Morning everyone. Yesterday I was taken unwell while at work. I had some palpitations and felt a little short of breath. I work in Ambulance control room so was able to have an 12 lead ECG and observations done. My BP was very high, 184/97 (possibly due to me panicking as this did come down) I has ECG changes also so ended up having bloods done at hospital. The ED doctor was happy after more tests that it was possibly thyroid related.
Its been a year since my last blood test. My TSH level had gone up to 4.8 so my levothyroxine was increased from 75mcg to 100mcg a year ago as I was getting symptoms and feeling quite poorly. The ED doctor has said that my TSH was 0.7 yesterday and this could be the reason for the arrhythmia. They are going to write to my doctor with a suggestion I see an endocrinologist I am GP led at present. I have no other thyroid results and when I asked no others were down as TSH was in normal level. The doctor has told me to reduce levo to 75mcgs one day and then 100mcg the next.
My question is I thought 0.7 was a good TSH level to have? Generally I feel well... hair loss is minimal, best I've felt in ages with the exception of the hospital visit.
I will be getting some private thyroid tests done. Does anyone have any thoughts? Thank you
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Celestineuk
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Thank for the response slowdragon. I did notice that when I got my prescription 2 weeks ago, the levothyroxine was a different brand. Does this make a difference?As for supplements, I take B12 (i used to get tablets on prescription but GP told me to supplement myself) Selenium, Vitamin D, Zinc, probiotic and Codliver oil.
My last blood tests were just over a year ago but unfortunately I was just told the results were 'normal' and due to my surgery linking to another, my patients access doesnt work so cant see the levels. I am unsure if vitamin levels were checked.
I think with covid and lockdowns and the pressure of working for NHS, I've taken my eye off the ball with my own health.
What brand were you taking and what are you taking now
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 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
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.
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
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
Thank you! This is great information. It never dawned on me that different brands could make a difference. My usual prescription is Mercury Pharma. This time I have been given Accord. To my knowledge, I've not had any of the others.
I take my levothyroxine first thing in the morning with water and nothing else for about an hour.
I take my atorvastain and supplements before bed. I found that the atorvasatatin made me feel quite nauseous for quite a while after taking it so I switched it to evening.
Explain that brand was changed and new brand is possibly causing issues and you need to rule that out before considering changing your dose levothyroxine
My question is I thought 0.7 was a good TSH level to have?
Assuming it was within the range (presumably they didn't tell you the reference range, many start at around 0.27 or 0.35) then that is not an abnormal result. But dose adjustment shouldn't be made on TSH, please refuse any dose reduction until a full thyroid panel - TSH, FT4 and more importantly FT3 - has been done. It's the FT3 that tells us if we are overmedicated and rarely done.
Thank you Seasidesusie. I shall make sure I keep taking my usual dose until that's sorted. So difficult with GP as they rarely pay any attention to anything other than TSH and when you try to explain, they quickly dismiss you. I will get private ones down and go in armed with the evidence.
Going by your TSH and hormone dose this doesn't look like it is thyroid related. You really need TSH, fT3 and fT4 measured but my guess is they will be fine.
Have you been referred to a cardiologist? It seems more important to check out your heart at the moment as your thyroid is probably OK.
Hi Jimh111I have not been referred to anyone as yet. I was seen in ED initially. They did bloods to rule out a cardiac event and I also had a chest x ray to rule out any PE.
I've never had abnormal ecg before and my BP is usually on the lower side of normal with a slower HR usually between 49-54.
It was the ED registrar that intimated it was thyroid related and he also told me to change my dose, which i am very reluctant to do given i have better than I have in a long time. He asked if I was seen by endocrinologist but as we all know, my type of hypothyroidism is GP led and usually not very well
I'm hoping i get an appointment/follow up in the next few days.
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