Hi does anyone know when would be a good idea to retest thyroid after starting HRT as I read that oestrogen affects thyroid meds an DC you often need to take more . Would a couple of weeks be long enough ? Thanks
HRT patches affecting thyroid : Hi does anyone... - Thyroid UK
HRT patches affecting thyroid
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Blackpanther46
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SlowDragonAdministrator
I would get full thyroid and vitamin testing 6-8 weeks after any significant changes
For full Thyroid evaluation you need TSH, FT4 and FT3 tested.
Also EXTREMELY important to test vitamin D, folate, ferritin and B12
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)
When were vitamin D, folate, ferritin and B12 last tested
Is this how you do your tests?
Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins
List of private testing options
thyroiduk.org/getting-a-dia...
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
Medichecks Thyroid plus antibodies and vitamins
medichecks.com/products/adv...
Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test
bluehorizonbloodtests.co.uk...
Thriva Thyroid plus antibodies and vitamins By DIY fingerpick test
Thriva also offer just vitamin testing
Looking at previous posts you are negative for thyroid antibodies
Have you had ultrasound scan of thyroid
SlowDragon ....post above
Blackpanther46,
If you are sticking patches on, you are bypassing the liver so the oestrogen shouldn't have too much impact on thyroid meds. If you want to test, I would leave the usual six weeks.
So they say, but I really notice I'm more hypo when I push my oestrogen levels up. I've just explained it to my husband. I think it's because I'm already under dosed on thyroid meds so the changes in oestrogen levels slows me down more. I am OK with good oestrogen levels, but I wanted optimal and can't get their withy thyroid like it is.
Working on both together is a nightmare. I see a specialist for both subjects. The HRT lady only sees HRT as the problem area. At least the endo agrees both areas work together.
FancyPants54,
Yes, both do work together (HPT, HPA, HPG axes) & many symptoms overlap. There are even oestrogen receptors in thyroid follicular cells. Low thyroid hormone messes up all signalling. Even brain neurotransmitters are influenced to induce inadequate serotonin & the consequential low moods.
I didn’t realise the importance of sex hormones (apart from for sex & reproducing 😁) until medicating HRT & the positive changes in myself were so evident. Small amounts of sex hormone are hugely important for healthy ageing & we only need to supplement because our adrenals are so compromised from supporting years of undiagnosed hypothyroidism.
I wasn’t low in O & P, I was totally deficient and having a little replaced made me feel amazing, easing a year long depression, and together with T3 meds has actually improved bone density. I am having another DEXA scan soon so it will be interesting to see the next degree of damage reversal. Endo is very enthusiastic.
Progesterone needs adequate thyroid hormone for production & then increases thyroid hormone levels by decreasing TBG where as oestrogen being the antagonist in every way will decrease thyroid hormone availability if raised too quickly or excess is medicated. This is where you might be finding it tricky.
Are you on patches or pump/pill? If patches it may be there is a little too much oestrogen to match that of other hormones. You will know if you get the classic weight gain, achy boobs, and bad moods 🙄. It may be that until thyroid hormones are optimal you can't medicate an optimal dose of HRT but require a slightly lower dose.
Hi I’m on 80 mg patch of oestrogen along with mirena coil . I take 3 grains of NDT aswell . Aches and pains , low mood , exhaustion, vaginal atrophy, hot sweats are all symptoms that are there and my thyroid levels are optimal so must be the O and P that are out of whack .
Blackpanather46,
No, not necessarily. It might be that thyroid hormones are not working effectively due to the usual hundred & one reasons.
Go back to basics - adequate iron, Vit B12, folate, Vit D.
Then look at gut health - is your absorption good or are there still unaddressed issues (ie IBS, candida overgrowth, etc ). Maybe you need some Betaine HCL. Maybe you need some healing supports.
Then look at adrenals - are blood sugars balanced, maybe a change of diet (I had to cut out wine completely & switch to gin 😆), maybe an adaptogen is required to help normalise cortisol levels.
Then look thyroid antibodies - high bodily inflammation can alter the way enzymes work in utilising thyroid hormones. Also uses up precious cortisol as pain (aches pains) stresses the body.
Supplementing milk thistle helped me clear congestion in the liver where a load of stuff takes place including thyroid hormone conversion.
Our health journeys never end and the order of fixing is individual. Usually fixing one thing will either fix a whole myriad of others or suddenly expose/create further deficiencies/elevations.
The goal is homeostasis but because we have been so broken, it I can be slow to achieve. The broken parts can also be hard to recognise but you are on the right road because you are trying 😊
I have just checked your previous posts and you have only had patches for two months. Hormones and the systems involved can takes many months to rebalance & consequently symtoms can lag behind good biochemistry.
I agree I take all those already you e suggested . Blood sugar I try to keep in balance but been stressed a lot at work
I use milk thistle
My last thyroid test was good only recently though on 3 grains with optimal T3 and T4 and suppressed Tsh that’s why I’m surprised I feel like this and it seems like menopause rather than thyroid
Yes if your thyroid is good ( and on NDT at a decent dose it probably is) those symptoms are very likely due to not enough oestrogen. I didn't absorb patches well at all. I was using 125mcg patch and had a blood level around 200. Vaginal atrophy is obviously oestrogen deficiency but even those on HRT sometimes need vaginal oestrogen as well. There's an excellent book out, written by a patient, called My Menopausal Vagina. You might want to give that a read. Other women say it's a life changer.
So can you use the vaginal oestrogen and the oestrogen patch together then ?
Yes. Vaginal oestrogen for a year at prescribed doses is equivalent to 1 oestrogen tablet that would be taken daily. It's minuscule, but right where it needs to be. Not all GPs realise this. But some do.
You are right radd and I think that is why I was not able to increase my oestrogen dose as much as my hormone doctor wanted me too. Although at no point, even with blood levels of 1600, did I have sore boobs or bad moods. But I felt way more hypo. Pennies are starting to drop! You and jimh111 who said something yesterday have really helped me put what's happening together.
I'm on the newish Lenzetto spray oestrogen. It's a wonderous thing the spray. I have reduced my dose to the point where I think it's not affecting the thyroid much. But I'm still on a decent dose provided I'm absorbing it. As for weight gain! I've gained so much in the past 5 years I can't recognise myself. But that's a combo of hypo and menopause.
Oestrogen stopped me wanting to die. And gave me the ability to read a book for pleasure back. But it's never improved my skin because I think that dry skin is thyroid. The HRT doctor just says more, more, more and I can't do it. It makes me worse.
FancyPants54,
More is not always better.
How old are you? I am 57 and only need a little bit to replace the little bit that is missing 😊
I don't absorb oestrogen through the skin very well. We all need our blood levels over 250pmol for good bone growth. A lot of us need it higher for mood and brain function. I'm just 58 now. Using a 125 patch I barely registered a blood level of 120. That's no good for me. Osteoporosis is a family trait. I am using HRT mainly to avoid that.
My blood levels are 100 so defo low then ? that’s before the patch so I’ll get a test done after a while .
Yes that's low. Not good enough to protect your bones.
My estrogen levels, when last checked were 24, I was on patches.
🤔 ... and what did jimh111 say?
I don’t know what I said!
Drat! Now I can't remember either. It helped something to click in place for me. I will have to search for it.
🤣
I am now reading all my old answers trying to work out what that light-bulb moment was. But I'm feeling really spaced out today so nothing is clicking.
Know the feeling !
Sometime it's better just to stand still ...... and then breath 😊
I takes a change in dose of HRT longer to settle than a change in thyroid dose. So I'd see if you can wait 2 months after a change in HRT dose before you retest thyroid. 3 months would be even better as that's around the time the body settles onto the current HRT dose. Some people say transdermal HRT doesn't affect thyroid, but some of us can feel it changing things. So yes, you may well need an increase in Levo.
I'm 9 months in on transdermal oestrogel (oestrogen) and utrogeston (progesterone).I'd like opportunity to try testosterone but not gone there yet.
So yes to your question, but wait a couple of months, my GP called me back regarding this area after 3months and nothing changed for me re thyroid, however I think it's taken a lot longer to adjust, and I have upped my hrt (my GP knows and is ok with it).
I have another blood test at the end of the month but also changed brands of levothyroxine, so I'm going to see if tests show anything.
I've wanted my med revised for a while but my tests are always stable apparently 🙄, so will see this time, I do feel I'm a little under medicated at the moment, but possibly been like this a while, even before starting hrt.
I think many women for 35 onwards really don't realise what impact balancing all our hormones can have on our body, some have no problems with adjusting to menopause but when you really look closely there's evidence it's had some impact if not physically, mentally then there are others seem to have a multifactorial symptoms on going , which we all put down to one specific thing that's out of whack, and can be exhausting to pinpoint which is which.
Menopause can knock things out of whack as these hormones decline with the possibilities of causing shifts in everything and not just hormones our digestion, memory joints and muscles and more, leaving us more at risk of many things.
Obviously this is mainly a women's problems but for men it might be worth looking at all hormones too, but this is my experience and is menopause related.
I look at it as like we take levothyroxine for lack of thyroid hormones, and like diabetics would take insulin, then likewise if you don't do well without these hormones, which play a bigger role in our body than just fertility.
I see them as just another replacement, in quantities to keep quality of life on an even keel, just balance our hormones... the big dips in these hormones effects is all differently.
Really good information can be found on the Menopause Dr (Dr Louise Newson) website it is full of information, she often has fab up to date information on Instagram & Fb.
She is behind the menopause charity that is supplying every surgery in UK with a free HCP to be trained in menopause (another area that's is frequently not much looked at on curriculum at med school) and is responsible for the Davina McCall Channel 4 documentary which is worth a watch.
Thanks yes I’ve read her website very good I’m hoping I won’t need the testestero e and just need oestrogen patches instead .
It will interesting to see what your next blood test is like and If u need to increase dose .
I see Dr Louise. She's lovely. But she doesn't get the balance between thyroid and HRT. She knows I need T3 and said she hoped I could get some. But as with so many, she's totally absorbed in her own specialty and has no time to look wider. This is why we get missed. Specialists are too narrow and no one tries to patch it all together.
What a shame she's not referred you or written to your GP at least with this recommendation, if she feels you'd benefit from T3.Did she test T3, so you can show your GP to follow this up?
Can you ask her to write to your GP?
I guess like you say they're absorbed in their speciality and that's why we see them, as they're experts in their field.
Endocrinology area is big and you hear many say their endocrinologists still have no idea regarding Thyroid which is a shame... I wonder why though.
I get GPs knowing only the basics, as they supposed to refer after following guidelines, but why do so few endocrinologists know or help people with thyroid?
I thought there was a list of "thyroid" endocrinologists on here or a UK thyroid forum which supposedly are more helpful in sorting the conundrum of this condition.
I think endocrinologists are the only ones initially allowed to prescribe you a 3 months trial of T3 to see if it's of benefit, via NHS.
Do correct me if wrong, as not looked at NICE guidelines to be sure.
You'd expect your GP to put the pieces together, but as we all know this inevitably doesn't happen unfortunately, and we are left seeking information elsewhere, going private, doing tests sometimes not recognised by our GPs (NHS)
As unregulated practices are frowned upon, I've had this conversation with my surgery regarding things in the past.
I don't want to spend few hundred pounds on a dna test I'm interested in having, to not actually be able to go forward with the information and make changes in my health.
I'm at this point, but probably will talk again as this is apparently reputable company and some GPs have used it albeit privately.
Hope you get your T3 you need.
If you see a private doctor for HRT they do write to your GP with recommendations and prescription requirements. They do that after every follow-up appointment. But only about oestrogen, progesterone and testosterone. They won't get involved in other areas of health.
I have to pay for a private endocrinologist for help with thyroid and I have my T3 on a private prescription from him. I have to buy it of course. He too writes to the GP every time and tells him what we are doing and why. The GP's file these letters and that's that. Mine is good in that I get my oestrogen and progesterone without question from him. But I have to buy the testosterone.
GP says my issues are not thyroid. But has no idea what they are. However he can't understand the Dio2 genetic issue either so what does he know.
All a GP does these days for awkward patients is run full blood counts and declare you "fine".
I have seen consultants privately on a few occasions over past 7 yrs (I have private health insurance) and mine have all put my thoughts across to my GP when there's not much more in their area to do but routine tests to be looked at so back to the care of my GP... which has lead to GPs taking a more proactive approach.Latest one had joined dots with me as couldn't just see me in pain but we couldn't find anything wrong with bones and joints (bit if wear and tear) to be the problem and along with the timeline of things we thought it was worth investigating hormones, and I definitely thought the balance of all hormones are to blame and not just my thyroid, in my case.
So as getting all this in line so far so good but I just would like to know regarding this elusive T3, to rule out if this would actually help a bit more.
It's more a curiosity as not looked at it, which I feel especially those on T4 only meds should be included in routine testing of ongoing symptoms to rule it out.
I've never had my antibodies tested from what I know unless it was my first test.
As I have diagnosed (by bloods and gastroscope) Coeliac disease, it's highly probable I have Hashimotos and a T3 conversion issue.
Which may help further and although I have asked a couple of GPs to refer due to my thyroid bloods being stable they won't.
I've not insisted but might if I get this dna test done to give them something to consider, but will talk to them first I will have to pay for this probably.
My problem is mobility, I have hyper flexibility in hips and even exercises aren't strengthening other areas to help, and since taking levothyroxine have high creatinine which trying to investigate that more.
I was so hung up on it's just being thyroid it was driving me mad, but it totally made sense when I wrote down when things went awry with me, that perimenopause was probably not helping one bit.
There's many areas I feel we're so behind with regarding health.
I think there's a shift though, as many medics are bringing attention to it.
We've got to move away from what is shown on a screen and what symptoms are showing up and find root cause and not just treat symptom.
So did you say if it's not thyroid and you don't know, shouldn't you run more in-depth tests or refer.
I've now had they think it's just one of those things, re my back and it could well be, but until investigated all, I'm not accepting that.
I think many like us are in limbo with ongoing problems, but you say you now have T3, so has that not resolved your issues?
I do feel if I could show some good evidence that thyroid has impact on my problems they'd be more likely to oblige and refer.
I already have an endocrinologist in mind I'd like to see... I might have to end up paying privately to ease my curiosity... but maddening when could all be done under my health insurance 🙄
GP has finished his investigations. He referred me to an NHS endo about 3 years ago. He was a very young underling and had no idea what I was talking about so he discharged me. Job done. I'm fine. So GP has done that. He runs all the blood tests I ask for, which is good. He knows I am now working with a private endo and he does what this man asks for, apart from prescribe T3.
I've been slowly increasing T3 since Christmas. So far no better, in fact worse because now my FT4 and FT3 levels are both low. FT3 is showing slight signs of improvement but it takes time. Even though I'm on 20mcg a day, it's not enough. FT3 level is under 50% of range. I just have to keep going slowly. It has not been the miracle for me. Probably because it ended up dropping my T4 fast and thus I lost any conversion I was getting resulting in lower or no better T3. It's a nightmare to work out.
The next T3 increase might pop me over the 50% range. I took 5mcg more this morning. I had been trying to raise Levo dose, but it was making me feel more hypo so I've stopped it and am trying a small rise in T3. Finger's crossed.
I found I was needing to take more meds - two years into hrt now - commented to doc that it might be the hrt (gel not patch) and Endo agreed likely.
How much more meds ? I’ve increased by 1/4 grain but still feel like crap
I´m sorry, I am no expert, but I know that the so called functional doctors claim that transdermal estrogen will not affect thyroid hormone levels, only oral estrogen will as it increases TBG levels (thyroid binding hormone). According to them, women on oral estrogen may need to increase levo/T3/NDT to take account of that (they only recommend transdermal E - patches, gels, creams, sprays - as it´s easier on the liver). I have been on transdermal E for a few years and never had to adjust my thyroid hormone dose while on it which seems to confirm that transdermal E will not affect thyroid hormone levels. However, I have friends on thyroid hormone replacement who - while on the pill (oral E) - had to increase levo by 25-50 mcg daily in order to get the same lab results as the pill tended to lower FT4 and raise the TSH. I had my TBG levels measured a few months ago, and it came back well in range (while on transdermal E).
Of course, unless you´ve had a hysterectomy, estrogen needs to be taken with (preferably) bio-identical progesterone, either cyclically or continuously.
Blackpanther46 in reply to
Good to know Thankyou . How much transdermal gel do you take and what form . I have a mirena coil which provides the progesterone.
in reply to Blackpanther46
Lenzetto. It`s an estradiol spray with each spray delivering 1.53 mg of estradiol. I am currently on 2 sprays a day, but my doctor thinks I will only need one once post menopause.
Blackpanther46 in reply to
Did u try the patches ever ? I’m on 80 mg patch I’m not sure how that compares to the spray .
I think it’s like 1.5 sprays of lenzetto
in reply to Blackpanther46
I did try patches briefly but they kept falling off...I exercise several times a week and like taking a hot bath at night and they just wouldn´t stay on. Here is a conversion chart which I find very useful:menopausedoctor.co.uk/menop...
Blackpanther46 in reply to
Oh I see . I have avoided hot baths for that reason but do miss them , so I think if I have one the patch will probably slide off then as I thought ! Lol In that case I think I’ll ask for the spray then next time .
PS. I can also add that I take my thyroid meds first thing in the morning and use Lenzetto at the same time, and it has not affected my lab results in any way. Which proves that transdermal hormones do not interfere with thyroid hormone uptake. Oral estrogen, on the other hand, needs to be taken at least four hours away from thyroid meds. Another reason I find transdermal E so convenient.
Blackpanther46 in reply to
Great . My thyroid results have been optimal that’s why I’m sure that these symptoms are meno ones . It’s driving me insane and affecting my life so much . It’s the stiffness , aching legs going upstairs that I’ve never had before despite doing exercises. So I know only do light exercises but my legs feel like lead aching joints and feet hurt all the time so I gobble like an old lady ! Then there’s the vaginal atrophy , mood swings, exhaustion and anxiety to contend with ! What symptoms have you had and have improved on HRT !
in reply to Blackpanther46
Hot flushes and night sweats were by far the worst. It seems weight management is a little more difficult these days but could of course also be thyroid-related, the slightest decrease in FT4 and FT3 seems to result in putting on a few pounds. But the hot flushes were a big problem as they would happen several times a day and always when most inconvenient...like in front of other people. I hated how my face would go all red and sweat start dripping from my forehead. Night sweats were also horrible, forcing me to sleep with a fan next to my bed even in winter. I would wake up several times a night drenched in sweat and had to change my bedlinen every day. With HRT both hot flushes and night sweats have more or less disappeared, and the few remaining ones are occasional and nothing in comparison.
I read on menopausematters.co.uk (where I have found excellent advice) that, in menopause, estradiol levels are more important than progesterone levels. While you need to combine the two if you still have a womb, the advice is to focus on raising estradiol levels (progesterone is said to be more important when investigating infertility). I have found that to be true; if my estradiol levels drop below a certain point, symptoms reappear regardless of my progesterone levels.
It’s a nightmare isn’t it . I haven’t had that degree of hot sweats like you have had . I’ve had night sweats though .
Great HRT has improved the symptoms for you. How long did it take to work can you remember?
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