nausea remedies?

[camomile9]

hi, any advice for what to take for constant nausea? my teenage daughter has it all day every day since diagnosis 3 years ago. No other digestive problems. She's on 100mg levothyroxine, taken first thing several hours before eating; plus vit D, B complex, magnesium and iron. July 2021 Tsh 1.38 t4 11.2, results have been fairly consistent. Will post up vitamin levels when I get them done in a few weeks, but this is a quick question meantime. Most anti sickness tablets are for too much acid, which I think is the opposite of what is needed for hypothyroid, is that right? Thanks

[SlowDragon Administrator]

She's on 100mg levothyroxine, taken first thing several hours before eating; plus vit D, B complex, magnesium and iron

Vitamin D, magnesium and Iron supplements must be minimum of 4 hours away from levothyroxine

Iron supplements should be at least 2-4 hours away from all other supplements, apart from vitamin C

How long has she been on 100mcg levothyroxine

Please add ranges on TSH and Ft4 results

Ft4 looks far too low (need range on result to confirm that)

Were tests done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

Which brand of levothyroxine has she tried

Many people find different 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 her 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.

healthunlocked.com/thyroidu...

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...

If she tries taking at bedtime…..bloods should be retested 6-8 weeks later …..

No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.

Some like iron, magnesium, or vitamin D should be four hours away

(Time gap doesn't apply to Vitamin D mouth spray)

If 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

[camomile9 in reply to SlowDragon]

Thanks.

Private GP said supplements close to thyroxine is better than none at all. Not ideal. But dealing with very difficult patient. She will only take supplements first thing when still half asleep and unable to argue! Apart from iron which she was given specific advice from private GP about, and will take at night, although not every day.

Thyroxine brand was changed a few months ago from teva to mercury and I dont see any difference, if anything slightly worse. Ranges TSH 1.38 (0.35-5.0) FT4 11.2 (9-21)

thanks again, going to get bloods done in a few weeks.

[SlowDragon Administrator in reply to camomile9]

On levothyroxine Ft4 should be at least 50-60% through range

Assuming test was done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

Clearly Ft4 is too low

Ft4 is only 18% through range

Helpful calculator for working out percentage through range

chorobytarczycy.eu/kalkulator

How long has she been on 100mcg

Vitamin supplements likely stopping absorption of levothyroxine

Definitely do NOT give vitamin D or magnesium or vitamin B at same time as levothyroxine

[camomile9 in reply to SlowDragon]

Thanks. Been on 100 mcg for 2 years. Will stop supplements for a while. But odd because fT4 was the same (11.2) in Aug 2020 and supplements only started in June 2021.

[SlowDragon Administrator in reply to camomile9]

Then she’s under medicated

When were TSH, Ft4 and Ft3 last tested together

[camomile9 in reply to SlowDragon]

Were done last year but she was missing some doses last year so results were all over the place. I'm going to get them done soon

[greygoose]

Most anti sickness tablets are for too much acid, which I think is the opposite of what is needed for hypothyroid, is that right?

As far as I know, that is not right. The problem often is with hypo that the person has stomach acid that is too low. So, what happens is that the food sits in the pit of the stomach for too long, and ferments. That can cause nausea. So, possibly what she wants is more acid in her stomach.

Have a look at this article and get her to try the home test at the end:

healthygut.com/3-tests-for-...

[camomile9 in reply to greygoose]

yes i think thats what i meant! Unlikely she will do any kind of test unless instructed by a proper professional. Will speak to private GP.

[greygoose in reply to camomile9]

What makes her think 'proper professionals' know what they're talking about. Very often, they have no idea, and that's why forums like these exist. But, it's only a matter of swallowing a little bicarbonate of soda. I wasn't suggesting she does a biopsy of some kind.

[camomile9 in reply to greygoose]

I know, its a good idea and I will suggest. But this is someone who wont brush her teeth or wash her clothes or drink water. 🙄

[greygoose in reply to camomile9]

She has a water phobia?

[camomile9 in reply to greygoose]

oh no i dont mean that, just she is very unmotivated in every way and doesnt like advice

[greygoose in reply to camomile9]

She sounds very hypo. Lack of motivation is one of the major symptoms. Even after 20 odd years, it still over-comes me from time to time. But, there are times when we just have to put on our big girl knickers and make an effort, for our own good.

[RoboTh]

Domperidone is what my daughter and I have been on but GPS don't like to prescribe it anymore 😳

[Tristy]

I had constant nausea when I was first diagnosed. I got all my vitamins sorted from the good advice on here and then went gluten-free. I’m not sure if it was the vitamins, right dose of Levothyroxine, going gluten-free or all three that got rid of the nausea but it did. Maybe going gluten-free free if she’s willing may help a lot. It wasn’t instant, I felt better after about 6 weeks.

[camomile9 in reply to Tristy]

thanks, she doesn't want to do gluten free, but she is a very difficult teenager. I have suggested she try it when she is old enough to take responsibility! Good you got that sorted.

[Tristy in reply to camomile9]

Such a shame as it could make her feel so much better. Maybe one day.

[June25]

The remedy really depends on what the underlying problem is, however ginger tea is a good nausea remedy and should do no harm.

Get a fresh ginger root and slice it about 0.5 cms thick. Boil about 6 slices in a few cups of water for 20 mins and it's ready. You can pour a cup and leave the pot to steep, overnight too, just topping the water up, so you have tea all day. Renew the ginger every few days as needed. Add whatever you like to taste.

GInger speeds up the transit of food through the digestive tract so it can also help with constipation.

[camomile9]

Thanks so much, I will have some myself too

[Litatamon]

A good trick for ginger tea is after you boil the ginger root is to put it into ice cube trays. Then you can pop one or two out with water and heat up whenever.

[Wetsuiter]

I think i know the answer here, but does she eat salad? I now use Apple Cider Vinegar daily(ish) in salad dressing, & I think it helps with stomach digestive problems. Some people drink it, I tried, but...erm...no.

[camomile9 in reply to Wetsuiter]

Thanks thats a good idea for the future, she has sometime in the distant past eaten salad so you never know.

[Wetsuiter]

I ve come back to add that I am always giving people info about their thyroids, and some people (even when already diagnosed) just glaze over 'here she goes again'.You obviously care, and are doing for her what every one of us would do, in your place. But I'm wondering how i would ve been as a teenager with my mum 'fussing' over me 'here she goes again'. I say that not because I think you are fussing but that may be how she feels. Teenagers are odd creatures (and let s face it, we hypos can also be rather odd), so you're on a hiding to nothing.

I have a friend who's a headteacher who had a 15 year old have 3 heart attacks and 'die' at school. She recovered. The adult staff who revived her will probably have nightmares for the rest of their lives. But because is (now) 17, and has teenager brain, she outright refuses to carry the heart machine, which she knows will save her life, should the worst happen again. Cos it's 'not fair'. (of course, she is correct).

What I'm trying to say is, you may have be extra patient with her, even if you want to throttle her.

[camomile9]

Thanks that is good to be reminded. I never say a single word about her hair, clothes, weight or her terrible school results! And I let her stay out till 9 or 10 pm even though we will all pay for it the next day. I do think she is undermedicated though.