Struggling with symptoms I presume are from Lev... - Thyroid UK

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Struggling with symptoms I presume are from Levothyroxine

Thyroidsam profile image
41 Replies

Hi there.

A bit of background before I waffle on…

RAI treatment (for overactive thyroid in Feb 20). Thyroid became tender and I felt unwell about 1 1/2 weeks after treatment. Put on block and replace until Sept 20 (due to my thyroid being irritated by the RAI). Taken off all meds to see what my thyroid would do and I then went underactive. Started on 125mg Levothyroxine and within a week or so I started having symptoms, that at the time I presumed were due to being underactive (now I’m not so sure and think it was perhaps due to the levo).

The symptoms I was getting at the time included a really tender thyroid, noticeable uncomfortable sensation in my throat, generally feeling unwell, very dry mouth, the feeling of needing to keep clearing my throat, glassy eyes and bags under them, lack of appetite, fatigue etc.

Rather quickly and due to constantly complaining to my GP of feeling so unwell I was bumped up from 125mg a day, to 150mg and then up to 175mg (I was having TFT’s every 4 weeks).

My first TFT after 4 weeks(ish) on 125mg a day was

T3 3.4

T4 21.8

TSH 19.22

4 weeks later 23rd Nov 20 -

T3 - 3.6

T4 - 21

TSH - 18.26

Then upped to 150mg levo a day and after a week or so the side effects that had initially eased, became worse. GP upped me to 175mg levo a day.

TFT 21st Dec 20

Tsh 0.52

T4 34.1

T3 6.4

I had all of the above symptoms for several weeks. After my TFT in Jan 21 I was reduced to 125mg levo per day.

12th Jan 20

TSH 0.34

T4 32.1

T3 4.9

At some point of the following weeks, the symptoms seemed to ease and I went through most of 2021 within a ‘normal range’ with the odd change to my daily dosage (but still complaining of not feeling right).

Looking at all my TFT’s my T4 was always 22 or above (seemingly creeping up over the year).

Present day…..was taking 125mg levo daily and 150mg every 3rd day (925mg weekly).

Started feeling worse and worse from Oct onwards.

TFT Oct 26th 21

TSH 4.39

T4 27.5

Felt absolutely terrible…

TFT 12th Nov 21

TSH 2.25

T4 29.9

Was unable to get any direction from GP as my Endo was not responding to any requests for advice. Felt so unwell and could barely function.

Finally spoke with endo on 15th Nov and stopped taking levo for a week. After 5/6 days the symptoms (headache, generally feeling unwell, sore eyes, lack of appetite, very tender thyroid on one side etc.) eased. Started back on 125mg levo a day and after 5 days the symptoms started to come back. Dropped to 100mg a day and the symptoms eased for a few days but after being back of 100mg a day of levo for 10 days, the symptoms are coming back.

Endo has no real idea why I’m feeling so unwell when in his eyes, my T4 was not really high. He suggested staying on 100mg for a month to see how I got on. However, as the same symptoms are now coming back now (after 10 days), I’m not sure if I can hack feeling so unwell for another 3 weeks as the result of the tft is irrelevant if I still feel so unwell!

Has anyone else had the symptoms (especially the tender thyroid) when taking Levothyroxine? Have your symptoms come and gone when changing dosage? What if they don’t go away?

I know I can’t stop it all together as I’ll go underactive in the weeks to come, but I also feel so unwell when taking it. I’m presuming I’ve been over-medicated the past year, but I’m lost as to why my body is now reacting in the same way it did when I started taking Levo just over a year ago!

p.s. although I had some symptoms on block and replace, I presume that as my thyroid was ‘switched off’, I didn’t suffer from the tender thyroid etc.

I’ve had two ultrasounds, one was completed a couple of weeks ago while I was complaining about the tenderness, however, my thyroid is tiny and there has been no change in it for the last year.

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SlowDragon profile image
SlowDragonAdministrator

Just testing TSH, Ft4 and Ft3 is completely inadequate

Which brand of levothyroxine are you currently taking

Do you always get same brand levothyroxine at each prescription

How do you take your levothyroxine

Waking or bedtime

Always on empty stomach and then nothing apart from water for at least an hour after

Dose levothyroxine being charged by too much and too frequently

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

Waiting longer if dose reduced

For full Thyroid evaluation you need TSH, FT4 and FT3 tested.

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

Low vitamin levels EXTREMELY common after Graves’ disease

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 and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins

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

Gluten intolerance is often a hidden issue with Graves’ disease or Hashimoto’s

Request coeliac blood test BEFORE considering trial on strictly gluten free diet

Link about thyroid blood tests

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

Extremely common after RAI to have poor conversion of Ft4 to Ft3

Getting vitamins OPTIMAL can help improve conversion

When were vitamin D, folate, ferritin and B12 last tested

What vitamin supplements are you currently taking

Strictly gluten free diet can help improve absorption and conversion and reduce symptoms

SlowDragon profile image
SlowDragonAdministrator

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 only make 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...

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

Some people find liquid levothyroxine gives much better results and absorption

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, HRT, omeprazole 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

Thyroidsam profile image
Thyroidsam in reply to SlowDragon

Hi,

I’m presuming that I’ve had at least 2/3 different brands over the last year (I’d binned some older packs but what I had left was Teva, Accord & Wock). From memory, the latter part of this year I’ve been on accord and Wock, however, I’ve recently asked to just been on Wock, so any dose changes can be on a single brand.

Unfortunately I’d never been advised by my GP or Endo about test times etc. so they have always been random (mornings and afternoons). I always take my levo on waking with a couple of mouthfuls of diluted juice. I don’t eat for an hour after taking it. I take vit D (at night) and I was previously taking multi-vitamins, however, I was recently told about biotin affecting results (so I’ve stopped).

JAmanda profile image
JAmanda in reply to Thyroidsam

Better to take it with a good amount of water and wait an hour for it to absorb before having any food or juice or drink.

Thyroidsam profile image
Thyroidsam in reply to JAmanda

Thanks, started with just water today!

SlowDragon profile image
SlowDragonAdministrator

Started feeling worse and worse from Oct onwards.

TFT Oct 26th 21

TSH 4.39

T4 27.5

Felt absolutely terrible…

TFT 12th Nov 21

TSH 2.25

T4 29.9

Was unable to get any direction from GP as my Endo was not responding to any requests for advice. Felt so unwell and could barely function.

Finally spoke with endo on 15th Nov and stopped taking levo for a week. After 5/6 days the symptoms (headache, generally feeling unwell, sore eyes, lack of appetite, very tender thyroid on one side etc.) eased. Started back on 125mg levo a day and after 5 days the symptoms started to come back. Dropped to 100mg a day and the symptoms eased for a few days but after being back of 100mg a day of levo for 10 days, the symptoms are coming back.

Please add ranges on Ft4 and TSH (figures in brackets after each result)

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

Obviously all these test results are completely inadequate as there’s no Ft3 (the most important result) or vitamin D, folate, ferritin and B12

Which brand of levothyroxine are you currently taking

What vitamin supplements are you currently taking

Thyroidsam profile image
Thyroidsam in reply to SlowDragon

I always request that my T3 is checked and often the nurse writes it on the paperwork, however, for some reason it’s not always then checked… I was on Accord (100mg) & Wock (25mg). I’ve been on Wock (x4 25mg) for a week now. Tests have been at random times of the day, just as and when the surgery could fit me in.

I have however ordered a test from Thriva to included vitamins etc.

SlowDragon profile image
SlowDragonAdministrator in reply to Thyroidsam

So to make progress….like thousands upon thousands of U.K. patients you will need to take control and do full testing yourself

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

Private testing….only test early Monday or Tuesday morning and post back via tracked postal service straight away

Beware ….postal rush of Christmas

Don’t test if weather is very cold or very hot ….risks sample getting damaged in post

Only do test after minimum of 6-8 weeks on unchanging dose and brand of levothyroxine

Come back with new post once you get results

SlowDragon profile image
SlowDragonAdministrator in reply to Thyroidsam

Lab frequently over rules what’s written on test form

Ft3 test rarely done……even if patient is prescribed T3 by NHS (madness)

Thyroidsam profile image
Thyroidsam in reply to SlowDragon

Thanks for the info!After having done a bit of reading, I was already thinking about how the current testing regime at my GP practice leaves a lot to be desired.

Fully agree with having consistency around how/when testing takes place. Especially as my Endo bases everything on what’s on his screen..

I’m just hoping the tender thyroid etc. all fades in the coming weeks if I stick to the same dose. It’s like my body doesn’t like the levo input!

Starling87 profile image
Starling87 in reply to SlowDragon

I do wonder why they never bother doing T3.. I thought for ages it had to do with being really expensive, but I've had phlebotomists telling me this isn't the case. Apparently it's the same cost as testing TSH and T4.

It's weird isn't it. Unless there is another reason besides this "cost".

Charlie-Farley profile image
Charlie-Farley in reply to Starling87

Just cost……oh and total ignorance…. They really don’t know what they are doing! My last 18 months is testament to that - I stand today quite well and getting better thanks to this forum alone.

greygoose profile image
greygoose

A few 'facts' about taking levo:

* It often happens that when you start taking levo, new hypo symptoms appear, or old ones exacerbate. And, the symptoms you mention sound more like hypo symptoms than reaction to the fillers in Levo.

* We should only test after at least six weeks on a steady daily dose. Four weeks is too soon, changes in levels can still occur up to six or eight weeks.

* Often when we start an increased dose, we feel well for a while - or start to feel better after a week or so - and then the symptoms start to come back. This does not mean the levo has 'stopped working' or that it's not right for you, it just means that it is time for another increase.

* When going for a blood draw, always leave a gap of 24 hours between your last dose of levo and the blood draw. With those high FT4 results you've given above, how long was the gap between your last dose and the blood draw?

* When giving blood test results, please include the ranges because they vary from lab to lab, and we need the ranges that go with your results.

You say you have been taking a multi-vit. How long have you been taking that? Multi-vits are really not recommended, for many reasons. It could be something in the multi-vit that is making you feel bad. :)

Thyroidsam profile image
Thyroidsam in reply to greygoose

Hi,

In recent times (from Oct onwards), the symptoms I was having I presume were from too much Levo. My thyroid was tender but I was also jittery, had red glazed eyes etc. Thats when my T4 was around 29. Those symptoms were consistently getting worse from early Oct up until 15th Nov when my Endo finally reacted and stopped my levo for a week.

I hoped in that after a short break and going back on to a lower dose that everything would just settle down (which it didn’t). I’d only taken 7 days off and was going on to a slightly lower dose (which was then dropped to 100mg).

The bigger picture is to really find a level that I feel ‘normal’ on - which having done a bit of research, isn’t as straight forward as the NHS makeup. The assumption being that you take your tablets everyday and have a blood test now & again and everything is great!

I had hoped that a year after coming off block and replace, that I’d now be in a better place, where as I actually feel like I’m starting out again. The tender thyroid (on one side) and the general neck discomfort can be terrible.

Reference my test results (sorry I don’t have the ranges), the October test was in the afternoon I think and the November test was at 10am (I took my levo around 0730am that day). All of my blood tests over the last year have been at random times, always with taking my levo in the morning.

I would have taken various multi-vits this year and the last continual use back in Aug/Sept - although I’d taken a few days a couple of weeks back. Unfortunately with the amount of variables over the last year (that I didn’t realise mattered), it’s hard to pinpoint why I’ve now felt the worst I have since coming off block and replace and just using levo. However, the thyroid sensation/discomfort/pain is always related to also not feeling generally very well.

Prior to posting on here, I’d ordered a TFT from Thriva, and although I knew that it would be too soon to get accurate levels from being on 100mg, I was going to use the b12 etc. readings to make changes if needed. I suppose the alternative would be just to get my vitamins checked for now separately (baring in mind I came off levo on the 15th Nov, went back on it at 125mg on 22nd-25th Nov and then on 100mg since then - so 10 days).

greygoose profile image
greygoose in reply to Thyroidsam

There's no reason that taking levo would make your thyroid feel sore. Levo doesn't affect the thyroid gland itself, it just replaces the hormone your thyroid can no-longer make or make enough of. It's not a stimulant to make your thyroid work harder.

OK, well, re your blood test results, given that the tests were all done randomly, not leaving the 24 hour gap, and that you don't have the ranges, they're all pretty useless, really. Time to start again. Always do your tests in the recommended manner, after six weeks, etc. and then you can start comparing them to see how you're progressing. Your problem could either be that you're under-medicated, or that you're a poor converter. Remains to be seen which - or even both! :)

Some general comments about multi-vits:

You shouldn't be taking a multivitamin anyway for all sorts of reasons.

* If your multi contains iron, it will block the absorption of all the vitamins - you won't absorb a single one! Iron should be taken at least two hours away from any other supplement except vit C, which is necessary to aid absorption of iron, and protect the stomach.

* If your multi also contains calcium, the iron and calcium will bind together and you won't be able to absorb either of them.

* Multi's often contain things you shouldn't take or don't need : calcium, iodine, etc. These things should be tested before supplementing.

* Copper and zinc need to be kept balanced, but hypos are often high in one and low in the other - often low in zinc. So, both should be tested before supplementing. Taking either of them when you already high in it, will reduce the other and make you feel worse.

* Multi's often contain the cheapest, least absorbable form of the supplement : magnesium oxide, instead of magnesium citrate or one of the other good forms; cyanocobalamin instead of methylcobalamin; folic acid instead of methylfolate; etc. etc. etc. This is especially true of supermarket multis.

* Multi's do not contain enough of anything to help a true deficiency, even if you could absorb them.

* When taking several supplements, you should start them individually at two weekly intervals, not all at once as you would with a multi. Because, if you start them all at once, and something doesn't agree with you, you won't know which one it is and you'll be back to square one.

* Most supplements should be taken at least two hours away from thyroid hormone, but some - iron, vit D, magnesium and calcium (should you really need to take it) should be taken at least four hours away from thyroid hormone.

*Vit C should be taken 2 hours away from B12 because it affects how the body uses B12.

*Never take magnesium/zinc/calcium at the same time as they affect the absorption of each other.

*Take zinc and copper separately as zinc affects the absorption of copper, if you need to take both.

*Vits A/D/E/K are all fat soluble vitamins, and if taken together can compete for the source of fat. They are best taken away from each other.

* The magnesium you take - and just about everybody needs to take it - should be chosen according to what you want it to do:

Magnesium citrate: mild laxative, best for constipation.

Magnesium taurate: best for cardiovascular health.

Magnesium malate: best for fatigue – helps make ATP energy.

Magnesium glycinate: most bioavailable and absorbable form, non-laxative.

Magnesium chloride: for detoxing the cells and tissues, aids kidney function and can boost a sluggish metabolism.

Magnesium carbonate: good for people suffering with indigestion and acid reflux as it contains antacid properties.

Worst forms of magnesium: oxide, sulphate, glutamate and aspartate.

With a multivitamin, you are just throwing your money down the drain, at best, and doing actual harm at worst. Far better to get tested for vit D, vit B12, folate and ferritin, and build up your supplementation program based on the results. A vitamin or a mineral is only going to help you if you need it, anyway. More of something you don’t need is not better, it's either pointless or even dangerous, as with iodine, calcium, iron or vit D. :)

Thyroidsam profile image
Thyroidsam in reply to greygoose

Thanks for the info!

Perhaps it’s my body trying to make my thyroid work harder or slow down (when my tsh is going up or down -due to all the inconsistency) that causes the tenderness etc. I just never used to experience it being in block and replace.

I think I’ll do the Thriva test when it arrives purely for the vitamin check. At least I can then start to address that side of things while I wait for 6 weeks point on 100mg levo daily.

I’ve an inclination that as my T4 has barely ever been below 22 this year and at some points my T3 has been at the lower end of the ‘normal’ range it could be around the conversion side of things - but without removing all the previous variables I’ll not know for sometime yet.

greygoose profile image
greygoose in reply to Thyroidsam

You cannot conclude anything about conversion from those labs because you weren't leaving the recommended 24 hour gap between your last dose of levo and the blood draw - plus the amount of time you left was variable. So, no, you cannot know anything at all yet. :)

Thyroidsam profile image
Thyroidsam in reply to greygoose

Even better lol!

Batty1 profile image
Batty1 in reply to Thyroidsam

Wonder if your having some type of flare especially since you mentioned red eyes and painful thyroid. I can tell when my PSA is getting ready to kick my backside my eyes get painful and my joints start to hurt.

pennyannie profile image
pennyannie

Hello Thyroidsam and welcome to the forum ;

I too have had RAI thyroid ablation but mine was a " walk in the park " - I drank the drink, was put immediately on 100 mcg T4 and got on with my life, but I become very unwell around 8 years later - details on my profile page.

RAI slowly burns out the thyroid in situ :

Primary hypothyroidism caused by RAI is known to be more difficult to treat :

RAI can trash vitamins and minerals :

In order for T4 - Levothyroxine to work effectively you need optimum vitamins and minerals, especially those of ferritin, folate, B12 and vitamin D.

It is essential that you are dosed and monitored on your T3 and T4 blood test results with the aim to have these vital hormones in the ranges, and balance t around a 1/4 ratio T3/T4.

T4 is a storage hormone and needs to convert within your body to T3 the active hormone that the body runs on. T3 is said to be around 4 times more powerful than T4 with the average person needing around 50 T3 daily just to function.

A fully functioning working thyroid would be supporting you daily with trace elements of T1. T2 and calcitonin plus a measure of T3 at around 10 mcg plus a measure of T4 at around 100 mcg.

Some people can get by on T4 only, some people find that at some point in time T4 seems to stop working as well as it did and need the addition of a little T3 with the T4 making a T3/T4 combo , some people can't tolerate T4 and need to take T3 only whilst other people prefer to take Natural Desiccated Thyroid which contains all the same known hormones as that of the human gland and made from pig thyroid.

All thyroid hormone replacement options were available through your doctor some 20 odd years ago, and if T4 didn't solve your hypothyroidism the alternatives were available.

Currently in primary care doctors can only prescribe T4 monotherapy and it would seem only able to order a TSH and maybe a T4 blood test on which to monitor which isn't correct if you want to restore health and well being.

Have you been referred to a specialist regarding your eyes?

If you go into Thyroid UK, the charity who support this forum, you will find a list of both hyper and hypo symptoms and this help you understand what is happening - but unfortunately some symptoms do cross over both conditions but it might just help you see where you currently are.

I can't see Levothyroxine hurting your thyroid and would guess this feeling is more to do with the build up of drugs and then ingesting the toxic substance and believe the same for your eye issues.

Thyroidsam profile image
Thyroidsam in reply to pennyannie

Hi,

Thanks for the info.

I’ve definitely gone down hill since my T4 has crept up. My eyes being red and sore etc. has decreased since reducing my daily Levothyroxine - along with the he jitters etc.

As you and others have kindly pointed out, my blood tests throughout this year have mainly been missing T3 and I’ve also been on different brands/doses and tested at various times of day. So useless!

I’m presuming that the pain in my thyroid (only ever on the right side) and general discomfort around that area is due to my TSH either going up or down and my body trying to speed up or slow down my thyroid - which it can’t as I’m taking levo (my thyroid is tiny now). If I posted my blood tests for the rest of the year you’d see everything going up and down due to all my inconsistencies. There’s been times this year where I’ve had a blood test within a couple of weeks of the last and my tsh has jumped from 1.64 to 2.13. For example those tsh results were back in June when I started to not feel right again - then a month later near the end of July they finally tested T3 again (I think I’d asked if it was a bit low in comparison to my T4 at that point).

TSH 2.01

T4 23.1

T3 3.6

I’ve read my info and advice on here over the last few days than I’ve been given by either my GP or Endo!

pennyannie profile image
pennyannie in reply to Thyroidsam

Can you please give a bit more detail ;

When and what were you diagnosed with :

Which antibodies were found to be over range and positive ?

How long were you on AT drugs, Carbimazole or PTU -

When was Block and Replace introduced - did you have then issues with the T4 ?

Were you offered long term AT medication as a treatment option to RAI or a thyroidectomy ?

P.S, The TSH is the least reliable number of them all - you must insist on T3 and T4 bloods.

As for the 2 ultra sounds, apart from your thyroid being small, was there any answer as to there being any thyroid function at that point in time or was your thyroid deemed totally disabled and atrophied ?

As for your eyes - are you taking any prescription or OTC products containing preservatives ?

Thyroidsam profile image
Thyroidsam in reply to pennyannie

I was diagnosed with an overactive thyroid back in 2012. I spent about 18 months on 20mg carbimazole and 100mg then 125mg daily of levo (still had headaches etc. during that time. At some points had awful symptoms. The best I probably felt was when I first went on to carbimazole without taking any levo while my levels came down). Came off block and replace after 18 months due to low white blood cells (spent most of the time on block and replace moaning about feeling unwell). Had around 3 years of feeling normal (the ringing in my ears finally stopped) and then I went overactive again mid 2019 (caught it quickly 2nd around). When back on to block and replace until Feb 20 when I had RAI. Started to get symptoms after a week or so and a blood test a few weeks later showed that I was overactive again. Went on block and replace until Sept 19 when my original endo wanted to treat me with RAI again. I was referred to another endo by nuclear medicine as they had noticed I’d not come off block and replace. The new endo took me off all medication to see what my thyroid would do, at that point I was told that I was now hypo.

I have never been told that I have graves and the first endo kept telling me it was viral. I had always had sore throats and large tonsils up until I was diagnosed with an overactive thyroid. After about 8/12 months on block and replace, my tonsils shrunk to the smallest they have ever been. When I came off all medication they gradually over time increased in size again. I mentioned this to both endos and several GP’s who had no comment…

I’d never had an ultrasound until about a year ago where the endo said it appeared to be atrophied. The 2nd ultrasound I had a couple of weeks ago the radiologist said there had been no change in size etc.

Eyes-wise, no not taking anything. Usually my eyes become glazed/glassy looking when I start going down hill. With my T4 being 27 back in Oct and then going upwards over the last couple of months they have been worse. After around 5 days of no levo they started to look a bit more normal - along with my skin.

pennyannie profile image
pennyannie in reply to Thyroidsam

Well, it's all a bit confusing as generally speaking first an antibody blood test has to be run to determine why you have become " hyperthyoid " :

If there are positive and over range Graves antibodies - either a TSI ( a thyroid stimulating ) or a TR ab ( a thyroid receptor blocking ) antibody this is th medical evidence needed before the AT drug is prescribed.

Graves is persistent high over range T3 and T4 readings and the AT drug blocks your T3 and T4 rising any further and slowly your levels of both thyroid hormones slowly fall bck down into rage with you feeling more comfortable.

Graves is an autoimmune disease and as such, for life, but once the thyroid is destroyed by the RAI you are thought to be better off being hypothyroid.

It's likely a myth, and medical dogma but then everybody well on T4 after RAI treatment isn't on here asking questions but getting on with their lives, so I guess we've just that % fall out that need additional help, treatment and understanding.

For reference - for likely wellness - when on T4 only medication your T3 and T4 need to balanced in the ranges at around a 1/4 ratio T3/T4 :

Your T4 needs reducing and your T3 needs increasing as they are currently off balance, Imagine them on a see- saw - your T4 is stuck up high in the sky and your T3 stuck down in the mud :

The accepted conversion ratio when on T4 only is said to be 1 / 3.50 - 4.50 T3/T4 with most people feeling at their best when they come in at around 4 or under :

So to find your ratio you simply divide your T3 into your T4 and I'm getting yours coming in at 6.42 :

Conversion can be compromised by low vitamins and minerals but considering you haven't a functioning gland you'll never likely achieve an acceptable level of T3 to give you back your health and well being unless you introduce T3 - Liothyronine to replace your own lost T3 production, or switch to another thyroid hormone replacement option.

P.S.

If you are ever prescribed any ointment, lotion or potion for your eyes please make sure it is preservative free as my eye issues were compounded by both my doctor and eye consultant prescribing eye ointments and drops containing " preservatives " :

Thyroidsam profile image
Thyroidsam in reply to pennyannie

Great info thanks! Hopefully this will be a new start for me now so I’ll establish my vitamin levels now and then at the 6 week point get a TFT (taking into account all the great info on here). At least that will give me an accurate baseline to start with. Before coming on here and reading all the great info, I had been thinking about getting a private prescription and trying NDT - just as I’d kept thinking my T4 was too high. But as others have kindly commented, I need to establish the accurate facts first.One year wasted, on to 2022!

vocalEK profile image
vocalEK in reply to Thyroidsam

Your mention of tonsils made me curious so I Googled "tonsils thyroid" and found this: empowher.com/community/ask/...

"Dr. John Theodore King of Baltimore argued that at least exophthalmic goitre is intimately connected with chronic tonsillitis. His thesis: the lymph channels of the thyroid and the lymph glands of the neck (including the tonsils) are closely interconnected. This is a newly discovered fact. Through these lymphatic channels any infection of the neck can spread and affect the sympathetic nervous system which serves the neck and eye sockets. All this led Dr. King to suspect that the most frequently infected gland of the neck, the tonsils, might be the cause of exophthalmic goitre."

As a child I had a "cold" that never got any better. It was impossible for me to breathe through my nose, so I was a mouth-breather. Finally, when I was 8 years old, my aunt convinced my mother to get my tonsils out. My mother said the doctor told her it was the pussiest mess he ever had. (These days, I think a doctor would get the infection cleared up before operating ... but this was 1954). Once they removed my tonsils (adenoids came out, too, as well as my 4 front teeth) I was able finally to learn to breathe through my nose.

I wasn't diagnosed with hypothyroidism until well into middle age, but a recent CT scan of my neck and head saw this as an incidental finding: "THYROID: Not well seen, probably small/atrophic."

Thyroidsam profile image
Thyroidsam in reply to vocalEK

Very interesting research!

It would have been great to have had an ultrasound of my thyroid before RAI (no idea if it’s always been tiny or if that was post RAI).

rillo1472 profile image
rillo1472

By any chance did the worsening of your thyroid coincide with taking the flu jab or covid vaccines? I have been having some issues of pain in my thyroid and terrible hypothyroid symptoms and the only thing that happened after being stable for years is I had odd reactions and worsening of TSH after having the vaccines that is ongoing a year later.

Thyroidsam profile image
Thyroidsam in reply to rillo1472

Ummm I don’t think so as I had my 2nd covid jab back in June (I think).

I was having ‘lesser’ thyroid symptoms (feeling hungover etc.) back in Sept. However, I’d see my endo at that point and he was confused as to why I was feeling like that so he carried out a full blood works (not vitamins) and found nothing of concern (slightly low potassium and TP0 antibodies 51 with normal range being 36ish I think - he was keeping an open mind that it wasn’t thyroid related.

But after my flu jab in Oct I went downhill. I’d say that was just coincidentally though as I was already moaning about lesser symptoms.

Roadrunnergreg profile image
Roadrunnergreg

On top of the other comments you might want to read this to see if the side effects mostly or In part healthline.com/nutrition/ir...

Thyroidsam profile image
Thyroidsam in reply to Roadrunnergreg

Thanks!

Funnily enough, after downloading the Thriva app ready for my blood test. I found I’d done a health check back in 2018 when I wasn’t on any medication (I’d forgotten about it). I had low folate and vit D. So we shall see this week….

pennyannie profile image
pennyannie in reply to Thyroidsam

Did that earlier blood test from Thriva give you a T3 and T4 reading so you have an idea where you felt well and something to work towards for your unique metabolism of your T3 and T4 levels?

Thyroidsam profile image
Thyroidsam in reply to pennyannie

Hi Pennyannie, i've a new post up now with my latest results and further evidence to suggest that since RAI i'm not converting properly. The post is under "high TSH, high T4, Low T3 - advice needed".

pennyannie profile image
pennyannie in reply to Thyroidsam

Yes I know that, which is why I'm here trying to remind myself of your situation and trying to piece together what's happened.

Thyroidsam profile image
Thyroidsam in reply to pennyannie

Ahhh, sorry! Thanks 😀

pennyannie profile image
pennyannie in reply to Thyroidsam

No worries - I usually look back in order to go forward as I can't remember everybody all the time.

Thyroidsam profile image
Thyroidsam in reply to pennyannie

Very kind of you.

pennyannie profile image
pennyannie in reply to Thyroidsam

Sorry, but do we know you initial diagnosis and why you had RAI thyroid ablation ?

Was it Graves Disease ?

Thyroidsam profile image
Thyroidsam in reply to pennyannie

Sorry, I don't think I was ever told back then. I think the Endo put it down to a viral thing.. Had I been more clued up back then, I would have questioned everything so much more.

pennyannie profile image
pennyannie in reply to Thyroidsam

Ditto :

Thyroidsam profile image
Thyroidsam in reply to pennyannie

After initially being on block and replace for 18 months or so, I was taken off it due to low white blood cell count. I then have a few years of no medication etc. until I went overactive in 2019. At that point the Endo put me forward for RAI.

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