Thyroid swelling from levo

[Ajva]

I was put on levo t4 50mg 2.5 weeks ago. I was on NDT armour for 6 months. Had to come off of it due to heart issues.

The heart isssues are probably worse on the levo, plus I have a really swollen thyroid and glands. It started as soon as I switched over. It is actually causing me issues struggling to get oxygen to my lungs.

I did have an ultra sound a few weeks back which showed a goitre. But what ever is going on has got really bad since being on levo.

I am a bit stuck what to do and wondered whether anyone else has had the same issue.

[SlowDragon Administrator]

50mcg is only a STARTER dose levothyroxine

How much NDT were you taking

What were last thyroid test results and ranges

Request GP test vitamin D, folate, ferritin and B12

What vitamin supplements are you currently taking

When were vitamin levels last tested

Air hunger or breathlessness common hypothyroid symptom….especially if iron/ferritin are low

Thyroid levels should be tested 6-8 weeks after any dose change or brand change in levothyroxine

Which brand of levothyroxine are you currently taking

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

[Ajva in reply to SlowDragon]

I was only on 1 grain armour. These were my last labs. As you can see my t3 was getting really high & t4 low. I have bloods booked for a few weeks time which will be 6 weeks after starting levo. I do understand I am on a small starter dose so will need an increase.

I am getting all vitamins and iron tested as iron is low. I supplement alot take iron, magnesium, pro biotic, omegas, multi vit and vit D.

I guess I won’t really know what is going on until I get lab results will I. I am waiting to see if my private thyroid Dr can get my levo compounded at their pharmacy, will also add in some t3 after next bloods.

Red

[SlowDragon Administrator in reply to Ajva]

High thyroid antibodies confirms autoimmune thyroid disease also called Hashimoto’s

Approx how much do you weigh in kilo?

Have you had coeliac blood test done yet

Or are you already on strictly gluten free diet

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

Multivitamins never recommended on here

Which multivitamin are you currently taking

Most contain iodine not recommended for anyone with Hashimoto’s

How much vitamin D are you currently taking

Important to regularly retest vitamin D twice year when supplementing

Retest full iron panel test including ferritin 3-4 times year if taking iron supplements

Test folate and B12 at least annually

[Ajva in reply to SlowDragon]

I am on strictly GF diet. I have not had bloods done for coeliac so that is something I can do. I am taking 2,000 vit D. My vit D levels are actually quite high according to my last blood test. I weigh in stone around 8.9. I would say I am slightly over weight for my height at the moment. I am usually 8 stone and that is fine. But my medication and energy levels are causing me to gain weight even though diet is good.

Will get al vitamins tested in next bloods

Thank you

[SlowDragon Administrator in reply to Ajva]

Come back with new post once you get retested after 6-8 weeks on 50mcg levothyroxine

Always test 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 are you currently taking

Rather than taking a multivitamin, test folate, ferritin and B12 at least annually and only supplement if necessary

Test vitamin D twice year when supplementing

No point testing for coeliac as already on strictly gluten free diet

[Ajva in reply to SlowDragon]

I am on teva brand. Yes of course will come back in 6 weeks to post as I have a blood test booked. Thank you!

[SlowDragon Administrator in reply to Ajva]

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 next 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...

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, 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

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