Levothyroxine, Pulmonary hypertension

[Harlech]

Had chest x-ray shows pulmonary hypertension, endro as stopped levothyroxine.

Advice appreciated

[Hidden]

Your results on 9th March were:

Tsh 0.84. (0.27 - 4.2)

Ft4 20.7. (12 - 22)

Ft3. 4.6. (3. 1 - 6.8)

Taking 5ml liquid thyroxine.

Do you have any more recent results?

[Harlech in reply to Hidden]

No those are the last 1's.

[SlowDragon Administrator in reply to Harlech]

Approx how old are you

Approx how much do you weigh in kilo

50mcg is only a starter dose levothyroxine

How long have you been left on just 50mcg

Have you had thyroid antibodies tested at any point to confirm autoimmune thyroid disease

Was test done early morning, ideally before 9am and last dose levothyroxine 24 hours before test

FT4: 20.7 pmol/l (Range 12 - 22) 87.00%

FT3: 4.6 pmol/l (Range 3.1 - 6.8) 40.54%

Ft3 is clearly too low

When were vitamin D, folate, ferritin and B12 levels last tested

High B12 can be deceiving with hypothyroidism

Paradoxical B12 deficiency

b12oils.com/paradoxical.htm...

(I always had high B12 …..until I corrected other low B vitamins by adding a good quality vitamin B complex)

[Harlech in reply to SlowDragon]

Age 74. Weight 9 1/2stone, Levo increased to 50 October 2020.

Antibodies Blue horizon

Anti- Thyroidperoidase.abs. <9.0. ( 34

Anti-Thyrogloblin abs. <10. (115

Those are for yrs 2018 2019 2020 2021

Vit D average over the above years 70. Deficiency. <25

Insufficient. 25. -50

Ferritin for 4yrs 67.5), 69.6),76.3) 68.2) (R 13-150)

B12 marked high for 4 yrs. Deficiency. <145,

Insufficient <145- 250 consider reducing dose >569

735, 1342, 1311, 1272

Folate 4.28. 5.24 4.95. 4.84. (8.83 -60.8)

NHS

2019 Vit D. 72. 7. (50 -150

2020. " <30. only just noticed

No more vit D

2020. Foliate. 4.7. (3- 12

2021. " 8. "

2022. 5.9. "

Ferritin none

B12 2020 1532. ( 200-900

2021. >2000. "

2022. >2000. "

[SlowDragon Administrator in reply to Harlech]

So your folate is deficient

This can explain high B12

All the B vitamins need each other in order to “work”

supplementing a good quality daily vitamin B complex, one with folate in (not folic acid)

This can help keep all B vitamins in balance so they can all work

Difference between folate and folic acid

chriskresser.com/folate-vs-...

B vitamins best taken after breakfast

Thorne Basic B or Jarrow B Right are recommended options that contains folate, but both are large capsules. (You can tip powder out if can’t swallow capsule)

IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate methyl folate supplement

Do you have any Low B12 symptoms?

b12deficiency.info/signs-an...

[radd in reply to Harlech]

Harlech,

Your rising Vit B12 isn’t harmful per se as long as it doesn't keep going higher & higher, but may indicate a utilisation problem, and it is possible to have high Vit B12 levels but still be deficient. For best efficacy folate and Vit B12 should balance as use the same pathways.

When the cells are unable to use Vit B12 properly they export it back to the blood, and bound to haptocorrin it is imported to the liver & recycled via bile in the ‘salvage & recycle’ pathway to the gut. Transcobalamin is another carrier transporter in the blood. If you are not utilising and have excretion issues common in people with MTHFR impairments your Vit B12 levels could continue to rise.





The NHS don't usually offer 'Active B12' tests in primary care but given your diagnosis and elevated Vit B12 levels I would ask your consultant because this may help to identify the problem. I have been given an Active Vit B12 twice on the NHS and it is used as standard at Guys Hospital (I think). Otherwise ask for further investigation because extremely high Vit B12 can be due to hematologic or hepatic disorders.

Testing homocysteine won't give indication of Vit B12 deficiency because it elevates in the presence of folate deficiency which you have, and also B6. However, having homocysteine measured might be a good idea just to alert yourself of possible oxidative stress & professionals of other cardiovascular disease risks. Also people with elevated homocysteine have been found to have low FT3 levels and this may be an incitement for your Levothyroxine to be reinstated.

Below I may have inadvertently indicated PH can be wholly reversed but should have said reversal or partial reversal is dependant upon the extent and depth of cell damage and remaining inflammation, so apologies.

If the causes are removed/reversed then there encourages a better chance of the tissue/cell damage repairing but conventional medicine doesn’t recognise a holistic approach and the conventional thought is once a diagnosis is made, it can not changed.

I am sorry you are going through all this and not receiving proper help. Keep posting here because members are always very supportive 😊.

[Harlech in reply to radd]

My Dr's will not accept private b/tests , so the last 1 i had done recommend by NHS MMH still get ignored .In 2019 I mentioned b12 was high at 1342 (145 - 569) told it was ok.

.

NHS. Aug. 2020 1532 (200 - 900) again told ok.

Sept 2021 >2000 comment from labs make app. with gp.

Jan. 2022 >2000. " abnormal - no action.

Had a phone conversation with gp in January, she said she would email an endro, phoned February and asked a about the b12 her reply was an endro and haematology say if liver b/test is OK there's no need to worry , so it's a b12 yearly b/test wait and watch I was told.

I had active b12 b /test which was over range and the Dr's have a copy. I always give the surgery copies of the private b/ tests plus I write to be added to my medical records ?.

All I can do at the moment is to phone hospital and try to speak to the endro as I forgot about high b12 and also mention PH issue .

Your reply much appreciated.

[SlowDragon Administrator]

Is your endocrinologist aware of your ever increasing B12 levels

healthunlocked.com/thyroidu...

I don’t really understand this article

But it seems to suggest high B12 and pulmonary hypertension may be linked

bmcpediatr.biomedcentral.co...

Here’s another

academic.oup.com/ehjcr/arti...

[radd]

Harlech,

If you haven't had any previous lung/heart disease and your hypothyroidism remained undiagnosed for many years and then not well managed since, your pulmonary hypertension and hypo are most likely linked.

Inadequate thyroid hormone (especially T3) produces many changes in lung & cardiac function, BP, and systemic or pulmonary vascular resistance. This usually reverses when thyroid hormones are adequately replaced together with optimal nutritional & iron cofactors that allow them to work effectively.

You are in need of optimal thyroid hormone levels more than ever and especially to raise FT3. Your endo should know this and not be withholding your Levothyroxine. I would be asking for a second opinion asap, and forwarding the links below.

Thyroid gland and pulmonary hypertension.

pubmed.ncbi.nlm.nih.gov/234...

.

Pulmonary arterial hypertension and thyroid disease. (This paper is old but evidences clear association).

scielo.br/j/jbpneu/a/VjzfzV...

.

Low T3-Syndrome & Respiratory Muscle Dysfunction In Patients With Pulmonary Arterial Hypertension.

journal.chestnet.org/articl...

[Litatamon]

Nothing to add besides I am so very sorry you have gone through all that Harlech, sigh.