Levo and anticoagulants

[Aniela]

I have Hashimoto disease which I have had since 18 years of age. I do not take any medication for it as my thyroid function test is normal. However I am due to have thyroidectomy soon and wondered whether the medication I am prescribed for the replacement of thyroid will upset my anticoagulant medication. I am on Edoxaban anticoagulant. I am new to this site.

[bantam12]

I take Apixaban and Levo, no problems at all. There are lots of hypo people on the heart forums who also take Levo.

[Aniela in reply to bantam12]

Thanks for that. I am happy to hear that you experiencing no problems with both Levo and Apixaban. It's a relief for me to know that.

[greygoose]

Can I ask why you are having a thyroidectomy? That is not normal with Hashi's.

[Aniela in reply to greygoose]

I have multi nodules which have moved towards my larynx and are distorting my airways. As I am awaiting an umbilical operation too, there is a problem with intubation. So here I have a problem, which operation comes first, as each is as important as the other.

[greygoose in reply to Aniela]

Oh dear! I'm so sorry to hear that. Difficult situation. Sounds like the thyroidectomy should come first, though. You have to be able to breath!

I wish you all the best with your operations, let us know how you get on. Take care.

[Aniela in reply to greygoose]

Thank you. I will come back and let you know when I've had the operation, whenever that will be. I was told last August now because of catchup operations and priority cancer operations. my op has been rescheduled for February next year, if I am lucky. So having been told by the surgeon how important and urgent it is to have this op, obviously it seems it isn't that urgent.

[greygoose in reply to Aniela]

Oh, and the waiting is the worst!

[Aniela in reply to greygoose]

Precisely. I saw the Consultant in April this year. He said I would be scheduled for the op in three months time and now it's planned for February 2022, and maybe later due to backlog operations and Covid.

[SlowDragon Administrator]

Before considering thyroidectomy you need FULL thyroid and vitamin testing

How much levothyroxine are you currently taking

Do you always get same brand levothyroxine at each prescription

What vitamin supplements are you currently taking

A fib can be linked to thyroid levels not being well managed….Ft3 too low (or too high)

As you have Hashimoto’s are you on absolutely strictly gluten free diet

What were your most recent thyroid and vitamin results

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

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested.

Very 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)

Low vitamin levels common as we get older too

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 and last dose levothyroxine 24 hours before test

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Are you just on levothyroxine….or taking T3 as well

If on T3

On day before blood test, split T3 into 3 smaller doses, at roughly equal 8 hour intervals, taking last 1/3rd of daily dose approx 8-12 hours before test

Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins

List of private testing options

thyroiduk.org/getting-a-dia...

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...

If you can get GP to test vitamins 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

[Marz in reply to SlowDragon]

OP not on any medication 🤔

[SlowDragon Administrator in reply to Marz]

I thought she was…..

Aniela

This probably explains your ongoing low iron levels

Likely low vitamin D, folate and B12 too then

Being hypothyroid frequently causes low stomach acid and poor nutrient absorption and low vitamin levels as direct result

Low vitamin levels tend to lower TSH

Come back with new post once you get FULL thyroid and vitamin test results

[radd]

Aniela,

Welcome to our forum.

An op for Hashi is obviously necessary if airways are becoming blocked but it is unusual and your thyroid problem is only secondary to the immune problem. As Hashimotos doesn’t warrant immunosuppressants, the medical profession have no understanding of controlling the autoimmunity side and literally ignore it. Also doctors will say a thyroid gland is functioning 'normally' if hormone levels lie within range and/or TSH is still relatively low, but Hashi sufferers often have a smaller window of tolerance than the wide ranges given for healthy thyroids.

Even the dialogue becomes mixed depending on what you read with nodules and cysts being used interchangeably, but these changes are commonly seen because the thyroid gland whilst trying to improve hormone production produces colloid which is a jelly-like substance that causes lumps in thyroid tissue. Larger ‘lumps’ are commonly swellings caused by the infiltrating lymphocytes (WBC’s) that see your thyroid gland as a foreign invader.

Your ‘urgent’ op that obviously-isn’t-so-urgent allows time to reconsider options. If this were me I would be getting a comprehensive thyroid function test that allows a truer assessment of thyroid status. It may be there is room for replacement meds which when given usually reduce lumps/swellings because suddenly the thyroid gland is not having to work so hard. Then if the immune response was lessened by aiming to reduce thyroid antibodies, your thyroid gland may recover enough to last quite some time and more importantly avoids that op and the sudden shock of a thyroidectomy. How are you feeling? Do you have any hypo symptoms?

Edoxaban is fine to take with Levothyroxine. I have just started Clopidogrel and just ensure to take it 2 hours away from thyroid meds.

[Aniela in reply to radd]

I had an MRI scan last year for my thyroid problem and when I saw the Consultant/Surgeon in April this year he allowed my husband to take photos on his mobile of the scan which shows that the goitre has distorted the trachea. So in effect the goitre has become substernal and my symptoms now are wheezing (treated incorrectly for asthma), difficulty breathing when lying flat and sometimes problems swallowing starchy foods. As a result oxygen to other organs is becoming restricted, hence my diagnosis of AF.

[helvella Administrator Thyroid UK in reply to Aniela]

If you need, you can request the full MRI scan. Not sure of how they would now be delivered - used to be on a CD. There might be a charge.

[Aniela in reply to helvella]

Thank you for that. The reason we got a copy of the MRI on the mobile is because I mentioned to the surgeon that the Cardiologist had referred me to the Apnoea clinic as apnoea could be triggering my atrial fibrillation at night so the surgeon suggested that I show them the scans of the goitre restricting my breathing which would indicate that Apnoea was not the trigger of my AF but that it was probably due to my goitre.

[helvella Administrator Thyroid UK in reply to Aniela]

A photo might well be enough for that! But wanted you to be aware in case you felt the need in future.

[Aniela in reply to helvella]

Thank you for that.

[radd in reply to Aniela]

Aniela,

Oh gosh, that sounds more than the point of good return. No wonder you want a thyroidectomy asap.

Your thyroid state evidences it has been struggling for a long time. As well as nodules & goitres, afib & sleep apnoea are common symptoms of long term inadequate thyroid hormone levels commonly seen on this forum. As you have remained unmedicated for 18 years I would strongly recommend a full thyroid panel.

If you feel well it will offer a baseline for when you medicate after your op & if you feel symptomatic it will determine a dose for possible replacement meds asap. A comprehensive test would include TSH, FT4 & FT3. Some members have to pay for private FT3 testing but given your situation you might be eligible for NHS.

Your huge nodules & swellings have revealed the most telling of Hashimoto symptoms but because of the insidious nature of Hashi, there risks more unknown. Iron and nutrient deficiencies are notoriously common due to long term insufficient thyroid hormone impairing gut absorption abilities. It is recommended to at least get ferritin, Vit B12, folate and Vit D tested. This would allow you to address any deficiencies and placing you in a stronger position before your op.

I hope you don’t have to wait too long. It must be a difficult and extremely worrying time for you 😊.