anxiety/palpitations

[sidneymark70]

I’ve had under active thyroid for many years. At the moment I take thyroxine (75 one day, 100 the next) I also take 50 mg sertraline for anxiety and depression. I had Covid beginning October very bad after effects after and ever since have had terrible anxiety and palpitations. Yesterday my blood pressure was raised. I haven’t felt this unwell in years and I’m looking at my medication. Does anything here ring any bells with anyone as to what I should be checking please. I have to monitor my blood pressure 10 times and then see GP.

[Lalatoot]

Raised blood pressure and anxiety can be undermedicated symptoms. I would get tsh, ft4 and ft3 tested if poss. You may need an inc in dose Also as you have been ill maybe see if vitamin levels are good and supplement where necessary.

[sidneymark70 in reply to Lalatoot]

thank you very much Lalatoot

[sidneymark70 in reply to sidneymark70]

also do you know if NHS test F3 as well as F4 please?

[Lalatoot in reply to sidneymark70]

It only seems to get done if tsh or ft4 are wildly out or if you are prescribed liothyronine t3.You might need to do a fingerprick yourself to get all the tests

[sidneymark70 in reply to Lalatoot]

ok thanks so that would be with a company like Blue Horizon? (Thank that’s their name!)

[Lalatoot in reply to sidneymark70]

Yes medicnecks is another mentioned on here. I haven't used any of them as I am lucky enough to get the gp to do mine.

[RedApple Administrator in reply to sidneymark70]

sidneymark70, ThyroidUK has a list of private lab test companies here thyroiduk.org/help-and-supp...

If you just want to do TSH, FT4 and FT3, monitormyhealth.org.uk/ are the best value and currently have a 20% BlackFriday discount code running for this week. Enter BLACKFRI20 at the checkout.

[SlowDragon Administrator]

Do you always take your levothyroxine on it’s own on empty stomach and then nothing apart from water for at least an hour after

Any other medications or supplements should be at least 2 hours away

Do you always get same brand levothyroxine at each prescription

What vitamin supplements are you currently taking

How long since thyroid and vitamin levels were last tested

request GP test thyroid and vitamins

Book early morning appointment around 9am and last dose levothyroxine 24 hours before test

 

For full Thyroid evaluation you need TSH, FT4 and FT3 tested

Just testing TSH is completely inadequate

plus both TPO and TG thyroid antibodies tested at least once

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

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 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...

[sidneymark70 in reply to SlowDragon]

thank you so much Slow Dragon for all that info! I do take Levo on empty stomach - sometimes it’s much longer than an hour as I take it when I wake up and that might be in the early hours. Does that matter? It’s so I don’t forget as I sometimes do!

Didn’t know about no other medication or supps 2 hours after taking it.

No I’m not always given same brand. There seems to a shortage of medication at my pharmacy.

I take Vit D and 2 capsules of a probiotic. Only just started them!

It’s been about a year since my levels were checked! Pretty sure he’ll say NHS don’t test bits or T3 on the NHS

YOU’re so lucky to get yours done

Thank you very much again

[sidneymark70 in reply to sidneymark70]

sorry Vits!

[SlowDragon Administrator in reply to sidneymark70]

oh I gave up long ago trying to get NHS to test …..waste of time

I use Medichecks or Blue horizon once a year - thyroid and vitamins

Currently Medichecks on offer 25% off

Monitor My Health in between times if you have dose change or brand change to test TSH, Ft4 and Ft3

Currently 20% off

GP very happy to accept private test results

[SlowDragon Administrator in reply to sidneymark70]

sometimes it’s much longer than an hour as I take it when I wake up and that might be in the early hours. Does that matter?

No it’s doesn’t matter…..the longer the better

Y

[sidneymark70 in reply to SlowDragon]

so is this blood test one you do at home please? But nervous about doing it myself. Would they do it in their clinic do you think?

[SlowDragon Administrator in reply to sidneymark70]

Both Medichecks and Blue Horizon have large list of clinics to get blood drawn at

Medichecks

medichecks.com/pages/clinic...

Blue horizon

bluehorizonbloodtests.co.uk...

You still need to post kit back after blood test done

Only booking an early morning test on Monday or Tuesday morning

watch out for postal strikes

Perhaps wait until after Christmas?

[sidneymark70 in reply to SlowDragon]

Hi SlowDragon, don’t think I can go on much longer feeling as I do. I’m frightened too with how my heart pounds. I’ve been told my a vety blunt and unkind nurse at my surgery to do 10 blood pressure readings. They’re not great. I do 3 readings and they’re all so different. First one not good and 3rd one top reading bit better but bottom always over 90! I just don’t understand it. It wasn’t so long ago my GP said my BP was fine. I feel it’s gone haywire since I had Covid badly in October. Also when I put the arm band on, when you switch the machine on and it goes up before going down to give you a reading, the band gets so tight, it’s almost unbearable. This doesn’t happen at the surgery. Is this normal?

Sorry I’m rambling but I am very low and very anxious

[SlowDragon Administrator in reply to sidneymark70]

If you order kit now ….you might get it delivered to you next week and book test for following Monday Dec 12th - post back via guaranteed 24 hours delivery

Another Strike on 14th

Alternatively beg GP for full thyroid and vitamin testing now

TSH, Ft4 and Ft3 plus vitamin D, folate, ferritin and B12

[SlowDragon Administrator in reply to sidneymark70]

Many people find Levothyroxine brands are not interchangeable.

 Many patients do NOT get on well with Teva brand of Levothyroxine.

Teva contains mannitol as a filler, which seems to be possible cause of problems. Teva is the only brand that makes 75mcg tablet. 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)

Aristo (currently 100mcg only) is lactose free and mannitol free. May 

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

beware 25mcg Northstar is Teva

List of different brands available in U.K.

thyroiduk.org/if-you-are-hy...

Posts that mention Teva

healthunlocked.com/search/p...

Teva poll

healthunlocked.com/thyroidu...

Once you find a brand that suits you, best to make sure to only get that one at each prescription.

Watch out for brand change when dose is increased or at repeat prescription.

Government guidelines for GP in support of patients if you find it difficult/impossible to change brands 

gov.uk/drug-safety-update/l...

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. 

academic.oup.com/jcem/artic...

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

verywellhealth.com/best-tim...

markvanderpump.co.uk/blog/p...

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)

As 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

[DippyDame]

Without a full thyroid test it's impossible to be certain but my guess, based on your symptoms, is that you are considerably undermedicated

thyroiduk.org/if-you-are-un...

Anxiety and palpitations can both be the result of low thyroid levels....but we don't know if that is FT4 or FT3, or both!

Re covid....I have read a theory that Covid can result in decreased levels of serum T3 and/ or T4 with no increase in TSH

This could explain your current ill health

My BP goes up if my hormone levels are insufficient.

It is vital that the essential nutrients ( see test list) are optimal to support thyroid function

I was prescribed Sertraline over 20 years ago for fibromyalgia pain....my medical knowledge back then was scant and I'm not sure it helped much. Eventually I very slowly titrated it down....and I'm very glad I made that decision. My health improved with optimal thyroidmedication.

The therapeutic efficacy of Levothyroxine can be decreased when used in combination with Sertraline.(ex DrugBank)

Full thyroid test includes...

TSH, FT4, FT3, vit D, vit B12, folate, ferritin and antibodies TPO and TG

Many of us have private tests because NHS won't do them all...discounts are available

thyroiduk.org/help-and-supp...

I'd suggest that a full thyroid test followed by correct medication would mean you no longer need Sertraline or have those debilitating symptoms.

Just a thought.....good luck!

[sidneymark70 in reply to DippyDame]

thanks so much DippyDame. All very interesting. I’ve decided to take myself off sertraline gradually. I just wish GPS knew more about the thyroid. I have seen a private endo via Benenden but he just said all my levels were fine. I looked him up on Google more thoroughly than I had done before and I think his speciality was actually diabetes. I was really disappointed. Since having Covid and feeling so ill with the after affects I’m desperately trying to help myself again. But thank you again. I have a lot of reading to do and I will chose the best place for me to tested

[SlowDragon Administrator in reply to sidneymark70]

His speciality was actually diabetes

Vast majority of endocrinologists are diabetes specialists and useless for thyroid

Before considering booking any consultation we ALWAYS recommend getting FULL thyroid and vitamin testing done

Likely to need dose adjustment on levothyroxine and/or improving low vitamin levels before seeing any thyroid specialist

roughly where in U.K. are you

Email Thyroid U.K. for list of recommended thyroid specialist endocrinologist and doctors 

[e-mail]

[Fourwhitesheps]

Hi I hope you are feeling better I was prescribed sertraline and ended up in hospital with seratonin syndrome. It lowered my BP and kept my pulse at about 56 BPM. I also have under active thyroid. Have never felt so ill when I was on them