Has anyone else got my problem please? Every time I take my Thyroxine tablet I get indigestion! Ive tried taking more water, warm water, tea, nothing makes a difference! Does anyone else get this or know why this should happen?
Should I only take it empty stomach? But if this was the cause, would it hurt straight away
There are different brands of thyroxine. You may need a different brand. What brand are you taking at present?
I wondered that, maybe its the pill coating....its A...something...Almass or Accord?
Have you tried crushing the tablet with your teeth before swallowing it with a glass of water?
Hi no i havent...wouldnt it be oh so bitter?,! 😵💫😵💫😵💫
Hi the Levo I take is prety tasteless. Its Accord. I have a bad habit of chewing pills as I often find they get stuck. I've even been known to do it with paracetamol. Now that's bitter.
If you've got low stomach acid due to being hypo you could try adding a bit of pure lemon juice to the drinking water or some apple cider vinegar to make it more acidic. It might help.
Thank you so much! I will try that,
Would I have low stomach acid even with regular treatment for hypothyroid?
Hi
I'm not sure, but stomach acid declines as we age anyway, irrespective of whether we have thyroid issues or not. It's very common.
People always assume indigestion is caused by too much acid but often its not enough, which leads to food not being digested properly and vitamin deficiencies. In turn this leads to bloating, gas, burping, acid and food just sitting in the stomach instead of passing through our digestive tract.
You can buy digestive enzyme tablets which contain HCL (hydrochloric acid, found in the stomach) and peptides. They might be worth trying.
Thats just what my sister recommended, many thanks
I would just urge caution with anything intended to 'increase stomach acid'. If you have oesophagitis or just too much stomach acid it can cause you a LOT of pain and some damage. I tried this alleged cure after reading a lot of alternative sites so sure it was low stomach acid and the 'digestive enzymes' I took nearly killed me, at least pain wise. They did quite a bit of damage and it took a long time to heal, so go very careful with them. You might feel as if you have too much stomach acid, and therefore indigestion, because you DO have too much stomach acid and more will only make it worse.
Not really...I do it all the time with T3!Also, consider that indigestion can be a symptom of hypothyroidism/ low stomach acid...
You could try taking it with some vit C. That would raise your stomach acid slightly and help you absorb it.
PS I tried lemon juice and ginger in water and it made it worse!
Please don't add anything that might increase stomach acid unless you know your levels are low, otherwise you could cause damage to your oesophagus. Google and do the home test for stomach acid before doing anything else. 🙂
Thank you, I will try that!
You could also trial a bedtime dose, as long as you've last eaten a couple of hours before.
How much levothyroxine are you currently taking
When were thyroid and vitamin levels last tested
Indigestion is a common hypothyroid symptom
Approx how much do you weigh in kilo
Guidelines on dose levothyroxine by weight is at least 1.6mcg levothyroxine per kilo per day
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
What vitamin supplements are you currently taking
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...
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
If TPO or TG thyroid antibodies are high this is usually due to Hashimoto’s (commonly known in UK as autoimmune thyroid disease). Ord’s is autoimmune without goitre.
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 too
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...
Come back with new post once You Get results
Hi Slow Dragon...question...is it common to have indigestion even though you are taking Levothyroxine?
If you’re not adequately treated….yes
Hello again sorry its taken me so long but i find all these details about testing so confusing and intimidating! Which one should I do first?!To answer your questions: I weigh 69.3kg, I take 100mg levo per day, and my last test was this Sept and showed normal TSH levels and also my blood sugar is now showing as pre diabetic, at 44, whatever that means. Ive still got the indigestion! Ive been on ppi's for a month and it has shown some improvement. I will have to take a private test as Dr reluctant but which one? Thanks for your help!
Exactly what was TSH result
Normal just means within range
Just testing TSH is completely inadequate anyway
Suggest you get full thyroid and vitamin testing done via Medichecks or Blue horizon medichecks.com/products/adv...
bluehorizonbloodtests.co.uk...
Money off codes here
thyroiduk.org/help-and-supp...
If you order and do test in New Year
Only do test early on a Monday or Tuesday morning and then post back via tracked postal service
Don’t test if weather very cold/snow (or very hot)
Always test as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test
Do you always get same brand levothyroxine at each prescription
Which brand
What vitamin supplements are you currently taking
Remember to stop taking any supplements that contain biotin a week before ALL blood tests as biotin can falsely affect test results
Come back with new post once you get results
My results were:Serum TSH level 0.35 mIU/L [0.35 - 4.94]
Most important results are Ft3 followed by Ft4
But also important that all four vitamins are optimal as well
Also my bloods were thus:
CRP HS 10.3 mg/l
Ferratin 189 ug/l
Folate 16.54 ug/l
B12 7150 pmo/l
Vit D 37.8 nmo/l
TSH 1.12 mu/l
Free T3 3.64 pmol/l
Free Thytoxine 18.2pmol/l
Doctor said my iron was high, my Vit D too low
Can you make any sense out of these numbers as I cant?!
Do they tell you anything?
Were thyroid antibodies tested
Common to have high ferritin due to inflammation with autoimmune thyroid disease……especially after menopause
GP should do full iron panel test every couple of years, just to check iron levels aren’t high too
But ferritin is only very slightly raised….GP unlikely interested in testing
Typo on B12 result …..do you mean 150pmol
Are you currently taking any B vitamins?
Vitamin B complex or separate B12
Thyroid levels
Was test done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test
Results show Ft4 is 62% through range
But ft3 only 14.6% through range
Most people when adequately treated will have Ft3 at least 50% through range
So slightly under medicated and extremely poor conversion of Ft4 to Ft3
Improving low vitamin D is first step
Aiming for vitamin D at least around 80nmol and around 100nmol maybe better
Low vitamin D
GP should prescribe 1600iu everyday for 6 months
NHS Guidelines on dose vitamin D required
ouh.nhs.uk/osteoporosis/use...
GP will often only prescribe to bring vitamin D levels to 50nmol. Some CCG areas will prescribe to bring levels to 75nmol or even 80nmol
leedsformulary.nhs.uk/docs/...
GP should advise on self supplementing if vitamin D is over 50nmol, but under 75nmol (but they rarely do)
mm.wirral.nhs.uk/document_u...
But with Hashimoto’s, improving to around 80nmol or 100nmol by self supplementing may be better
pubmed.ncbi.nlm.nih.gov/218...
vitamindsociety.org/pdf/Vit...
Once you Improve level, very likely you will need on going maintenance dose to keep it there.
Test twice yearly via NHS private testing service when supplementing
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…one spray = 1000iu
Suggest you start with 3 sprays per day
amazon.co.uk/BetterYou-Dlux...
It’s trial and error what dose we need, with hashimoto’s we frequently need higher dose than average
Vitamin D and thyroid disease
grassrootshealth.net/blog/t...
Web links about taking important cofactors - magnesium and Vit K2-MK7
Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine
betterbones.com/bone-nutrit...
medicalnewstoday.com/articl...
livescience.com/61866-magne...
sciencedaily.com/releases/2...
Great article by Dr Malcolm Kendrick on magnesium
drmalcolmkendrick.org/categ...
Vitamin K2 mk7
betterbones.com/bone-nutrit...
healthline.com/nutrition/vi...
Yes thats correct Vit b12 pmol
You wrote
B12 7150 pmo/l
You meant…..
B12 150 pmo/l
Yes thats right
Just read on Medichecks report you have high TG antibodies
How high?
This confirms autoimmune thyroid disease
NHS only really accepts high TPO or high TPO and high TG antibodies as confirming autoimmune thyroid disease (hashimoto’s)
Significant minority of Hashimoto’s patients only have high TG antibodies
High TG antibodies can cause symptoms
pubmed.ncbi.nlm.nih.gov/303...
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.
According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but a further 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
Ideally coeliac test via GP ….if not
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. May cure indigestion
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.
Alternatively…..have you considered you might be lactose intolerant?
With such poor conversion of Ft4 to Ft3…..you are likely to need addition of T3 prescribed alongside levothyroxine eventually
Improving low vitamin levels first step
Trial strictly gluten free diet
Retest thyroid levels in 2-4 months
If Ft3 remains low …Email Thyroid UK for list of recommended thyroid specialist endocrinologists who will prescribe T3
NHS and Private
tukadmin@thyroiduk.org
Many thanks for ur quick response xTo be clear, does the test show I have Hashimoto's? Not taking any B vits
What does nmol mean ?
THYROGLOBULIN ANTIBODIES
05 Jan 2022
830
IU/mL
< 115 R
0
115
Will check out links
Yes high TG antibodies confirms autoimmune thyroid disease
However currently NHS only tests TG antibodies if TPO antibodies are high ….
presumably your TPO antibodies are below range?
You are in the minority of autoimmune thyroid patients who only have high TG antibodies
So you might have difficulty getting autoimmune thyroid disease diagnosis admitted by GP/endo
But as NHS ignores the autoimmune aspects of autoimmune thyroid disease and only treats the subsequent hypothyroidism….they aren’t really interested anyway
HOWEVER it’s important to you, the patient know that your hypothyroidism is autoimmune thyroid disease
Thanks for response. Can you explain what you mean by"You are in the minority of autoimmune thyroid patients who only have high TG antibodies"
Youre saying Ive got Hashimoto's but Im in the minority for what reason? What are TG antibodies? Sorry, I find all the abbreviations and terms confusing! Thanks for your time x
There are two different antibodies implicated in autoimmune thyroid disease
I don’t think anyone knows why some people have both types high or just one
High thyroglobulin antibodies
healthline.com/health/antit...
medlineplus.gov/lab-tests/t...
Im so sorry but Im still confused! What is it that puts me in the minority?
Most autoimmune thyroid patients have either
High TPO antibodies
Or
High TPO and high TG antibodies
NHS currently only tests TG thyroid antibodies if TPO antibodies are high …..
unless people test privately….. most thyroid patients never who only have high TG antibodies are never tested/never know
So youre saying Ive only got TG antibodies? And does that affect me in any way, healthwise? If so, how?
No…if either TG or TPO antibodies are high it confirms autoimmune thyroid disease
But NHS GP might not agree
Thanks, but why am I a rare case? Sorry to be thick!
Not rare …just less tested for and therefore less diagnosed
There are many members on here who ONLY have high TG antibodies….
Because thousands of members have tested privately and therefore can see they have high TG antibodies
Here’s one
Hello Slow Dragon and Happy New Year to you!!Ive now had my blood tested by Medichecks and heres what they said also the blood results which I cant make sense of myself, tbh!
69.3 x 1.6 = 110.88mcg levothyroxine per day
That’s approx 775mcg per week
So you are possibly under medicated by at least 75mcg per week
Many people need to fine tune dose
You might need 25mcg extra every other day…..or cut 25mcg tablets in half to get 112.5mcg daily
Using a weekly pill dispenser if taking different dose on different day, or if cutting tablets
GP should test folate, ferritin, B12 and vitamin D……especially as now on PPI
We frequently have low vitamin levels when hypothyroid
PPI will tend to lower vitamin levels even more, especially magnesium and B12
gov.uk/drug-safety-update/p...
webmd.com/heartburn-gerd/ne...
pharmacytimes.com/publicati...
PPI and increased risk T2 diabetes
gut.bmj.com/content/early/2...
Iron Deficiency and PPI
medpagetoday.com/resource-c...
futurity.org/anemia-proton-...
onlinelibrary.wiley.com/doi...
sciencedirect.com/science/a...
If you can get GP to test vitamin levels you could test just thyroid via Monitor My Health……TSH, Ft4 and Ft3
Cheapest option at £26.10
Many thanks to you. Trouble is, trying to get your GP to do any of this!
Write/email GP and request they test vitamin D, folate, ferritin and B12 plus thyroid antibodies for autoimmune thyroid disease (if antibodies never been tested)
PS do you think that the Gp will HAVE to take notice of the test a patient has done privately? Im worried that I would go to the expense of testing only to have them ignore or Diss it!
If vitamins are deficient then GP is obligated to treat
They will usually have to test via NHS to confirm
If vitamins are low, but not deficient it’s down to you to self supplement to bring to optimal
Thyroid results
If Ft4 is low within range, you can request GP for dose increase in levothyroxine
This is quite likely as your current dose is probably too low
If Ft4 is at top of range and Ft3 is low then you have poor conversion of levothyroxine (Ft4) to active hormone (Ft3)
First steps to improve conversion
Get all four vitamins tested and OPTIMAL levels by supplementing
Trial Strictly gluten free diet
Many thanks for your help xxx
Wow thats a lot of info, thanks!
Yes you should only ever take it on an empty stomach.
I had terrible indigestion (alongside other side effects) on different brands of Levo and Eltroxin. The indigestion produced so much acid reflux I couldn’t lie down. In the end I had a private consultation and moved to ERFA Thyroid, an NDT. I have been on this for just under five months with no side effects from day 1. I am celiac (fully GF diet) and have another condition that stops me producing pancreatin, a digestive enzyme, which I take in tablet form when I eat. ERFA was chosen as very few fillers and all are celiac friendly.
Good luck!
Thanks you for your answer. What is ERFA and NDT?
Erfa is a brand of Natural Dessicated Thyroid….made from dried thyroid from cows
This was the standard treatment for hypothyroidism until 1970-80’s before levothyroxine was manufactured
NDT contains T3 and T4
Naturally our thyroid would make approx 80%-90% Ft4 and 10%- 20% T3
Many people can’t manage on just levothyroxine (T4)
Common to have poor conversion if coeliac, gluten intolerant or lactose intolerance and for conversion to get worse the longer we are on levothyroxine…..especially after menopause
About 5% of Hashimoto’s patients are coeliac and further 80% of Hashimoto’s patients are gluten intolerant or find strictly gluten free diet reduces symptoms
At least 20% of thyroid patients need addition of T3 prescribed alongside levothyroxine, or to be prescribed NDT
thyroiduk.org/if-you-are-hy...
On levothyroxine
To see how well you convert Ft4 to Ft3 you need to test TSH, Ft4 and Ft3 together……always test as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test
All four vitamins need to be OPTIMAL for good conversion of Ft4 to Ft3
Hence essential to test vitamin D, folate, ferritin and B12 at least annually
Many thanks for your info and advice xx
How do you get the ND thyroxine? I cant see the GP giving it to me!
I’ve tried all brands of levo and can’t take it because of bad reactions to the fillers. The burning never stops. I’ve tried everything to help. So on no treatment because my doctors won’t help and are not interested
Wow, thats harsh on you!
Email Thyroid UK for list of recommend thyroid specialist endocrinologists
...NHS and Private
tukadmin@thyroiduk.org
Can’t afford private,, I’ve been hand washing for six months without a washing machine, so certainly can’t afford private fees or buy the medication I need.But thanks
Hi, you can also put the pill in a coated capsule so it doesn’t dissolve in the stomach.
That sounds interesting, where would I buy such a thing, do you know?
I get them from Amazon. They’re called enteric coated capsules.
Many thanks x
Falling asleep after taking meds in the morning 
Feel rubbish after morning meds …… 
Taking water with thyroxine tablet 
lethargy after taking magnesium glycinate
Sickness taking Levothyroxine
