Hi, I feel so sorry for my daughter in law at the moment. She had symptoms of underactive thyroid after giving birth to her first child who is now 9 years old (hair loss, swollen face hands feet and legs, painful feet and hands, extreme tiredness). Finally after the birth of her second child who is now 3 she was diagnosed and given 75mcg of levothyroxine. She’s been asking for an increase ever since and has finally been given 100 mcg. Her GP told her to stop taking vitaminD and iron (which hadn’t been tested for but I told her to maybe try them) so that they could see if the thyroxine increase had helped. Now, a couple of weeks after her increased dose her arms, legs and feet are swollen even though the weather is cool. She’s piled weight on and is feeling extremely tired. She doesn’t know where to turn now and is considering taking iron tablets again as they helped in the past. Any advice would be appreciated - they didn’t increase her dose because her TSH was ‘normal’ then a GP agreed to increase it as her symptoms were so bad
Post pregnancy underactive thyroid: Hi, I feel so... - Thyroid UK
Post pregnancy underactive thyroid
She needs FULL thyroid testing 6-8 weeks after any dose change or brand change in levothyroxine
Which brand of levothyroxine was she on before
Is she still on same brand
GP should test vitamin D, folate, ferritin and B12 NOW
Has she had thyroid antibodies tested for autoimmune thyroid disease also called Hashimoto’s
For full Thyroid evaluation she needs 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 with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)
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 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
If TPO or TG thyroid antibodies are high this is usually due to Hashimoto’s (commonly known in UK as autoimmune thyroid disease).
About 90% of all primary hypothyroidism in Uk is due to Hashimoto’s. Low vitamin levels are particularly common with Hashimoto’s.
Gluten intolerance is often a hidden issue to.
Link about thyroid blood tests
thyroiduk.org/getting-a-dia...
Link about Hashimoto’s
thyroiduk.org/hypothyroid-b...
List of hypothyroid symptoms
thyroiduk.org/if-you-are-un...
Hi, thank you very much - I’ve passed this on to her - very helpful, I hadn’t thought about brand change
If she was on a single 75mcg tablet that will have been Teva brand (only brand that makes 75mcg)
Teva is a Marmite brand…..many can’t stand it….but it really suits some people…usually if lactose intolerant
Hi Slowdragon, yes she was on Teva as I’ve got Hashimotos and we were both on 75mcg together.
Just thinking about that, my GP agreed to increase my dose to 100 mcg a couple of months ago, my blood test was normal but she listened to my symptoms. My blood test had showed low vitaminD and I’ve been on that since. Although I feel a lot better since, I seem to be gaining weight faster - could the change to MercuryPharma from Teva with my 100 mcg increase cause this?
Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine
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...
How low was vitamin D
How much vitamin D are you currently taking
Vitamin D should be tested twice year when supplementing
Will have to test via NHS private testing service as GP only allowed to test once every 2 years
Aiming for vitamin D at least around 100nmol
Vitamin D mouth spray by Better You is very effective as it avoids poor gut function. There’s a version made that also contains vitamin K2 Mk7
amazon.co.uk/BetterYou-Dlux...
It’s trial and error what dose we need, with hashimoto’s we frequently need higher dose than average
Calculator for working out dose you may need to bring level to 40ng/ml = 100nmol
grassrootshealth.net/projec...
Vitamin D and thyroid disease
grassrootshealth.net/blog/t...
When not testing via Medichecks or Blue horizon use
NHS easy postal kit vitamin D test £29 via
Important to also test folate, ferritin and B12 at least annually
When were these last tested
Presumably you have Hashimoto’s too
Have you had coeliac blood test done
Are you on strictly gluten free diet
How much do you weigh in kilo approx
You might need higher dose levothyroxine after retest
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
bestpractice.bmj.com/topics...
Guidelines are just that ....guidelines.
Some people need more ….some less
healthunlocked.com/thyroidu...
Hi my weight is approx 60.80 and I’m 66 in November - thank you for this information. Maybe my daughter in law should be on a much higher dose as she’s 36?
Weight is more important than age, though if have very active lifestyle likely to need higher dose
60.8 kilo x 1.6 = 97mcg as likely dose levothyroxine required daily
So you might benefit from small dose increase…..5 x 100mcg and 2 x 75mcg per week for example
Essexlil
It's never a good idea to supplement iron or Vit D without testing first to see if you need them. Too much iron is as bad as too little. Vit D is fat soluble and any excess gets stored and can lead to toxicity.
Please don't encourage her to take these again without testing first. If GP wont test then she can do both these tests herself at home with a fingerprick test. Put results on the forum for suggestions on whether she needs to supplement and with what dose.
She can do Vit D with a fingerprick blood spot test from an NHS lab who provide this for the general public for £29:
She can do an iron panel with a fingerprick test from Medichecks for £39 less 10% discount:
medichecks.com/products/iro...
Details of discount code here: thyroiduk.org/help-and-supp...
Alternatively she can do a full thyroid/vitamin panel with Medichecks or Blue Horizon.
Thank you for replying - I did worry when she said she’d take iron tablets again as I don’t agree with self medicating and how dangerous it can be. I’ll warn her again after your reply and suggest she gets tested
I think a number of people can gain weight when on levothyroxine alone.
This is a link from Stopthethyroidmadness forum:-
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