Levothyroxine and breast tenderness?

[woosMum]

Has anyone else experienced breast tenderness whilst on Levothyroxine? I've been on 50mcg since December and have been tender best part of 8 weeks. I've always had a bit of a "hormone" belly which is a bit bigger than usual. Have seen a nurse and had my breasts checked but she couldn't find any reason for it. I know it isnt listed as a side effect but with it all being hormonal plus quite a few comments when Googled, I wondered if any of you had this? Xx

[SlowDragon Administrator]

High prolactin can be caused by being hypothyroid

Hyper prolactin can cause sore breasts

Request GP test prolactin levels

50mcg is only a starter dose levothyroxine

Have you had thyroid levels retested

Bloods should be retested 6-8 weeks after each dose change

Have you had thyroid antibodies tested for autoimmune thyroid disease and vitamins

About 90% of all primary hypothyroidism in Uk is due to Hashimoto’s.

If not been tested yet request these are included at next test

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)

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

Recommended on here that all thyroid blood tests early morning, ideally before 9am 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 and money off codes

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

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.

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...

[woosMum in reply to SlowDragon]

Thats brilliant, thank you. I had blood tests last week as I have been getting lots of pain in my wrists and elbows but I cant access my results, they just tell me to get it repeated in 3/ 4 months time. I do have a goitre, although it it years since I had an ultrasound. I did remember to not take my Levothyroxine before my last blood test. This is all so interesting, going to have to make notes as I cant retain information! Thank you again. Xx

[SlowDragon Administrator in reply to woosMum]

You are legally entitled to printed copies of your blood test results and ranges.

The way to get access to current and historic blood test results is to register for online access to your medical record and blood test results

UK GP practices are supposed to offer everyone online access for blood test results. Ring and ask if this is available and apply to do so if possible, if it is you may need "enhanced access" to see blood results.

Link re access

healthunlocked.com/thyroidu...

In reality many GP surgeries do not have blood test results online yet

Alternatively ring receptionist and request printed copies of results. Allow couple of days and then go and pick up.

Important to see exactly what has been tested and equally important what hasn’t been tested yet

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

Which brand of levothyroxine are you currently taking

Have you had thyroid antibodies and vitamins tested at diagnosis or recently, if not request that they are tested

Carpal tunnel extremely common when hypothyroid/under medicated

You’re highly likely in need of next dose increase in levothyroxine

On levothyroxine TSH should always be under 2

Aim is to be on high enough dose for Ft4 to be in top 1/3rd of range and Ft3 at least 50% through range

All four vitamins need to be tested and at GOOD levels for levothyroxine to work well

NHS only tests and treats vitamin deficiencies

Come back with new post once you get results

Thousands upon thousands of U.K. thyroid patients forced to test privately

[woosMum in reply to SlowDragon]

Thank you. I requested access well over a year ago but as yet it hasnt happened. Am waiting on an appointment with the nurse/ clinical practitioner I saw last week so will bring it up then. Thanks again. Xx

[SlowDragon Administrator in reply to woosMum]

Strongly recommend getting printed copies of your test results BEFORE consultation with nurse practitioner

That way you can see exactly what has been tested

And more importantly what still needs testing

[woosMum in reply to SlowDragon]

Good idea, thank you. Xx

[SlowDragon Administrator in reply to woosMum]

Come back with new post for advice, before you see the nurse

50mcg is only a starter dose, likely you are ready for next dose increase in levothyroxine up to 75mcg daily

Which brand of levothyroxine are you currently taking

You don’t want to change brand while increasing dose, (always best to reduce the variables)

TSH should be under 2 as an absolute maximum when on levothyroxine

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 median TSH in healthy population is 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...

Persevere - have all guidelines printed out and be ready to quote them

healthunlocked.com/thyroidu...

[woosMum in reply to SlowDragon]

My current batch is from North Star? Xx

[SlowDragon Administrator in reply to woosMum]

Many people find Levothyroxine brands are not interchangeable.

Northstar 50mcg and 100mcg are Accord brand

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

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 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

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

[woosMum in reply to SlowDragon]

Blimey, so much to try to understand. Thank you for all the information, its good to know there is somebody who knows what is going on. Xxx

[SlowDragon Administrator]

This is better article on high prolactin and hypothyroidism

ncbi.nlm.nih.gov/labs/pmc/a...