyroid hormone that every cell in the human body needs in order to work well).

Doctors have little or no interest in nutrients, and very few of them seem to know that low nutrients are extremely common in hypothyroidism. Also, they are often only interested in nutrients when levels are actually deficient, not just low in range.

The reason for mentioning nutrients is that low levels of iron, vitamin B12 and folate are all really important in pregnancy. Low levels of iron, for example, can cause tachycardia, palpitations, chest pain, missed beats. Similar symptoms can often occur in cases of low vitamin B12 and/or low folate.

Hypothyroid people often have low blood pressure, at least in the early days of the condition, but eventually blood pressure rises and can rise to become dramatically high. Read this link for a patient anecdote on the problem :

Another thing you really need to know is what TSH is "normal" for healthy people - and bear in mind that many hypo people actually need a lower TSH than healthy people in order to feel well. See this link for more info on TSH :

healthunlocked.com/thyroidu...

Levels of thyroid hormone which are too low could reduce your chances of getting pregnant and could also increase your risk of having a miscarriage. Similar comments apply to the nutrients I've mentioned - if they are low in range or below range they could make it harder for you to conceive and could increase your risk of miscarriage.

Can I suggest that you do searches for "effects of low vitamin B12 on pregnancy", "effects of low iron on pregnancy" etc. and do the same for other nutrients

RollyPoll profile image
RollyPoll

Thank you very much, humanbean - I will look into it.

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