can levothyoxine restart your periods? - Thyroid UK

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can levothyoxine restart your periods?

meow8 profile image
9 Replies

im new and need help please

ive not had them since iv been on cerelle 75mg as it stopped them yrs ago and since starting levo 25mg in april 2021 iv started getting cramps, spotting, discharge (brown, pink, some weird purple stuff ) its driving me mental as my body cant decide if it on or off..its on with cramps n weird some heavy discharge (enough to have to change tampon less than 2 hours)

the first couple of weeks i had nothing, then i started getting light pink discharge, then nothing for a bit, then its on/off on/off through the day every few hours. When i think ts over for the day, i get crud again.

being a nightshift forklift driver and being on the forks for most of the shift, i have to carry tampons around with me all the time as i dont know if my body is goin to play silly buggers or not.

i have an appointment for phone call from the GP friday, but wanted help/advice while waiting as i am worried.

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SlowDragon profile image
SlowDragonAdministrator

Are you still only on 25mcg levothyroxine

Do you have test results from BEFORE starting on levothyroxine?

Standard starter dose of levothyroxine is 50mcg unless over 60 years old

Starting on too low a dose levothyroxine can exacerbate symptoms

Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine

Have you had bloods retested yet?

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 and especially when under medicated

Ask GP to test vitamin levels (and thyroid antibodies if not been tested yet)

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

On levothyroxine TSH should always be under 2

Most important results are always Ft3 and Ft4, aiming for both at least 50-60% through range.

Dose levothyroxine is increased slowly upwards in 25mcg steps, retesting 6-8 weeks after each dose increase

Extremely important to regularly retest and maintain optimal vitamin levels too

meow8 profile image
meow8 in reply to SlowDragon

Hi slowdragon

I had test before being put on 25mg levo.. Have had BT and my levels are normal (according to test results) thing is I never had anything like this before being on levo..its kinda like a period thing now but not..😕 I don't know..

When just on cerelle 75mg I didn't hav anything except the odd break thru brown disharge/bleed for a day or so and that was it..was happy as Larry as it didn't interfere with my job..but now it's whenever it wants..just need to wait for phone call Friday morning from doctor..

SlowDragon profile image
SlowDragonAdministrator in reply to meow8

Was test done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

What are the actual test results and ranges

On levothyroxine TSH should be under 2 and Ft4 near top of range.

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

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...

Guidelines are just that ....guidelines.

Some people need more ....some less

healthunlocked.com/thyroidu...

hyporeb profile image
hyporeb

Hi Meow8

Firstly, try not to worry.

I have exactly the same as you and you and I am also on Levo and Cerelle.

I have been taking both for a number of years but the weird random stop start periods (if you can call them a period) have only been going on for the last 18 months or so.

Not sure how old you are but I have put it down to peri-menopause (as I’m 50) because it doesn’t happen every month like clockwork - it’s all very random x

meow8 profile image
meow8 in reply to hyporeb

Hi hyporeb

Im 38 and used to have terrible painful periods which could last upto a month at a time some times and I was put on 3 different pills over the yrs to help until I was on cerelle 75mg which I have been for years now as it stopped my periods completely and was happy as a pig in poop..i was put on thyroxine (don't know which) when I was younger (which I didn't really take) but my levels corrected themselves (which can happen) ..now they are out again which means now I'm on 25mg (as I mentioned in the post) and already I'm regretting being on this meds because of the screwy period thing..I just want to stop them so I go back to the way I was..i can't stand this stop/start thing that's going on whenever it feels like it..im worried its something different..will find out on Friday..

SlowDragon profile image
SlowDragonAdministrator in reply to meow8

Levothyroxine doesn’t top up failing thyroid, it replaces it. So taking just tiny dose frequently makes issues worse

What were thyroid and vitamin results from before starting on levothyroxine

meow8 profile image
meow8 in reply to SlowDragon

TSH level

TSH levels down to normal
meow8 profile image
meow8 in reply to meow8

Normal t4

T4 level normal
SlowDragon profile image
SlowDragonAdministrator in reply to meow8

What time was most recent test done?

Ideally always test as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

Do you take levothyroxine early morning or last thing before bed?

Must always be on empty stomach and then nothing apart from water for at least an hour after

Which brand of levothyroxine are you currently taking

Obviously need thyroid antibodies tested, plus vitamin D, folate, ferritin and B12 too

TSH should be under 2 as an absolute maximum when on levothyroxine

gponline.com/endocrinology-...

Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L.

New NHS England Liothyronine guidelines July 2019 clearly state on page 13 that TSH should be between 0.4-1.5 when OPTIMALLY treated with just Levothyroxine

Note that it says test should be in morning BEFORE taking levothyroxine

Also to test vitamin D, folate, B12 and ferritin

sps.nhs.uk/wp-content/uploa...

Aim is to bring a TSH under 2.5

UK guidance suggests aiming for a TSH of 0.5–2.5

gp-update.co.uk/SM4/Mutable...

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,

"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l.

Most patients will feel well in that circumstance.

But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."

(That’s Ft3 at 58% minimum through range)

You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctor



please email Dionne at

tukadmin@thyroiduk.org

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