Itching and levothyroxin: Hi all, I was put on... - Thyroid UK

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Itching and levothyroxin

Bmco profile image
Bmco
15 Replies

Hi all,

I was put on levothyroxin for high TSH about three weeks ago. The first couple of weeks I had niggling headaches which thankfully seem to have passed but this week I’ve had crazy itching kick in!! It’s been awful, my hands, my scalp, my back. It seems to come in intense slots each place at a different time. I spoke to the dr who had given my a strong antihistamine and suggested I come off the thyroid medication for two weeks.

Just wonder if anyone else has experienced this? My thought was it’s perhaps too higher dose for me (my TSH was 10.3 but my 4 is fine apparently so I don’t technically NEED the meds this Dr said when asking me to stop).

Thanks in advance x

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Bmco profile image
Bmco
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SlowDragon profile image
SlowDragonAdministrator

welcome to the forum

A TSH over 5 is hypothyroid, so having TSH over 10 you definitely do need to be on replacement thyroid hormones

Starting levothyroxine - flow chart 

gps.northcentrallondonccg.n...

Which brand of levothyroxine are you currently taking

Many people find different brands give different results

Lots of people react to acacia powder in some brands of levothyroxine

Better to try different brand…..not stop the levothyroxine

How much levothyroxine have you been started on

Looking at your other posts, looking likely you have autoimmune thyroid disease

Have you had thyroid antibodies tested yet or vitamin levels?

Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine

 

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested.

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high thyroid antibodies 

Autoimmune thyroid disease with goitre is Hashimoto’s

Autoimmune thyroid disease without goitre is Ord’s thyroiditis. 

Both are autoimmune and generally called Hashimoto’s.

Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)

20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis 

In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)

Recommended on here that all thyroid blood tests early morning, ideally just before 9am and last dose levothyroxine 24 hours before test 

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins

List of private testing options and money off codes

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code

thyroiduk.org/getting-a-dia...

monitormyhealth.org.uk/

NHS easy postal kit vitamin D test £29 via

vitamindtest.org.uk

Only do private testing early Monday or Tuesday morning. Watch out for postal strikes, probably want to pay for guaranteed 24 hours delivery 

Link about thyroid blood tests

thyroiduk.org/getting-a-dia...

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

Symptoms of hypothyroidism 

thyroiduk.org/wp-content/up...

helvella profile image
helvellaAdministratorThyroid UK

Bmco,

Your TSH wouldn't be 10.3 if you didn't need thyroid hormone! (Barring some extremely rare conditions.)

Trying antihistamines is a good approach to proving that you are having a histamine reaction. But an awful approach to dealing with the problem.

There are many different formulations of levothyroxine even within the UK. You might find one affects you badly while the others have little or no such effect.

Some people seem to find that while they can tolerate things like lactose and mannitol and acacia in some products, when taken as part of levothyroxine they are more sensitive.

My medicines document has a matrix of the ingredients most often thought to cause problems against all UK makes.

helvella - Thyroid Hormone Medicines

I have created, and try to maintain, a document containing details of all thyroid hormone medicines in the UK and, in less detail, many others around the world. It is sectioned by UK - rest of the world, and by T4, T3, desiccated thyroid, etc.

From Dropbox:

dropbox.com/s/wfhrlmb5983co...

From Google Drive:

drive.google.com/file/d/11z...

Matrix of UK levothyroxine against some excipients
SlowDragon profile image
SlowDragonAdministrator

The only easily available brands are

Teva…..Widely available but upsets many people

Mercury Pharma …often listed at pharmacies as Advanz available in 25mcg, 50mcg and 100mcg

Accord …also boxed as Almus via Boots or Northstar via Lloyds. Only 50mcg and 100mcg tablets

Wockhardt ….some people only tolerate this brand. 25mcg tablets only. Can obviously get prescription for more tablets per day as dose is increased

Aristo …..possibly….only currently 100mcg tablets until next year

Jazzw profile image
Jazzw

How much levothyroxine were you prescribed? If it wasn’t a large enough dose it may have made things worse rather than better.

And what brand did you receive from the pharmacy?

As others have said, you’ll still need thyroid replacement hormone. Your doctor shouldn’t have said what they said about you not needing it. You do! Taking levothyroxine isn’t like taking an antibiotic. It’s thyroid replacement hormone you’ll need to take for life.

greygoose profile image
greygoose

Hi Bmco, welcome to the forum.

Technically, this doctor has no idea what he's talking about. No idea how this all works. He said your FT4 is 'fine' because it's somewhere within the range, but that doesn't automatically mean it's 'fine'. With a TSH of over 10, I would imagine it's pretty low in-range, which wouldn't be good enough.

TSH is a pituitary hormone - Thyroid Stimulating Hormone. When the pituitary - a gland in your brain - senses that there's not enough thyroid hormone in the blood, it releases TSH to tell the thyroid to make more. If the thyroid doesn't respond, it releases more and more TSH.

The thyroid hormones are T4 and T3. The tests to measure these levels are called Free T4 and Free T3. Really 'fine' levels of these - what we call euthyroid levels, of someone who has no thyroid problems - are around mid-range, with the FT4 slightly higher in-range than the FT3. And, a euthyroid TSH would be around 1 - never higher than 2, because at that level it means your thyroid is struggling.

The ranges for these blood tests are derived from averaging out the results from a sample - too small sample, usually - of the population. But, the people they use have not been screened for thyroid problems. So, they could be hypo or they could be hyper, which means that the ranges are far too wide and do include both hypo and mildly hyper results. So, it's where your result falls within the range that is important, not the number itself.

Now, you haven't given us the actual numbers: results, ranges, size of dose - so we don't know where it falls. But, imagine it does fall exactly mid-range. That might be mistaken for being euthyroid, if you just take the FT4 result in isolation. But, you can't do that. You have to look at the TSH - and, preferably, the FT3 as well - and see how the two/three fit together. Say you have a TSH of 10, and an FT4 mid-range. What that means is that the pituitary is having to work extra hard, to stimulate the thyroid, just to get that result. And that is not euthyroid. It is hypo. So, you needed the levo to raise your FT4, so that the pituitary would not need to release so much TSH. And, you should continue increasing the dose of levo until the TSH falls back to about 1 or under, and the FT4 and FT3 are in a place that makes you well.

So, your doctor was very wrong to say you didn't need it. You do. And you also need to get a copy of your blood test results, with the ranges, every time you have a blood test, and learn to understand them (we can help you with that). Because, I'm afraid, doctors often are wrong where thyroid is concerned. They just haven't had the education to know much about it. Which is why forums like this exist to help people with doctors like yours. :)

Bmco profile image
Bmco

Hi

Thanks for this and everyone for your replies. This sadly wasn’t my normal dr who is the one who first prescribed me, I have my full blood work (always do this) and she said that my FT4 is 15.8. Looking at the sheet this is definitely at the lower end.

I think what this has done is show me I also know nothing about this and just readily accepted whatever when it was mentioned, in the hopes I might feel better.

I’m on the 50mg produced by TEVA. And I did not take it today and have taken the strong antihistamine. The itching isn’t great but is better for sure. To be honest I was so desperate after 5 days of the itching I was happy to accept anything! I shall be booking a review next week, hopefully with my normal dr, and will discuss all of this. By mid week I am hoping that if it were the Tiva causing the itching then I will have seen a significant improvement - or that is what this dr suggested. But who knows!!

I haven’t had FT3 or antibodies tested. But my blood work from 3 weeks ago when I was put on the TEVA did include vitamin d, folate, ferritin and b12. All were in the “normal” range but folate was very low within it and b12 wasn’t great, despite me taking a decent multivitamin and iron (my ferritin is low too but actually fairly good for me - I frequently struggle with this unless I am in hardcore iron supplements for 6 months).

It feels like what the dr presented as a “shall we try you out on this” has thrown me down a rabbit hole!!

Thanks again all - I’ll report back after I get my head around it and follow up with the dr x

greygoose profile image
greygoose in reply to Bmco

despite me taking a decent multivitamin

More likely because you're taking a multivitamin. They are very bad things to take, for many reasons. But if it contains iron - which most of them do - you won't have absrobed any of the vitamins because iron blocks them. Also, if it contains iodine, it could be making you worse. How long have you been taking it?

Bmco profile image
Bmco in reply to greygoose

hi, I don’t take iron (which is on prescription) with anything else. My multivitamin is thankfully a good one which seems to helps me - bloods tests show. Although I know a lot can be a waste of time and harm absorption of other things. Despite having a very healthy diet I always struggle to keep levels above the lower end of normal. This one I’ve been on for a few months (the MV that is).

Today I’ve been intermittently coming out in red spots on my arms and legs so I think whatever this is caused by has really hit my allergic response. Dr again next week for sure and going to request another thyroid tablet rather than just stopping altogether - thanks to the insight from this group.

greygoose profile image
greygoose in reply to Bmco

But does your MV contain iodine?

Your nutrient levels are probably low because your stomach acid is low - another hypo symptom - making it difficult for you to digest food and absorb nutirents. It's not about how healthy your diet is, it's about how much you can absorb. And, as a general rule, hypos can't absorb much.

Bmco profile image
Bmco in reply to greygoose

just checked and no iodine.

but it’s interesting you say about low acid. For ages my dr kept saying it was the opposite and i very much felt it was different. As if I did drink (minimally) or have something acidic I actually felt better. No idea if it works like this but that is how I felt.

This also makes sense I went on PPI I became anaemia and had horrendously low levels of vitamins. They are known to limit absorption but when you combine it with me having a hard time doing that anyway…

Thanks so much for these helpful replies!

Regenallotment profile image
Regenallotment in reply to Bmco

This is so familiar, my gp suggested the same but a small glass of water with a dribble of cider vinegar actually helps! Interestingly whenever I had a gastro bug as a child/teen I would always crave acidic juices. Betaine with pepsin has been a game changer for meals I can't digest too.

Bmco profile image
Bmco in reply to Regenallotment

yes same - I really realised when I started with apple cider vinegar too! Now I take a pro biotic every day and things have calmed somewhat thankfully.

helvella profile image
helvellaAdministratorThyroid UK

Please consider putting in a Yellow Card report for any medicine which causes you problems - itching or anything else.

It is only when we tell them that they know. Otherwise they assume all is well. When it clearly isn't.

🟨 Making Yellow Card Reports 🟨

healthunlocked.com/thyroidu...

Bmco profile image
Bmco

hi all - thought I would do a quick update on here!

I ended up having to see a private dermatologist as was still suffering even two weeks after coming off levothyroxin. My dr did so many bloods and nothing showing up particularly apart from the TSH still being high (although lower than where it was).

I’m apparently suffering from urticaria - which they think was triggered by the change in thyroid and made worse by a virus. I’m back on levothyroxin (accord now not Teva). Have to take strong antihistamine twice a day for 6 months - they are hoping to reset the behaviour of the mast cells.

Thank you so much for all the amazing responses on here. It really helped me when it came to reviewing with my dr and then the dermatologist!

SlowDragon profile image
SlowDragonAdministrator

Highly likely you have autoimmune thyroid disease also called Hashimoto’s diagnosed by high thyroid antibodies

Has GP tested both TPO and TG antibodies

If not these will be included in your Medichecks test next week

Request GP do coeliac blood test

Very common once start levothyroxine that gluten intolerance becomes more obvious

nice.org.uk/guidance/ng20/c...

1.1 Recognition of coeliac disease 

1.1.1 Offer serological testing for coeliac disease to:

people with any of the following: 

persistent unexplained abdominal or gastrointestinal symptoms 

faltering growth

prolonged fatigue 

unexpected weight loss

severe or persistent mouth ulcers

unexplained iron, vitamin B12 or folate deficiency

type 1 diabetes, at diagnosis

autoimmune thyroid disease, at diagnosis

irritable bowel syndrome (in adults)

first‑degree relatives of people with coeliac disease.

Poor gut function with Hashimoto’s can lead leaky gut (literally holes in gut wall) this can cause food intolerances.

Most common by far is gluten. Dairy is second most common. 

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps, sometimes significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link) 

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies 

While still eating high gluten diet ask GP for coeliac blood test first or buy test online for under £20, just to rule it out first 

Assuming test is negative you can immediately go on strictly gluten free diet 

(If test is positive you will need to remain on high gluten diet until endoscopy, maximum 6 weeks wait officially) 

Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse

chriskresser.com/the-gluten...

amymyersmd.com/2018/04/3-re...

thyroidpharmacist.com/artic...

drknews.com/changing-your-d...

Non Coeliac Gluten sensitivity (NCGS) and autoimmune disease

pubmed.ncbi.nlm.nih.gov/296...

The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported

nuclmed.gr/wp/wp-content/up...

In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned

restartmed.com/hashimotos-g...

Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.

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