Hashi swing when already hypo?: Hi all I have... - Thyroid UK

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Hashi swing when already hypo?

HashisKate profile image
12 Replies

Hi all

I have been taking 75mcgs / 100mcgs alternate days for around 8 months it was reduced from 100mcgs as my TSH was too low and actually I did feel a lot better when they had decreased it. I had a blood test in June and all was in the normal ranges and I felt fine and that was confirmed with GP also taking annual bloods 2 months ago. I haven’t got the exact results and ranges as did not feel the need to scrutinise as I felt good. T3 was no where near top of the range tho as I am a poor converter.

Last week out of the blue I very suddenly developed debilitating ectopic beats and irregular heartbeats. These are near constant. I’m awaiting a holter monitor (probably months) and I have asked a GP to ring me soon as I feel so awful all of a sudden but no call yet 😔! So since the irregular heart beat (but normal heart rate) has started I’ve got increasingly worsening fatigue, headaches, facial flushing, anxiety & no appetite. I just wondered if having been on Levo for 3 years, I could suddenly get such a dramatic hyperthyroidism? Like a hashi swing I have heard some talk about? I was thinking that this happened more at the beginning stages of thyroid disease rather than where I am now but wondered if this could be causing my symptoms and I should push for another blood test?

I really do feel awful and scared 😟

Thanks

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HashisKate
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12 Replies
SlowDragon profile image
SlowDragonAdministrator

Do you always get same brand levothyroxine at each prescription

More likely under medicated/low Ft3

Can you get FULL thyroid and vitamin testing

Just testing TSH and Ft4 is completely inadequate

you need TSH, FT4 and FT3 tested.

Very 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 and last dose levothyroxine 24 hours before test

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...

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...

HashisKate profile image
HashisKate in reply toSlowDragon

All these were done in June and were fine /optimum. The only thing of concern was that my b12 had crept up significantly despite my not supplementing. I’ve never felt like this even before diagnosis - I feel awful 😥 hard to get the GP to take notice

HashisKate profile image
HashisKate in reply toSlowDragon

These are the results fromLast blood test

Results
SlowDragon profile image
SlowDragonAdministrator in reply toHashisKate

What vitamin supplements have you been taking since then?

Obviously need to test TSH, Ft4 and Ft3

Personally I would include retesting vitamins too

Are you on absolutely strictly gluten free diet

Which brand of levothyroxine are you currently taking

HashisKate profile image
HashisKate in reply toSlowDragon

I have only been supplementing with vitamin D. I’ve just recently added magnesium citrate, only a few days worth. I’ve tried gluten free before, and for me a good balance is very low gluten, which I do currently and have done for a while. I was tested 2 years ago and not caeliac.

I am taking Teva. Aside from one month with it was different about 6 months ago it’s always been Teva since I was first diagnosed.

SlowDragon profile image
SlowDragonAdministrator in reply toHashisKate

Are you lactose intolerant?

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. 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 (100mcg only) are the only lactose free tablets

Most easily available (and often most easily tolerated) are Mercury Pharma or Accord

Mercury Pharma make 25mcg, 50mcg and 100mcg tablets

Accord is also boxed as Almus via Boots, and Northstar 50mcg and 100mcg via Lloyds ....but Accord doesn’t make 25mcg tablets

beware 25mcg Northstar is Teva

List of different brands available in U.K.

thyroiduk.org/if-you-are-hy...

Posts that mention Teva

healthunlocked.com/search/p...

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

gov.uk/drug-safety-update/l...

If a patient reports persistent symptoms when switching between different levothyroxine tablet formulations, consider consistently prescribing a specific 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, 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

HashisKate profile image
HashisKate in reply toSlowDragon

I’ve always taken Teva and been fine on it, as I said this has started very suddenly 😔

SlowDragon profile image
SlowDragonAdministrator in reply toHashisKate

Ft3 was low before dose was reduced, likely dropped further on lower dose

HashisKate profile image
HashisKate in reply toSlowDragon

Yes it had, but this dose has been for 8 months and felt much better for all of that time. I was worried about lowering my dose but actually felt much better for it. Is a hashi swing actually possible when you’re this far in?

SlowDragon profile image
SlowDragonAdministrator in reply toHashisKate

Lowering dose levothyroxine so that high Ft4 drops can result in feeling better (initially)

But if lower dose results in lower Ft4, it will almost inevitably result in lower Ft3

Being under medicated/low Ft3 can feel remarkably similar to over medicated

You can’t guess…you need to test

HashisKate profile image
HashisKate

Also don’t have the other symptoms I had back then. I had incredibly heavy periods, constipation etc whereas that’s not my experience at the moment. I guess it must be unrelated to thyroid 😔

greygoose profile image
greygoose

Could be it's the reduction in your levo that is just kicking in, and your levels are now too low. Your symptoms are not specifically hyper/over-medicated, could easily be due to being hypo again.

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