constipation and hypothyroidism

[Xmrkn20]

I have very severe constipation and now have backache, am wondering if the two are linked. Am due to have another blood test in a couple weeks, as I have only recently been diagnosed so am on a low dose of Levythyroxine. Is this something others suffer with?

[SeasideSusie Remembering]

Xmrkn20

Constipation is a very common symptom of hypothyroidism. It may sort itself out once you are optimally medicated although there's no guarantee. I've been diagnosed/on Levo since 1975 and my constipation has never eased so the only way for me is to take magnesium citrate. Vit C might help too. With both you take enough to produce a BM the next day, build up slowly and if you get diarrhoea then reduce dose a bit, it's easier if you use powder rather than tablets/capsules so that you can tailor the dose to suit your needs.

[Xmrkn20 in reply to SeasideSusie]

thanks SeasideSusie . I will look into the magnesium citrate idea, sounds promising!

[pennyannie]

Hello Xmrkn :

Can you please give forum members a little more information - there is nothing on your profile page - what have you been diagnosed with, what has been prescribed and do you have a copy of the original blood test results and ranges and the medical evidence of this new diagnosis ?

[Xmrkn20 in reply to pennyannie]

sorry, yes I was diagnosed with hypothyroidism in November

[Jaydee1507 Administrator]

It's really common to get new symptoms once started on a low dose of Levo. Constipation is a very common hypo symptom. Mine resolved with a good dose of folate.

Get your GP to check key vitamin levels - ferritin, folate, B12 and D3. Low levels of these contribute to symptoms. As hypo people we get low stomach acid which means we don't absorb vitamins properly. Low vitamin levels will contribute to your current symptoms.

[Xmrkn20 in reply to Jaydee1507]

thank you Jaydee1507. I suffer with constipation a bit anyway but at the moment it’s terrible. Will mention to GP when I have blood test next week.

[SlowDragon Administrator]

How old are you

How much levothyroxine were you started on

Bloods should be retested 6-8 weeks after each dose change

Dose levothyroxine is increased slowly upwards in 25mcg steps

What were your thyroid and vitamin results when diagnosed

ESSENTIAL to test thyroid antibodies, vitamin D, folate, ferritin and B12 if not tested yet

Book early morning blood test and last dose levothyroxine 24 hours before test

Levothyroxine doesn’t “top up” failing thyroid, it replaces it. Important to get started on high enough dose and dose increased as fast as tolerated

Symptoms of hypothyroidism 

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

Constipation is extremely common hypothyroid symptom

As SeasideSusie said…..magnesium citrate in evening (at least four hours away from levothyroxine) can help

Calm vitality magnesium powder is cheap and easy to use. Start with a teaspoon in warm water …..increase until get desired effect. Too much can cause diarrhoea

Daily vitamin C might help too

But you are highly likely ready for next dose increase in levothyroxine

[Xmrkn20 in reply to SlowDragon]

Thanks   SlowDragon . I have another blood test next week, which will be 7 weeks since diagnosis. I am 56 and on 50 mcg Levythyroxine. Will look into Magnesium citrate, it’s getting real uncomfortable now.

Don’t actually know what my test results were, doctor just said both scores were low. I will ask for more info next week.

[SlowDragon Administrator in reply to Xmrkn20]

You are legally entitled to printed copies of your blood test results and ranges.

The best way to get access to current and historic blood test results is to register for online access to your medical record and blood test results

UK GP practices are supposed to offer everyone online access for blood test results. Ring and ask if this is available and apply to do so if possible, if it is you may need "enhanced access" to see blood results.

Link re access

healthunlocked.com/thyroidu...

In reality many GP surgeries do not have blood test results online yet

Alternatively ring receptionist and request printed copies of results. Allow couple of days and then go and pick up.

Important to see exactly what has been tested and equally important what hasn’t been tested yet

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)

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

ALWAYS test 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 thyroid 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/

Monitor My Health also now offer thyroid and vitamin testing, plus cholesterol and HBA1C for £65 (doesn’t include thyroid antibodies)

monitormyhealth.org.uk/full...

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...

[SlowDragon Administrator in reply to Xmrkn20]

So your highly likely ready for next dose increase in levothyroxine

it typically takes 6-12 months to slowly increase dose levothyroxine upwards in 25mcg steps

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.

The aim of levothyroxine is to be on high enough dose that Ft4 result (levothyroxine) is at least 60-80% through range and Ft3 (active hormone) at least 50-60% through range

Ft4 is inactive and must be converted into Ft3 before it’s useable

For good conversion of Ft4 to Ft3 we need good vitamin levels

[Xmrkn20 in reply to SlowDragon]

SlowDragon thank you so much, this is so useful. Now I know exactly what to ask for next week and can make sure they are testing everything if poss. So glad I joined this forum!

[elwins]

I always make sure I get a copy of results for future reference. As mentioned above you are legally entitled to them, I am lucky I can get printed copies soon after asking for them.

[Xmrkn20 in reply to elwins]

elwins i looked online last night and found my results. They didn’t tell me they were there!

[SlowDragon Administrator in reply to Xmrkn20]

So what were your results

Is this from BEFORE starting on levothyroxine?

[Xmrkn20 in reply to SlowDragon]

SlowDragon Yes the result was before I started on Levothyroxine. They tested ferritin, folate, B12, full blood count, all of which were ‘satisfactory’. Then glycosylated haemoglobin and vit D3 was ‘normal’ so only the thyroid function test was abnormal. The results for that was : FT4 = 7.3 pmol/L [7.7-15.1], TSH = 6.38 mil/L [0.34-5.6].

[SlowDragon Administrator in reply to Xmrkn20]

what were actual results for vitamin D, folate, B12 and ferritin

Within range = normal

That’s not necessarily optimal

Optimal vitamin levels are

Vitamin D at least over 80nmol and between 100-125nmol might be better

Serum B12 at least over 500

Folate and ferritin at least half way through range

[Xmrkn20 in reply to SlowDragon]

Folate was 17.4ug/L [3.1 - 19.9]. Ferritin 68ng/mL [11.0 - 306.8], B12 250ng/L [144.0-915.0], D3 57.5 nmol/L

[SlowDragon Administrator in reply to Xmrkn20]

so B12 and vitamin D need improving

Are you now taking any vitamin supplements?

Suggest starting with vitamin D

at least around 2000-3000iu per day

Retest vitamin D in 2-3 months

only add one supplement at a time

After 2 weeks add separate B12 supplement

Look at increasing iron rich foods in your diet to improve ferritin nearer 100

[Xmrkn20 in reply to SlowDragon]

Thank you. Really useful to see what they should be, doctor didn’t mention the other tests at all so I just thought ‘satisfactory’ didn’t need to be addressed.

[SlowDragon Administrator in reply to Xmrkn20]

NHS only tests and treats vitamin deficiencies

Down to us as individuals to maintain OPTIMAL vitamin levels

On levothyroxine we need vitamins at GOOD levels for good conversion of Ft4 (levothyroxine) to Ft3 (active hormone)

A correctly working thyroid makes approx 80-90% Ft4 but crucially also makes 10-20% Ft3 ……on just levothyroxine (Ft4) we need conversion rate as high as possible to try to keep Ft4 and Ft3 roughly equal through range (at least 50-70% through range)

Many people on just levothyroxine end up with high Ft4 and low Ft3 …..this results in poor gut function, poor nutrient absorption and low vitamin levels……making conversion rate worse

So it’s essential to maintain optimal vitamin levels

[SlowDragon Administrator in reply to Xmrkn20]

Low vitamin D

NHS Guidelines on dose vitamin D required

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 with Hashimoto’s, 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

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function.

There’s a version made that also contains vitamin K2 Mk7. 

One spray = 1000iu

amazon.co.uk/BetterYou-Dlux...

Another member recommended this one recently

Vitamin D with k2

amazon.co.uk/Strength-Subli...

It’s trial and error what dose we need, with thyroid issues we frequently need higher dose than average

Vitamin D and thyroid disease 

grassrootshealth.net/blog/t...

Vitamin D may prevent Autoimmune disease 

newscientist.com/article/23...

Web links about taking important cofactors - magnesium and Vit K2-MK7

Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine

Calm vitality magnesium powder is excellent for improving constipation

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

An article by Dr Malcolm Kendrick on magnesium 

drmalcolmkendrick.org/categ...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

Government recommends everyone supplement October to April

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

[SlowDragon Administrator in reply to Xmrkn20]

Low B12 symptoms 

b12deficiency.info/signs-an...

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

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...

With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a B12 supplement and add a separate B Complex (to balance all the B vitamins) after 2 weeks

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

vitamin B complex

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-...

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

[Suvi8901]

Constipation?

Have you tried Laxido?

Guaranteed to empty your bowels if you’ve got a sluggish gut particularly due autonomic neuropathy. My fibre intake is huge as a vegetarian but my autonomic neuropathy is probably causing poor peristalsis?

1/2 sachets per day for a week will loosen up faecal impaction and clear blockages higher up!👆

Also drink more water!

[Jaybrooke]

rhubarb complex capsules , twentyfirstcenturyherbs, anyone suffering chronic constipation , amazing results. No bloating no gripeing pain as you have with normal laxatives.

[Kapuna]

Absolutely! Go online and check for the symptoms of hypothyroidism. One of them is constipation.

[helvella Administrator]

I've just been looking at an old document from about 1899 which discusses the symptoms of hypothyroidism.

Repeatedly, it mentions constipation and rachialgie (French word meaning spinal pain).

Sorry to confirm your suspicion.

[humanbean]

I take magnesium citrate because a) everyone needs magnesium and b) I need help with constipation too. I struggle with vitamin C because I have chronic gastritis and can't cope with acidic things.

When I have no choice but to resort to commercial products I buy Sodium Picosulfate, sometimes called Pico Liquid, available from pharmacies without prescription. I use it the absolute bare minimum that will do the job. For me that is likely to be a maximum dose (20ml) one evening before bedtime. Say I do that on a Monday. If that is not as successful as I would like I will take a second dose on Wednesday.

Do not buy a huge bottle if you think you won't need it very often. If you do what the box tells you (which I don't) it suggests disposing of the contents after about a month ? or thereabouts, once the bottle is opened. I haven't had a problem with taking the stuff months after opening as long as it is before the expiry date.

[Chrysali]

I, too, was just very recently diagnosed. The constipation was quite bad, and it was magically resolved a couple of weeks after the dose of levo was upped to 75ug. What surprised me was that what I ate made no difference to bowel motions, or the lack of them. It seems that only getting a higher dose of levo helped. Now I am really hoping to lose some of the excess weight.

[Xmrkn20 in reply to Chrysali]

My dose was increased to 75mcg in March but constipation still an issue, it’s like the muscles in my bowels have just ceased!! But I think lack of exercise is making it worse as I have been overloaded at work lately. Planning to try gluten free diet and gym membership when I get to the end of my project in a couple weeks. Fingers crossed!!