Night sweats too much levothyroxine????

[BlueKeith]

Been to doctor about the night sweats I've been having and bowel issues and wondered if I maybe need an increase in levothyroxine . He said it probably sounds more like I'm over medicated. I'm getting blood taken and testing for thyroid, liver , kidney and lipids?? . Has anyone had problems with night sweats and it been over medication causing it?

[SlowDragon Administrator]

previous post discussing this

healthunlocked.com/thyroidu...

Presumably you have now had thyroid and vitamin levels tested

What are your results for B12, folate, ferritin and Vitamin D

Refuse to reduce dose levothyroxine

More likely to be under medicated on only 75mcg levothyroxine

ALWAYS test thyroid levels early morning and last dose levothyroxine 24 hours before test

Approx how much do you weigh in kilo

Guidelines on dose levothyroxine by weight is 1.6mcg levothyroxine per kilo of your weight per day

[BlueKeith in reply to SlowDragon]

I'm 84 kg . I am going to demand results and put them on this site .

[SlowDragon Administrator in reply to BlueKeith]

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

[SlowDragon Administrator in reply to BlueKeith]

84kg x 1.6mcg levothyroxine = 134mcg as the likely eventual dose levothyroxine required for someone of your weight

When left under medicated, it’s highly likely you will have developed low vitamin levels

When hypothyroid we frequently develop low stomach acid, this leads to poor nutrient absorption and low vitamin levels as direct result

For GOOD conversion of Ft4 (levothyroxine) to Ft3 (active hormone) we must have OPTIMAL vitamin levels

NHS only tests and treats vitamin deficiencies

You will need to self supplement to maintain OPTIMAL levels

Low vitamin levels tend to lower TSH because poor conversion results in high Ft4 and low Ft3

Dose levothyroxine should be only be increased SLOWLY upwards in 25mcg steps

[BlueKeith in reply to SlowDragon]

He said he's going to test for everything. I'm assuming vitamins as well. All the doctors at my practice are very cautious about increasing my levothyroxine. I've mentioned a few times and they usually give me a condescending laugh and say over is always worse than under. Now they on about reducing it. Why are nhs so anti levothyroxine?

[SlowDragon Administrator in reply to BlueKeith]

They seem incapable of reading basic guidelines

Levothyroxine doesn’t top up failing thyroid….it replaces it

it’s not a medication, it’s a replacement thyroid hormone….because your thyroid is no longer working

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.

NICE guidelines on full replacement dose

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

Also here 

cks.nice.org.uk/topics/hypo...

[SlowDragon Administrator]

ESSENTIAL to test TSH, Ft4 and Ft3

Private tests are available as NHS currently rarely tests Ft3

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/

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...

10% off code here 

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

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...

Tips on how to do DIY finger prick test 

healthunlocked.com/thyroidu...

[SlowDragon Administrator]

I'm getting blood taken and testing for thyroid, liver , kidney and lipids?? . 

When is this test being done

Book early morning, ideally just before 9am and last dose levothyroxine 24 hours before test

Come back with new post once you get results

High cholesterol (lipids) linked to being under medicated thyroid wise

Poor kidney function directly linked to being hypothyroid and is fully reversible

High HBA1C linked to being hypothyroid

Make sure B12, folate, vitamin D and ferritin are tested

Plus TSH, Ft4 and Ft3

[BlueKeith in reply to SlowDragon]

Thanks for explaining the lipids. The test is Thursday afternoon 4-20.

[SlowDragon Administrator in reply to BlueKeith]

waste of time

Rebook next week at 9am

[BlueKeith]

Will change it for an earlier slot. On holiday next week.

[SlowDragon Administrator in reply to BlueKeith]

come back with new post once you get results

Book as near 9am as possible

Don’t take your levothyroxine until after blood test

[SlowDragon Administrator]

Have you had thyroid antibodies tested for autoimmune thyroid disease yet?

If not request these are tested

TPO and TG thyroid antibodies

You also need coeliac blood test done BEFORE considering trial on strictly gluten free diet

[BlueKeith in reply to SlowDragon]

No antibody test. The doctor said no point because treatment is same. 🙄

[SlowDragon Administrator in reply to BlueKeith]

but you need to know

So if they don’t test antibodies will need to test privately via Medichecks or Blue horizon

See what else GP doesn’t test ….before ordering private testing. NHS rarely tests Ft3 or vitamin D

Assuming antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).  

Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels 

Low vitamin levels affect Thyroid hormone working 

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 test positive for coeliac, but a further 80% find strictly gluten free diet helps or is essential due to 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.

[BlueKeith in reply to SlowDragon]

Thanks for all the info again .