Advice please.

[TraceyT30]

Sorry for the long winded post but I really need some advice.

June 2021 I had bloods taken for my extreme tiredness. TFT came back fine but Ferritin was 9. I was put on iron tablets for 3 months in which time my ferritin had crept up but GP told me to stay on them for another 3 month. At the end of the 3 month the tiredness had improved significantly.

In February 2022 I commenced a 3 month course of Terbinafine for fungal nail. 4 week after starting Terbinafine I needed a blood test to check my liver enzymes as the medication can cause liver problems. I asked the GP if they could also check my ferritin level as the tiredness had returned. He also rechecked my TFT. Liver enzymes were extremely elevated but had these rechecked after another 4 week and they had returned to normal range, Ferritin was fine but my TFT showed hypothyroidism. I was started on 125mcg of Levothyroxine daily and needed another blood test 8 week later. Had repeat bloods last week and the results showed I have now gone hyperthyroid. GP has reduced my Levothyroxine to 100mcg and review in another 8 week.

I am concerned that the Terbinafine gave a false TFT result but have researched and can not see anything about this. GP never mentioned it and did not seem concerned.

I have attached photos of my before and after Levothyroxine results.

[SlowDragon Administrator]

You were started on a high dose levothyroxine

It can take several months to settle and fine tune dose levothyroxine

Important to test vitamin D, folate, ferritin and B12 at least annually

Low vitamin levels are extremely common when hypothyroid

Likely you were already hypothyroid when low ferritin was picked up

June 2021 I had bloods taken for my extreme tiredness. TFT came back fine but Ferritin was 9

What were actual thyroid results

Are you vegetarian or vegan?

Approx age ….pre or post menopause

Heavy periods can result in low ferritin

Heavy periods common hypothyroid symptom

Have you had thyroid antibodies tested for autoimmune thyroid disease

Approx 90% of primary hypothyroidism is autoimmune thyroid disease also called Hashimoto’s

Fungal nail more common when hypothyroid

yellowtoenailscured.com/thy...

[TraceyT30 in reply to SlowDragon]

Thank you for your reply TSH in June 2021 was 1.21 mU/L ( 0.27 - 4.2 ) just checked back on my results and FT4 and thyroid antibodies weren’t checked.

I’m not vegan or vegetarian. Age 57 and post menopausal.

I have had fungal nail for 10+ years and thought it was time to get it sorted.

[SlowDragon Administrator in reply to TraceyT30]

Come back with new post once you get vitamin results and thyroid levels should be retested 8-10 weeks after dose reduction

ALWAYS test thyroid levels early morning, ideally before 9am and last dose levothyroxine 24 hours before test

Which brand of levothyroxine are you currently taking

Many people find different brands are not interchangeable

Do you normally take levothyroxine waking or bedtime

It must always be on empty stomach and then nothing apart from water for at least an hour after

No other medications or supplements within 2 hours minimum. Some like iron, calcium, magnesium, vitamin D tablets or HRT must be minimum 4 hours away from levothyroxine

[SlowDragon Administrator]

Had repeat bloods last week and the results showed I have now gone hyperthyroid.

No you weren’t hyperthyroid, but you were possibly slightly over medicated …..hence dose reduction to 100mcg

Always test thyroid levels early morning, ideally before 9am and last dose levothyroxine 24 hours before test

This gives highest TSH and lowest Ft4

It can take 6-12 months to fine tune levothyroxine dose

Important to get all four vitamins tested and optimal by supplementing if necessary, as good vitamin levels improves how levothyroxine works

You may eventually need to increase levothyroxine a little once your body gets use to improved metabolism

Common to need to fine tune dose…..eg 100mcg 3 days a week and 112.5mcg 4 days a week

[fluffywhiteclouds]

Hi Tracy, I was diagnosed with Graves (hyperthyroid) and was prescribed Carbimazole to control the symptoms. Separately I had started taking Terbinafine for fungal toenails. Very fortunately for me the Graves disappeared, as did another auto immune issue I was having after a year or so. Interestingly at the same time my fungal infection got better. I do not know if the killing of nail and other fungi or the Terbinafine or just luck sorted the immune issues. I don't think the Terbinafine made anything worse in my case as I believe I had symptoms of Graves before I started taking the Terbinafine.