Levothyroxine making me tired and cold. Why?

[AP1234]

I was diagnosed w postpartum thyroiditis after my third child in summer 2021. They thought it would go away but it’s not. It’s gotten worse and now the doc put me on levothyroxine 100mcg. This is my first week taking it and It’s making me really tired and cold. My last labs were TSH 36.100 T4 .55 and T3 .67

[radd]

AP1234,

Welcome to forum.

Can you supply your results ranges (numbers in brackets) so members can comment.

[AP1234 in reply to radd]

(TSH 36.100 T4 .55 and T3 .67)

[radd in reply to AP1234]

AP1234

On your results sheet there should be numbers in brackets after each result .. something like this ..

FT4 17.5 pmol/L (12 - 22)

FT3 5.1 pmol/L (3.1 - 6.8)

TSH 1.0 mu/L ( 0.27 - 4.2)

T4 is thyroxine

T3 is triiodothyronine

[AP1234 in reply to radd]

F Free T4 0.55 LOW 0.76-1.46 (NG/DL)

F T3-Total .67 .10-8.00 (NG/ML)

F TSH 36.100 HI .358-3.740 (MlU/ML)

[radd in reply to AP1234]

AP1234

Your FT4, FT3 are low and TSH high, and this is a classic presentation for hypothyrodism, ie TSH rises as thyroid hormones fall.

Levothyroxine takes up to 6 weeks to initially saturate the body which will only tolerate small increases at any one time. Your doctor should retest your thyroid hormone levels after 6 weeks and adjust the dose according to results. Leave 24 hours between last dose and blood draw and have the blood drawn early in the morning whilst fasting (water only). This ensures TSH is highest and you won’t be left under-medicated.

Take your Levo on an empty stomach, one hour before or two hours after food, with a glass of water only (no tea, coffee, milk, etc), and water only for an hour either side, otherwise you risk absorption being affected. Take any other medication and supplements 2 hours away from Levo, and iron, calcium & Vit D four hours away.

People with thyroid issues often have vitamin deficiencies and it is recommended that you ask your doctor to test Vit B12, Vit D, folate and ferritin as optimum levels are required to ensure thyroid meds work effectively.

Fatigue & coldness are usual symptoms of inadequate thyroid hormone levels and may remain a while as symptoms often lag behind good biochemistry. The goal of Levothyroxine is to restore euthyroid status and for most people that means TSH around 1.0 or below.

If you post any future blood test results complete with ranges (numbers in brackets) members will comment.

Hope you feel better soon 😊

.

Hypothyroidism

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

[AP1234 in reply to radd]

Thank you very much!

[AP1234 in reply to AP1234]

What about weight loss? I haven’t been able to lose any of the baby weight I gained and seem to be gaining more. My diet is not horrible. I try to reduce sugar and carbs as much as I can. I’m hoping the meds will also help with losing some weight?

[radd in reply to AP1234]

AP1234,

Your weight gain from having inadequate thyroid hormones levels and slowed metabolism will have compounded the post -pregnancy weight, but once optimised on Levothyroxine weight should reduce more easily. Don't cut out all carbs because thyroid hormones rely on a few to work well,

[AP1234 in reply to radd]

Thanks for the reply! That’s helpful.

[AP1234 in reply to radd]

I’m doing some research and read that iron deficiency can be directly related to hypo. I did have iron deficiency when I was pregnant and my iron is still low. Also when I took iron while pregnant it made me itch badly. That’s when I first noticed uncontrollable itching. And was itchy again when I found out I was hypo. What do you know about this? Any thought? And should I start taking iron again? I’m still on the Levo and it seems my symptoms are getting a little better. Been taking since 1/6/22. Thanks for any advice you have.

[radd in reply to AP1234]

AP1234,

Yes, iron deficiency & hypothyroidism are strongly connected as iron is required in the manufacture of thyroid hormone production. Once we are medicating replacement meds members often find iron difficult to raise until low thyroid hormone levels improve but ironically the body can show intolerance to thyroid meds in the form of palpitations, jitteriness, etc, until iron is raised. A vicious circle!

Itching overlaps in the symptoms associated with both iron & thyroid hormone deficiency, together with hair loss, tinnitus, tastes changes, breathlessness, muscle pain, the list is endless. And it can be difficult trying to identify which belongs to what but when both are optimised many/all symptoms disappear.

Members complain of both localised or systemic itching and I used to get that feeling of spiders running all over my body in bed, and itching in my ears! These conditions have both resolved but I am still prone to RLS now and again 😬. The itching is a common topic on the forum and some members have found switching their Levo brand has helped, whilst others haven’t found a solution.

Other causes may be accumulated histamine due to the body’s inability to degrade it when thyroid hormones are low and gut issues are present, high levels of prostaglandins (these raise after menstrual cycles luteal phase & give us PMS), elevated cytokines (WBC antibodies) instigated by Hashi which can make the immune response more sensitive to change such as washing powder, or eating nightshades, ie tomatoes, potatoes, etc.

You have postpartum hypo but this does not eliminate Hashi without having antibodies tested. Pregnancy instigates immense immune changes and Hashi is commonly associated with postpartum hypothyroidism that does not reverse. I am not suggesting you immediately have antibodies tested but it may be helpful to eat mindfully and avoid gluten and/or dairy and/or nightshades to see if itching symptoms improve.

I am pleased to hear your symptoms are improving as your children need you feeling well 😊 but if you have an iron deficiency it is imperative you improve levels either by eating an iron rich diet and/or supplementing. If you supplement high levels you will need to retest bloods in a few weeks to avoid levels raising too high which can be toxic.

Iron can not be excreted well and depending on the depth of the deficiency can be better absorbed when doses are kept fairly low as interacting with multiple bodily systems, the body puts safety mechanisms in place to prevent toxicity .

You will need to take iron sups 4 hours away from Levo and they are best taken with Vit C to help absorption and avoid constipation. Also, because you suffer iron deficiency the chances are high that you are low/deficient in VitB12, folate and Vit D. Have you had these tested recently? Also ensure to get your six week TFT's as you may require a Levo dose adjustment.

The link below details the importance of iron & ferritin in hypothyroidism.

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

[AP1234 in reply to radd]

Thanks for your help! I am going for more blood tests in about a month. Until then I will take some iron. I normally take c and d and I will start taking b too.

[AP1234 in reply to radd]

I had new bloods done but it looks like they only did tsh this time. I’m still feeling bad. What do you think?

TSH 3.307 .358-3.740 (MlU/ML)

Result: Normal

Accession ID: 930627585

[radd in reply to AP1234]

AP1234,

Oh, what a shame they only tested TSH.

Many feel better when TSH drops to 1.0 or under but you are still at over 3.3 and fairly new to medicating. Obviously we can’t tell your thyroid hormones levels but if you are still symptomatic with a higher TSH than many do well with, it would be prudent to assume your thyroid hormone levels are still insufficient.

I noticed a subsequent post advises you have throat swelling & a scratchy voice which could indicate Hashimotos. Hashimotos is the most common form of hypothyroidism and a progressive disease. As already advised your having postpartum thyroiditis does not eliminate Hashimotos.

Did your GP discuss a Levothyroxine dose raise?

Did you discuss having thyroid antibodies tested?

Did you discuss having iron & nutrients tested?

.

These links explain the Hashimotos & pregnancy connection.

boostthyroid.com/blog/2018/...

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

[AP1234 in reply to radd]

I go to see her in a couple of days and will ask about these things. I just did bloods before my appt. I was disappointed that she only tested tsh this time. Last time she did antibodies and it was negative. I’m hoping for an increase and maybe that will help. Do you think t3 is better or is t4 sufficient? I’ve read that a lot of ppl do better w t3 but docs don’t want to prescribe it.

[radd in reply to AP1234]

AP1234,

T3 is mainly converted from T4 but some people have genetic mutations impairing their conversion abilities, so no matter what dose of Levo they medicate they will never achieve sufficient T3 levels for well being.

However, you can not possibly know if you need T3 meds until your T4 dose is optimised for many months and iron/nutrient deficiencies have been addressed which are inhibitors of good T4 - T3 conversion themselves.

Did you have both Hashi thyroid antibodies tested , ie TPOAb & TGAb? Also as you had thyroditis it would be quite possible that you had some TRAbs in there too.

[SlowDragon Administrator]

It will take at least 2-4 weeks to see any noticeable improvement, and bloods should be retested after 6-8 weeks

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

Have you had vitamin D, folate, ferritin and B12 levels tested. Vitamins are frequently low when hypothyroid

Also request thyroid antibodies tested at next test

About 90% of primary hypothyroidism is autoimmune thyroid disease also called Hashimoto’s diagnosed by high thyroid antibodies

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

No other medications or supplements within 2 hours.

Are you currently taking any vitamin supplements

[AP1234]

Thank you! I do take zinc b c and d on a regular basis but I will request vitamin test when I go back in 6 weeks. What are your thoughts on losing the weight gained. During pregnancy and after I have gained more weight. My diet is decent and try to limit sugar and carbs but weight has become and issue. First I thought it was the pregnancy but after 6 months not losing weight and now the thyroid issue. I’m hoping the Levo would help with weight loss??

[Josephineinamachine]

Hallo 😊 it will take a while for Levo to settle in but once you’re optimally medicated you should start seeing relief of symptoms and weight may start to go. At the moment your metabolism has stalled so weight loss will be difficult. Also don’t overly restrict your diet. Your body needs to be cared for while you regain health. You may also have a lot of water retention right now - also due to being hypo. That will shift as well. I hope you feel better soon and try not to worry about the weight right now (easy to say, and I know difficult to do!) x

[AP1234]

Thanks so much for the reply! That helps!