Hello, just wondering if anyone else has experienced this?
Since December my skin has been extremely dry and sensitive, and I had to change my moisturiser and make up as it started stinging my face (after having the same routine for years). I put it down to cold weather as my job is in and out of hot and cold temps/artificial heat.
However, I had a facial recently and was told my skin is extremely sensitive and reactive (not just normal ‘sensitivity’), and the first thing I was asked was if I had changed any medication at all - something I hadn’t considered. And then realised this change happened when I began taking levothyroxine.
I have been prescribed a different brand of Levo each time, and is 50mgs. Does anyone know what I could do about this and or if it could be related?
I’m also pretty sure I’m lactose intolerant. I’ve seen some posts that say some Levo has lacto in. Maybe that could be a factor.
Just asking here first as my GP is completely uninterested and dismissive, would like to arm myself with possible solutions before checking in!
Thank you in advance
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c_alex
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Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine
What were your results from BEFORE starting on levothyroxine
What are your most recent results?
Have you had vitamins tested and thyroid antibodies?
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 or if left under medicated
Ask GP to test vitamin levels and thyroid antibodies NOW 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
Levothyroxine doesn’t top up failing thyroid, it replaces it
So it’s extremely important to get dose increased high enough and as fast as tolerated
Also very important to get all four vitamins OPTIMAL
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
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.
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.
Thanks for your reply SlowDragon . I havent had a test since Feb (not been permitted by my GP and and life/busy-ness has meant I haven't changed GP yet) and these were the results below. Even that test I paid for privately, GP hasnt allowed me since December (before I started Levo!)
I'm now finally 'allowed' to do another next week so I will update with results, and have managed to get them to change my medication to Tevo, lactose free. As yes I am on a lactose and gluten free diet. Although I started these before being tested for either.
I've since been trying to supplement iron although finding it difficult to digest! And eating red meat, liver etc.
Things have been improving with my mental health, which has been the main problem (I thought it was/could still be PMDD as things were so severe), I just have no idea about my levels currently and I still feel I am putting on weight despite a lot of exercise.
Thanks for your thoughts!
Thyroid Function Panel -
CRP HS 0.60 mg/L (Range: < 5)
Ferritin 23.40 ug/L (Range: 13 - 150)
Folate - Serum 10.96 ug/L (Range: > 3.89)
Vitamin B12 - Active 71.600 pmol/L (Range: > 37.5)
Getting levothyroxine dose increased may help as yo7 become less hypothyroid
Suggest you read as many of humanbean replies and posts about ferritin
Look at increasing iron rich foods in diet
Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption
This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.
Thyroid disease is as much about optimising vitamins as thyroid hormones
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
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
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
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.
Eliminate Gluten. Even if you don’t have Hashimoto’s. Even if you have “no adverse reactions”. Eliminate gluten. There are no universal rules except this one.
So yes have just changed to Teva, however still on 50mcg. Hopefully I may increase after another blood test next week but we'll see. GP not too helpful so am looking to change
You will almost certainly need next 25mcg dose increase in levothyroxine after next test
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.
But for some people (usually if lactose intolerant, Teva is by far the best option)
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 including that if tablets don’t give good results trying liquid levothyroxine should be considered
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
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
i’ve taken ndt for 7 years which contains t3 and t4. when i tried to add levothyroxine to it i became super sensitive in my skin and especially my eyes were red and itchy
natural desiccated thyroid, it contains t4 ( which is what’s in levothyroxine) and t3 . i purchase it myself and the nhs monitors me ( although they are quite behind on monitoring this type of medication as they are still obsessed with tsh result which becomes irrelevant when taking anything containing t3)
i tried to link the thyroid uk page here but it wouldn’t let me, but if you google natural desiccated thyroid and thyroid uk there is a page on this.
You're not on enough Levo and that's why your skin is reacting. When my Levo is not high enough I get little white bumps, rashes, acne cysts and a reddened face. I use grapeseed oil in a non fragrant thick lotion with body still slightly damp and rub it in all over. I also make a face mask with French green clay, grapeseed oil, water, and leftover tea grounds. It brightens, hydrates and calms the redness and irritation.
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