Night sweats

[BlueKeith]

For the last 3 months I've been waking up in the night completely drenched in sweat. At first i thought it might be a virus then I thought it might be the metformin I've been prescribed for diabetes. I'm now thinking it might be the levothyroxine as I was talking to an old work colleague and she got put on levothyroxine same time as me and she has started doing the same. I'm only on 75mcg though . Anyone else with same problem?

[Lalatoot]

For me night sweats were one of the symptoms of being on too low a dose. If you could share thyroid blood results we would be more likely to give you informed opinions and help.

[SlowDragon Administrator]

Night sweats often low B12

When left on too low dose levothyroxine, vitamin levels frequently drop

ESSENTIAL to test B12, folate, ferritin and vitamin D

Request GP test these plus FULL thyroid test including TSH, Ft4 and Ft3…..plus thyroid antibodies if not been tested yet

How long have you been left on just 75mcg levothyroxine

ALWAYS test thyroid levels early morning, ideally just before 9am and last dose levothyroxine 24 hours before test

Which brand of levothyroxine are you currently taking

Do you always get same brand levothyroxine at each prescription

What vitamin supplements are you currently taking

Metformin frequently lowers TSH

So just testing TSH is completely inadequate

cureus.com/articles/50564-e...

[SlowDragon Administrator]

Levothyroxine doesn’t “top up” failing thyroid it replaces it

Essential to be on high enough dose

Approx how much do you weigh in kilo

Guidelines on dose levothyroxine is that most people eventually need to be on approx 1.6mcg levothyroxine per kilo of your weight per day

Typically dose is increased slowly upwards in 25mcg doses. Bloods should be retested 6-8 weeks after each dose increase. And repeat testing every 2-3 months until levels are stable

pathlabs.rlbuht.nhs.uk/tft_...

Guiding Treatment with Thyroxine: 

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.

[Mividauk2]

I recently started to have them too. I know I am unsermedicsted. Will argue my case with GP for an increase. I am also learning about a supportive diet for my gut.

[Mividauk2 in reply to Mividauk2]

I meant undermedicated

[SlowDragon Administrator]

Night sweats

Low B12 symptoms 

b12deficiency.info/signs-an...

methyl-life.com/blogs/defic...

Optimal vitamins

serum B12 is at least over 500

Active B12 at least over 70

Vitamin D at least over 80nmol minimum

Folate and ferritin at least half way through range

Assuming you have low B12 GP should test for Pernicious Anaemia BEFORE starting any B12 injections or daily supplements

If you don’t get B12 injections

B12 drops 

healthunlocked.com/thyroidu...

B12 sublingual lozenges 

amazon.co.uk/Jarrow-Methylc...

cytoplan.co.uk/shop-by-prod...

B12 range in U.K. is too wide

Interesting that in this research B12 below 400 is considered inadequate 

healthunlocked.com/thyroidu...

Note that improving folate when B12 is very low is not a good idea. Taking folate before B12 is good enough can lead to severe neurological problems.

en.wikipedia.org/wiki/Subac...

It is vital if you intend to supplement both B12 and folate that B12 is started a week before the folate.

vitamin B complex for other B vitamins

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

This can help keep all B vitamins in balance and will help improve B12 levels too

Difference between folate and folic acid 

chriskresser.com/folate-vs-...

Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid.

thyroidpharmacist.com/artic...

B vitamins best taken after breakfast

Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule) 

Thorne currently difficult to find at reasonable price, should be around £20 

If you want to try a different brand in the meantime, one with virtually identical doses of the ingredients, and bioavailable too, then take a look at Vitablossom Liposomal B Complex. Amazon sometimes has it branded Vitablossom but it's also available there branded as Yipmai, it's the same supplement

amazon.co.uk/Yipmai-Liposom...

or available as Vitablossom brand here

hempoutlet.co.uk/vitablosso... &description=true

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 and continue separate B12 until B12 is over 500

recommended to be taking a B12 supplement as well as a B Complex (to balance all the B vitamins)

once your serum B12 is over 500 (or Active B12 level has reached 70), stop the B12 and just carry on with the B Complex.

express.co.uk/life-style/he...

Night sweats can also be low blood sugar

healthline.com/health/diabe...

everydayhealth.com/type-2-d...

[Alanna012 in reply to SlowDragon]

Slowdragon, I would really love to print off your lists on posters and get them put up in every doctors reception area and every thyroid department waiting room. Or the side of buses. They are brilliant! I think I need them on bookmarks.

You and all the other moderators and contributers are brilliant, thank you so much!

[SlowDragon Administrator]

metformin also lowers B12

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

So as a hypothyroid patient, this increases likelihood of low B12…..and being on Metformin does also increase risk

What’s your diet like

If vegetarian or vegan that almost always results in B12 deficiency unless supplement daily

[BlueKeith in reply to SlowDragon]

My doctor did say that they would test for B12 after been so long on metformin if I showed any symptoms but is rare . I am booking to see a doctor even though I've had 2 telephone appointments already and been fobbed off. I told them I had brain fog first time and brain fog and night sweats the second . They just said could be the diabetes and to see if diet and metformin improves symptoms. I'm sure it's to do with thyroid though. Especially the brain fog. Thanks again slow dragon. Will post results when I get them. Thank you.

[SlowDragon Administrator in reply to BlueKeith]

make sure you get new thyroid test done early morning and last dose levothyroxine 24 hours before test

you need TSH, Ft4 and Ft3 tested ….plus thyroid antibodies

Plus B12, folate, vitamin D and ideally full iron panel test including ferritin

Are you still only on 75mcg levothyroxine

How much do you weigh in kilo

NHS only tests and treats vitamin deficiencies

You may have to self supplement if they won’t prescribe B12 injections or daily B12 supplement

Thousands of members self supplement Vitamin D and vitamin B complex……often need separate B12 initially

[BlueKeith in reply to SlowDragon]

I weigh 83kg now as I have lost 3kg since taking metformin. I still take 75mcg because my usual doctor thinks it's more than enough. He says increasing could cause more harm than good. There's only one doctor in my practice that said he reckoned he would raise the levothyroxine but I'm not allowed to see him . Its case of you get who you get .

[BlueKeith in reply to SlowDragon]

Its getting complicated as I have diabetes to add to the mix now. I need to eliminate low blood sugar too. Thanks for all advice slow dragon and everyone else on this website. If I had better general practitioners I probably wouldn't have to keep trying self diagnosing myself. When I get next blood tests I am going to demand a copy for myself. They have seemed very unwilling to do so the last few times.

[SlowDragon Administrator in reply to BlueKeith]

Frequently necessary to go over GP’s head and see thyroid specialist endocrinologist

Always test early morning and last dose levothyroxine 24 hours before test

Guidelines on dose levothyroxine by weight suggests you are likely to eventually be on approx 132.5mcg levothyroxine per day …..obviously way under that at moment so thyroid levels likely very poor

Dose levothyroxine is increased slowly upwards in 25mcg steps until Ft4 is near top of range, Ft3 at least 50-60% through range and all four vitamins tested and optimal levels (that often means self supplementing )

Still being hypothyroid because not on high enough dose levothyroxine can adversely affect HBA1C

Getting levothyroxine dose increased and fine tuned can improve diabetes numbers

diabetesincontrol.com/hypot...

Before considering booking any consultation you need FULL thyroid including Ft3 and thyroid antibodies and vitamins

Email Thyroid U.K. for list of thyroid specialist endocrinologists and doctors who will prescribe T3 if clinically appropriate 

[e-mail]

Roughly where in U.K. are you

like you I was left 5 years on 75mcg levothyroxine, by then in wheelchair or bedbound

Only by seeing endocrinologist did I get dose levothyroxine increased high enough. More on my profile

[BlueKeith in reply to SlowDragon]

I live in east Yorkshire. Thanks slow dragon

[Alanna012]

I had night sweats on levo 75mcg too. I would be freezing and simultaneously soaked in sweat. My personal opinion is that 75mcg is the worse dose to be on, because that's usually when TSH starts to drop significantly. The health practitioner then declares you are 'good' because the TSH has dropped somewhere below 5 and you end up languishing on that dose.

All the advice above is good, an increase will help.

[BlueKeith in reply to Alanna012]

Yes I wake at around 2 or 3 freezing soaked in sweat. Its trying to get through to the doctor. Thanks

[Lotika]

Nightsweats can also be a symptom of vitamin d deficiency - it is how I was diagnosed in the first place - so vit d levels would definitely be worth checking.

[SlowDragon Administrator in reply to Lotika]

low vitamin D and low B vitamins interconnected

drgominak.com/wp-content/up...

drgominak.com/about/

[Pearlteapot in reply to SlowDragon]

this article about vitamin D, B5 the biome and sleep disorders is really interesting! Note that he says b5 dose shouldn’t be more than 100 and only for a few months. Excess dose led to agitation and insomnia . Most supplements are sold as 500! I wonder how people are doing on that.

[BlueKeith in reply to Lotika]

Ok. Will ask if nhs checks for VIT d. Thanks

[BlueKeith in reply to Lotika]

Very interesting lotika. Was talking to someone today who gets numerous symptoms in winter including night sweats and he is Turkish but lives in uk and has had to start having vitamin d injections.

[SlowDragon Administrator in reply to BlueKeith]

Government in U.K. recommends everyone supplements vitamin D at very least Oct to April

gov.uk/government/news/phe-...

Test vitamin D first before starting, as hypothyroid patients are frequently extremely deficient

NHS Guidelines on dose vitamin D required depending on results

ouh.nhs.uk/osteoporosis/use...

GP will often only prescribe to bring vitamin D levels to 50nmol.

Some areas will prescribe to bring levels to 75nmol or even 80nmol

leedsformulary.nhs.uk/docs/...

GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)

mm.wirral.nhs.uk/document_u...

But, improving to around 80nmol or 100nmol by self supplementing may be better

pubmed.ncbi.nlm.nih.gov/218...

vitamindsociety.org/pdf/Vit...

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

Test twice yearly via NHS private testing service when supplementing 

vitamindtest.org.uk

Come back with new post once you get results

[Regenallotment Ambassador]

I’ve had nightsweats most of my life. Followed SlowDragon advice and now more optimal dose and vits improving and guess what, it’s gone! GONE! 🦋💚🦋