My wife was tested in 2020. Her results are below but show Hashinotos. Her GP put her on 50mcg levo but she's still lost her zing. I'm trying to encourage her to come here and discuss her symptoms (too frequent periods, RA, long covid, allergies, weight gain, etc) with you wonderful people but she's letting the NHS do their thing (excruciatingly slowly of course). She, bless her, puts everyone else before her own health but I want her to prioritise her own health - she will then have a better quality of life!
I read elsewhere today on another post that there are other actions to take with hashimotos. Suggestions were removing gluten and reducing stress. Is there an article I can get her to read on changes to try or advice that you may have?
She always puts other people (her parents, me, etc) first, which is admirable but she doesn't really look after herself. I've tried to paint her a picture suggesting she currently has 10 units of energy and she exhausts that on her work, her ill mum, family, etc not leaving enough to prioritise recovering and keeping her health. If she prioritised herself for a change and got well she'd have 100 units of energy to use wherever.
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Can see from other posts you are also on Levothyroxine
Are these results recent…after being on 50mcg levothyroxine?
50mcg is only a STARTER DOSE
Bloods should be retested 6-8 weeks after each dose increase
Dose is increased slowly upwards in 25mcg steps (sometimes in 12.5mcg steps) ….until TSH is around or below one…..Ft4 and Ft3 at least 50-60% through range
Make an appointment with GP and get dose increase to 75mcg levothyroxine daily
Which brand of levothyroxine is she currently taking
Many people find different brands are not interchangeable
Many people don’t get on with Teva brand
Teva is only brand that makes 75mcg tablets
Teva contains mannitol as a filler, which seems to be possible cause of problems.
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, Glenmark 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
She should have a review at least every year, more frequent for the first few years. Does she have more recent blood test result? If not it is quite likely she is seriously under-medicated.
It's possible her GP surgery have overlooked her during the COVID panic and failed to call her in for monitoring. You could get a cheap blood test thyroiduk.org/help-and-supp... , I use the Monitor My Health one because it is cheap and reliable.
Before looking into complex explanations it makes sense to get her on an adequate dose so try to persuade her to chase up her doctor. If her levels are low I'd be tempted to go straight onto 100 mcg levothyroxine as this is being used as a starter dose more frequently nowadays.
In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months.
The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).
The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range.
……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.
The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.
Arrgghh, 50mcg levothyroxine isn’t going to be enough. It’s as simple as that and the GP who’s just left her to languish on that dosage has been negligent.
When we start on levothyroxine we should have thyroid blood tests every 6-8 weeks and the dose of levothyroxine should be raised until symptoms resolve—which might not be until TSH is low in range, below 1.0 and sometimes lower than that. The levels of FT4 and FT3 are important too (but sadly many GPs have been taught that they aren’t).
The trouble is, when we’re left undermedicated we start to feel really low in mood as well as generally unwell, so I’m not surprised she doesn’t want to make a fuss—that’s surprisingly common—but her quality of life could be so much better than it is right now.
I like your analogy—it’s a bit like the spoons theory that many with ME/CFS/FM talk about. healthline.com/health/spoon...
I’d absolutely encourage her to make an appointment with her doctor for up to date thyroid function tests and for Vit B12, folate, iron, ferritin and Vit D tests too. She deserves to have the chance to feel well again. I wouldn’t worry about cutting out any food groups at this stage—getting to a good level of thyroid hormone replacement has to be the priority.
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