I have recently been diagnosed by my Nurse Practitioner with Hypothyroidism. This was after I called up regarding Sleep Apnea - which I have got a appoint for at the sleep clinic in August. This is because recently (last 6-9 months) I have had zero energy and as it wasn't going away, and my partner was worried about my breathing during sleep...
Despite these new finding, I have always been an excessive sleeper, I tend to not get out of bed till the afternoon if I have no work plans etc.
I must admit I've been a little bit down of late too. Nothing drastic, just a bit blue.
My concerns are, will this medication help, as my FT4 results are on the margin, and as I suffer with anxiety, will the medication exacerbate it?
NB.
Levothyroxine sodium 50microgram tablets, start tomorrow, blood test again in eight weeks. Previous results attached.
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B0K1
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Looking at those results it really would have helped you if you had been started on Levo back in 2018/19, I think they have cruelly delayed the inevitable.
Your symptoms are symptoms of hypothyroidism. Anxiety is a symptom of hypothyroidism. Once optimally medicated anxiety should hopefully disappear along with other symptoms.
50mcg is just a starter dose, you should have regular tests every 6-8 weeks and an increase of 25mcg each time until your symptoms abate and you feel well. This generally means for most hypo patients a TSH around 1 or below with FT4 (and FT3) in the upper part of range. Don't let them leave you with a high in range TSH and low in range FT4 and tell you everything is fine because your results are in range so any remaining symptoms must be due to something other than thyroid, the aim is to make you well not just get a number into a range.
Always advised here, when having thyroid tests:
* Book the first appointment of the morning, or with private tests at home no later than 9am. This is because TSH is highest early morning and lowers throughout the day.
In fact, 9am is the perfect time, see first graph here, it shows TSH is highest around midnight - 4am (when we can't get a blood draw), then lowers, next high is at 9am then lowers before it starts it's climb again about 9pm:
If we are looking for a diagnosis of hypothyroidism, or looking for an increase in dose or to avoid a reduction then we need TSH to be as high as possible.
* Nothing to eat or drink except water before the test - have your evening meal/supper as normal the night before but delay breakfast on the day of the test and drink water only until after the blood draw. Certain foods may lower TSH, caffeine containing drinks affect TSH.
* If taking thyroid hormone replacement, last dose of Levo should be 24 hours before blood draw, if taking NDT or T3 then last dose should be 8-12 hours before blood draw. Adjust timing the day before if necessary. This avoids measuring hormone levels at their peak after ingestion of hormone replacement. Take your thyroid meds after the blood draw. Taking your dose too close to the blood draw will give false high results, leaving any longer gap will give false low results.
* If you take Biotin or a B Complex containing Biotin (B7), leave this off for 7 days before any blood test. This is because if Biotin is used in the testing procedure it can give false results (most labs use biotin).
These are patient to patient tips which we don't discuss with phlebotomists or doctors.
Also, take your Levo on an empty stomach, one hour before or two hours after food, with a glass of water only, no tea, coffee, milk, etc, and water only for an hour either side, as absorption will be affected. Take any other medication and supplements 2 hours away from Levo, some need 4 hours (iron, calcium, Vit D, magnesium).
Thyroid hormone needs optimal nutrient levels to work properly so it would be a good idea to ask your GP to test
Vit D
B12
Folate
Ferritin
If GP wont do them we have recommended private labs who will do them.
Thanks for the informative reply. Actually I am taking Vit B-complex currently, for the last month or so, to help boost my energy levels. How does it skew the results?
B Complex contains Biotin. Most labs use biotin in the testing procedure and this gives false results, either false highs or false lows so to avoid this we need to leave any supplements containing Biotin for a few days before the test.
Yes , you should take it ....most of the problems you describe here (including anxiety) should improve once you are on the right dose of levo... but be aware that this can take many months to get the dose right, so don't expect everything to feel better on this starting dose of 50mcg ....... there will be up's and down's, as your body adjust to this dose (and as the dose is later increased until you have a good level of T4 and your TSH is back down to about 1 ish where it should be .
Most people eventually need somewhere between 75mcg and 150mcg ) ...... but taking the levothyroxine is definitely the right thing to do , and you do need to do it .
Your previous results show that you could/ should have been treated with levothyroxine in 2018/2019 ( if you had any symptoms of hypothyroidism)
Feeling depressed is probably a direct result of being hypothyroid.
Anxiety is also probably a direct result of being hypothyroid.
Having zero energy for the last 6-9 months is probably a direct result on being hypothyroid.
Sleeping excessively is probably directly related to being hypothyroid.
edited* (Sleep apnea is quite possible related too).
Your T4 has only recently gone under range , true ~ but your TSH (Thyroid Stimulating Hormone) has been 'shouting' very loudly for years that your body needed more thyroid hormone (T4) than your thyroid was making .....
TSH, is a message from the pituitary to the thyroid asking for more (or less) thyroid hormone (T4) to be made. a higher number means 'make more T4 please'.
A normal healthy TSH sits around 1 ish .. anything over about 3 /4 (if it stay's there) is getting a bit suspect.... 11 is a desperate plea for your thyroid to try to make more T4 than it was doing .. but your thyroid was not able to make more than a measly 12.4ish despite the TSH shouting at it so loudly ... and it is now not even able to make that much.
Just because your T4 was in range until now , it does not mean T4 of 12.4 was enough for you to be well.... the fact that your TSH was 11 means your 'brain' (pituitary) already sensed that 12.4 was not nearly enough T4 for you .
(If T4 of 12.4 was enough for you , then your TSH would have been about 1 ish .... not 11 )
So you have now been diagnosed and treated as a case of 'overt hypothyroidism ' (TSH over / fT4 under) ..... but rather than waiting for this to happen , they could/ should have diagnosed and treated you as a case of 'subclinical hypo' at any time since 2018 .
NHS guidelines for treatment of 'subclinical' hypothyroidism ( 'when T4 is still in range') say
GP's can consider treatment with Levo (if symptoms are causing a problem) once they see :
2 x TSH results that are 'over range but under 10' ~taken 3 months apart to confirm it's not temporary.
'TSH over 10' can treated straight away , even if fT4 is in range.
Having seen where the Thyroid gland is, I am wondering if another symptom I suffer from is related...Sometimes, especially when I eat dense food, like beef, I get food stuck in my throat, I can physically feel it stuck in my throat and can even feel it slide down once free. I don't know if my Thyroid is enlarged, but if it was, could this be a symptom?
Oh and other one, a throat wheeze, not a chest one (I have Asthma too so know the difference)
Thyroid glands can somtimes enlarge to become a goitre that shows when looking at/ or feeling the neck...... but sometimes they can enlarge backwards , or downwards and this isn't always apparent visually or by feel . and yes , an enlarged thyroid can sometimes result in symptoms of difficulty swallowing/ restrictions to airway .
if you have concerns , then a thyroid ultrasound scan will show the size and shape of the gland, and will also show if there are any nodules in it .
A GP could organise an ultrasound scan to investigate any swallowing difficulties etc if you are concerned.
but i don't know much about it, or how difficult it is to get an ultrasound from the NHS because mine has never been enlarged .
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