Supplements

[Cassie75]

What supplements should I avoid when taking 75mg levo

[Lalatoot]

Usually best to get vitamin levels tested first and then supplement with only those you are deficient in. Supplements taken 2 hours away from levo. Vit D taken 4 hours away from levo.

[Cassie75 in reply to Lalatoot]

Thank you

[SlowDragon Administrator]

Welcome to the forum

How long have you been on 75mcg levothyroxine

Which brand of levothyroxine are you currently taking

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)

Do you have most recent thyroid and vitamin results

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

On levothyroxine it’s important to test vitamin D, folate, ferritin and B12 at least once a year

Low vitamin levels are very common on levothyroxine

[Cassie75 in reply to SlowDragon]

Thank you for your reply, I was diagnosed with hypothyroidism over twenty years ago have been on 75mg levothyroxine for about the last 8 years.

[SlowDragon Administrator in reply to Cassie75]

What were your most recent thyroid results

High cholesterol suggests under medicated for thyroid

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

What vitamin supplements are you currently taking

Do you always get same brand levothyroxine at each prescription?

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 at least once year minimum

Low vitamin levels are extremely common, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)

Low vitamin levels more common as we get older too

Autoimmune thyroid disease with goitre is Hashimoto’s

Autoimmune thyroid disease without goitre is Ord’s thyroiditis. Both are autoimmune and generally called Hashimoto’s.

In U.K. medics never call it Hashimoto’s, just autoimmune thyroid disease (and they usually ignore the autoimmune aspect)

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...

monitormyhealth.org.uk/

NHS easy postal kit vitamin D test £29 via

vitamindtest.org.uk

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...

[Cassie75 in reply to SlowDragon]

This was latest, going to have another one on Monday, my levo is mercury pharma but it is not always the same .

Photo

[SlowDragon Administrator in reply to Cassie75]

How do you feel?

Presumably this is TSH result?

Just testing TSH is completely inadequate

You need TSH, Ft4 and Ft3 tested at same time, plus test vitamin D, folate, ferritin and B12 once year minimum

TSH has a diurnal variation….and is highest early morning

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

gponline.com/endocrinology-...

Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L.

NHS England Liothyronine guidelines July 2019 clearly state on page 13 that TSH should be between 0.4-1.5 when OPTIMALLY treated with just Levothyroxine

Note that it says test should be in morning BEFORE taking levothyroxine

Also to test vitamin D, folate, B12 and ferritin

sps.nhs.uk/wp-content/uploa...

Graph showing TSH in healthy population is around 1-1.5

web.archive.org/web/2004060...

Aim is to bring a TSH under 2.5

UK guidance suggests aiming for a TSH of 0.5–2.5

gp-update.co.uk/SM4/Mutable...

[SlowDragon Administrator in reply to Cassie75]

What time is blood test on Monday

was diagnosed with hypothyroidism over twenty years ago have been on 75mg levothyroxine for about the last 8 years.

Presumably you were on higher dose previous to dose reduction 8 years ago

How much was dose reduced

What were thyroid levels before dose was reduced

Dose should never be reduced based just on TSH

[Cassie75 in reply to SlowDragon]

blood test at 9:50 so i will just have water before. i think i was on 150 mg for a while and then settled on a 100mg recent blood tests say i am pre diabetes a borderline high cholesterol just want to make sure that it is not all connected.

[SlowDragon Administrator in reply to Cassie75]

High cholesterol and pre diabetes almost certainly linked to reduced levothyroxine

In future always test by 9am

NHS unlikely to test more than TSH (plus Ft4 if your lucky)

Likely to need to get full testing privately

Many thyroid patients when adequately treated will have TSH around or under one

Most important result is always Ft3, followed by Ft4

When adequately treated Ft4 should be at least 60-70% through range, if not higher. And Ft3 at least 50% through range

Low Ft3 tends to lower vitamin levels because being hypothyroid frequently results in low stomach acid

Low stomach acid leads to poor nutrient absorption and low vitamin levels as direct result

Low vitamin levels tend to lower TSH

[SlowDragon Administrator]

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

[SlowDragon Administrator]

High cholesterol and relatively high TSH for someone on levothyroxine suggests you may benefit from small dose increase in levothyroxine

Come back with new post once you get full thyroid and vitamin testing results

nhs.uk/conditions/statins/c...If you have an underactive thyroid (hypothyroidism), treatment may be delayed until this problem is treated. This is because having an underactive thyroid can lead to an increased cholesterol level, and treating hypothyroidism may cause your cholesterol level to decrease, without the need for statins. Statins are also more likely to cause muscle damage in people with an underactive thyroid.