Hi, I have Hashimotoes Thyroiditis, female 51. My bloods have come back:-
TSH 0.11 (0.27-4.20)
T4:- 11.8 (12-22)
T3:- 4 (3.1-6.8)
I take 125mcg of Levothyroxine
10mcg T3 Liothyronine
My meds were increased ftom 100-125mcg of Levo last time I had a blood test.
Feeling very on edge, panicky, depressed, 'tired/but wired'.
Any help would be greatfully accepted. Cannot get an appointment to speak to GP after ringing up for results!
millefleur40
When did you take your last doses of Levo and T3 before the test? This has a bearing on your results. Last dose of Levo should be 24 hours before test, last dose of T3 should be 8-12 hours before the test, splitting the dose and adjusting time the day before so that the last portiono f T3 is 8-12 hours before test.
Hi, yes that was all done prior to the test.
So if the timing for both was correct then your results are showing the normal amount of circulating hormone.
When taking T3 one expects to see TSH low or suppressed, FT4 lower in range and FT3 in the upper part of it's range.
TSH 0.11 (0.27-4.20)
T4:- 11.8 (12-22)
T3:- 4 (3.1-6.8)
Your FT4 is below range and your FT3 is only 24.32% through range. This points to you being undermedicated.
It's surprising to see FT4 below range when taking 125mcg Levo, which makes me wonder if something is stopping it being absorbed.
Do you take Levo on it's own (it can be taken with T3), one hour before or two hours after food, with water only, water only for one hour each side, no tea, coffee, etc.
Do you take all supplements and other medication at least 2 hours away from your thyroid meds, some need 4 hours (iron, calcium, Vit D, magnesium, Omeprazole and other PPIs, HRT, oestrogen).
Yes I take the Levo & half of t3 when I wake early hours of morning, so no food or drink or other meds close to. I take the other tiny half of T3 in the afternoon.
I have always struggled with feeling well since diagnosis in 1994. I was on 100mcg Levo for many years. Gp just said "fine, you're in range", but I was also having to take antidepressants, pain meds, sleeping tablets, IBS meds too. Always fatigued & anxious.
I got referred to an Endo a few years ago who agreed to put me on the 10mcg of T3. Thats all they offer though, they won't give you the option of monitoring you on any alternative meds. I have tried them myself though & can never get the dose right.
I currently take Sertraline, Zopiclone, Tramadol, Diazepam, Buscopan.
I had my gallbladder removed on 1st May this year too. I was low on folic acid, but apparently thats ok now.
millefleur40
Have you had key nutrients tested lately:
Vit D
B12
Folate
Ferritin
If not I'd get them done, privately if necessary. These all need to be optimal for thyroid hormone to work properly. Optimal/recommended levels are
Vit D - 100-150nmol/L
B12 - top of range for Total serum B12, for Active B12 100+ is suggested
Folate - at least half way through it's range
Ferritin - half way through range although some experts say optimal ferritin level for thyroid function is 90-110 ug/L.
Your thyroid results do suggest that you are undermedicated but I think it's worth looking at your key nutrients and possibly your other medications first, you are already on a reasonable dose of thyroid meds.
I currently take Sertraline, Zopiclone, Tramadol, Diazepam, Buscopan.
Depression is a symptom of hypothyrodism, it might be that getting you optimally medicated thyroid-wise may mean you don't need the sertraline and you can gradually come off it, and maybe even lead to reducing the others too. Rather than throwing all these drugs at you it might have been better to get you optimally medicated with your thyroid first then you may not have needed them.
Antidepressants can affect the thyroid:
medicalnewstoday.com/articl...
Antidepressants
Common antidepressant medications can also affect the thyroid, including selective serotonin reuptake inhibitors (SSRIs).
SSRIs can reduce T4 hormone levels by 11.2%Trusted Source. They also affect hormone signaling from the hypothalamus region of the brain. This limits hormone production even further.
Sertraline is an SSRI. Zopiclone can interact with SSRIs and Tramadol:
medbroadcast.com/drug/getdr...
There may be an interaction between zopiclone and any of the following:
*selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, fluoxetine, paroxetine, sertraline)
*tramadol
There may be an interaction between zopiclone and any of the following:
Taking Tramadol with Sertraline and Zopiclone isn't recommended:
mayoclinic.org/drugs-supple...
Drug Interactions
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
Sertraline
Zopiclone
There can also be interactions between Diazepam and Tramadol.
You have quite a cocktain of drugs there, I wonder if it might be worth you discussing all these with your local pharmacist, they seem to know a lot more about drug interactions than doctors. It could be that the combination is affecting your thyroid meds.
I do have private tests when my GP is being particularly unhelpful. I was given B12 loading dose a few years ago, but GP didnt continue with NHS guidelines to continue! I purchased privately from a B12 charity & my husband did them once every few months. The charity has been stopped now. Again GP says ok if 'in range' when you should be halfway up not clinging to the top or bottom & feeling terrible. I contacted a drug addiction place in recent months & have a Zoom meeting once a week. Not much help with prescription drugs. They have written three times to my GPs to help me come off the diazepam, zopiclone & tramadol - slowly. They never responded & have tried to get me out of the practice! They have been prescribing these drugs, Zopiclone & Diazepam for years on repeat & Tramadol for 2 years on repeat for gallbladder pain. Now its too much trouble to help me get off them.
Absolutely ESSENTIAL to test vitamin D, folate, ferritin and B12 at least annually
See GP and request these are tested
Plus coeliac blood test, if not had that tested
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.
IBS suggests gut issues
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
Before considering trial on gluten free diet get coeliac blood test done FIRST just to rule it out
lloydspharmacy.com/products...
If you test positive for coeliac, will need to remain on gluten rich diet until endoscopy (officially 6 weeks wait)
If result is negative can consider trialing strictly gluten free diet for 3-6 months. Likely to see benefits. Can take many months for brain fog to lift.
If no obvious improvement, reintroduce gluten 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.
hypothyroidmom.com/how-to-l...
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.
Hi SlowDragon,
I have been tested a few times over the years for Celiac, it came back negative. I have also had two endoscopy's (rear end?) & more recently tube down the throat both negative for Celiac. I tested positive for H-Pylori prior to throat tube & was given antibiotics. I have been very proactive over the years trying to get better. Especially once the internet came along & Stop the Thyroid Madness, Isabella Wentz etc wrote their books. It feels so depressing that the GPs & Endos do not seem to be up-to-date on the issues in those books. I understand that they have to follow NHS guidelines, but they continue to treat the symptoms (many) instead of the actual root cause.
Only 5% of Hashimoto’s patients are coeliac
But a further 80% are gluten intolerant
It’s always worth trying strictly gluten free diet
Unfortunately it’s rare for NHS medics to actually tell any patients this
Which brand of levothyroxine are you currently taking Do you always get same brand
Same question re T3
Do you suspect you have lactose intolerance ?
Hi I don't get the same brand of Levo I used to & I have argued it with pharmacists & GPs, as they use different fillers. But they won't budge. "Its all the same" apparently!! T3, again, not the same brand each time. I guess they are making cheaper ones since the one the NHS were using was costing them £9 per tablet!! They are a few pound for 100 in other countries. Not lactose intolerant either. I have purchased T3 on the internet & various brands of NDT, which again can change formulation & stop qorking so well. I wish the NHS were open to starting to use it again.
You must insist on same brand levothyroxine at each prescription
Which brand of levothyroxine suits you best
Many people find Levothyroxine brands are not interchangeable.
Many 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, or Aristo 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
beware 25mcg Northstar is Teva
List of different brands available in U.K.
thyroiduk.org/if-you-are-hy...
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
Request named brand on all future prescriptions
You may need to trial liquid levothyroxine
healthunlocked.com/thyroidu...
if a patient is persistently symptomatic after switching levothyroxine products, whether they are biochemically euthyroid or have evidence of abnormal thyroid function, consider consistently prescribing a specific levothyroxine product known to be well tolerated by the patient
if symptoms or poor control of thyroid function persist despite adhering to a specific product, consider prescribing levothyroxine in an oral solution formulation
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
Only make one change at a time
Get vitamins tested
Come back with new post once you get results
Likely to need to supplement
Trialing strictly gluten free diet
T3 it’s even more important to always get same brand
20mcg tablets are all exactly same price - £100 per 28 tablets
Only 3 brands to choose from
Teva (lactose free)
Morningside
Advanz (Mercury Pharma
bbc.com/news/business-42063274
bbc.co.uk/news/business-580...
I'm so glad they got fined! So many poor people had their T3 removed by the NHS over that.
Hi, I just thought I'd let you know that recently ( about a month ago ) MHRA guidelines say that if a patient changes brands of levothyroxine that they should have their blood tests repeated , the guidelines also say that patients should stick to the same brand of levothyroxine wherever possible.Maybe start badgering your doctor to do repeat blood tests if the pharmacy keep changing your brand , the doctor might then choose to specify the brand you need in your prescription if they don't want to keep doing repeat blood tests , sometimes sadly we have to be more crafty than they are. 
O wow thank you for that info, thats really interesting.
You're welcome, Good luck going forward 
Thank you, I need it with the GPs & Endos. I have taken in written proof of things that they should be doing to treat my Hashimotoes properly (save the NHS time & money), they don't like their patients showing they are proactive. Even though this info re. having the same brand of thyroid meds each time is something they should be up on, making the GP write an actual Brand on the prescription is pretty impossible (I tried with antidepressants). Even when the GP wrote the Brand, the chemist did not dispense it - "its just the same, we don't stock that Brand its too expensive".
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