Enlarged thyroid from medication?

[Aligoth]

I've been on medication since April 2021, different options were trialled, none available on the NHS seem to work. (I seemed to be on a good track with NDT but again not available on NHS)

I don't have hashimoto just a conversion issue for which I am.prescribed liothyronine. Most recently my dosage was upped to 40mcg but my numbers both t3 and the keep going lower. My TSH is of course suppressed at 0.01

In the last 6 months or so I've started having neck pains where I have to make an aware effort to keep my neck upstraight to avoid discomfort. I haven't quite developed a goitre but not sure I'd be able to tell since I have a fat short neck to begin with

Could medication (that for some reason doesn't seem to help my levels) have actually upset and enlarged my thyroid?

[SlowDragon Administrator]

On just T3 …..bloods should be retested 6-8 weeks after each dose increase

Always test thyroid levels early morning, ideally before 9am and day before split T3 into 3 smaller doses taking last dose approx 8-12 hours before test

Assuming testing 9am

So on 40mcg T3 …..day before test …taking 20mcg waking, 10mcg early/mid afternoon and last 10mcg dose between 9pm and 11pm

Only do private testing early Monday or Tuesday morning

Looking at previous posts

Can’t see any recent vitamin D, folate, ferritin or B12 test results

What vitamin supplements are you currently taking

When were vitamin levels last tested

[Aligoth in reply to SlowDragon]

The last tests were done In the hospital at at least 6 weeks after changes. Vitamin were done before starting last year, i used to supplement and still do all those you mentioned. everything optimal.

Takin liothyronine lowers my numbers but tanks my TSH so I do t produce anything on my own.

Is it possible this causes thyroid enlargement? Cause it seems weird I am having neck/throath issues now.

[SlowDragon Administrator in reply to Aligoth]

Common sensation when under medicated

Vitamin levels need testing at least annually, more frequently after all the many dose changes you have had

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

On just T3, when adequately treated, you would expect TSH to be full suppressed, Ft4 extremely low and Ft3 very near top of range

[Aligoth in reply to SlowDragon]

How long would you advice stop taking supplements before testing for vitamins as well? I already stop b complex 3 days before any test to avoid biotin interference but I still take vitamin d and iron bisglycinate

[SlowDragon Administrator in reply to Aligoth]

If testing iron, you should stop iron supplements a week before test, test full iron panel, early morning and fasting ….don’t eat high iron meal the night before test

Need full iron panel test 2-4 times year if self supplementing iron

medichecks.com/products/iro...

Vitamin D….take up to test, just not on morning of the test

Vitamin B complex, stop 5-7 days before. You might want to take a separate folate and separate B12 during that week you stop vitamin B complex

[Aligoth in reply to SlowDragon]

So vitamin d, folate and b12 i can take up to the day before the test, but not the b conplex or the iron, right?Ferritin was 40ug last check, I just started supplementingast month just in case cause tracking my food and micronutrients at times it seemed like I had a hard time reaching RDA

[SlowDragon Administrator in reply to Aligoth]

Yes correct

You only need to stop vitamin B complex because it contains biotin. Biotin is used in many labs as part of test process

Iron, only necessary to stop a week before if actually testing iron and ferritin levels

Never assume that because ferritin is low, that iron is too. You can have high iron and low ferritin, that’s why it’s important to get full iron panel test if taking iron supplements

[Aligoth in reply to SlowDragon]

Right I can easily do that then thank you. B complex I stopped exactly for the biotin but I kept hearing 72 hours so never stopped it for more than 3 days prior testing will try a week next time. Thanks again.

Do you know where I can find ideal rather than just in range values for those vitamins I. Case of hypothyroid?

[SlowDragon Administrator in reply to Aligoth]

Typically

Vitamin D at least around 80nmol and around 100nmol maybe better

Serum B12 over 500

Active B12 over 70

Folate and ferritin at least half way through range