Recently diagnosed with Hashimoto's

[pancake1971]

As the title says-just been diagnosed. I was lucky enough to see a good Endocrinologist and despite my TSH not being sky high (it was 4.3) he has put me on thyroxine 50mg once daily. I have been on it for 2 weeks now with no sign of improvement in my symptoms-fatigue, headaches, sinus issues, stomach problems, reflux. How long does it take for the medication to start helping with symptoms? I have a horrid feeling my symptoms are not related to the thyroid at all and I will face another battle to get to the route cause.

[SlowDragon Administrator]

It will take at least 2-6 weeks for dose to begin to have effect

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

50mcg is only the standard STARTER dose

Which brand of levothyroxine are you taking

Have you had vitamin levels tested yet, as per previous post

If not get these done ASAP or at next test

Plus coeliac blood test done if not already on strictly gluten free diet

healthunlocked.com/thyroidu...

[pancake1971 in reply to SlowDragon]

Thanks SlowDragon. I'm having a repeat Blood test at the 8 week mark. I'm taking Accord Levothyroxine. My TPO's were over 400. I did have vitamin levels tested. Unfortunately, I don't have the ranges but the Endo said the following were normal-B12 of 351 (never been very high), folate of 5.23 (again never been high) and ferritin 132 (which I think is good). T4 was 13.7 and T3 4.2.

Vit D was 44 which he said was low so am taking over the counter supplements. My testosterone was also tested (am 51 yr old female) and was undetectable so he has started my on some testogel.

My coeliac test was negative but he did advise a 'low gluten diet' because of thyroid (rather than 'no gluten diet') I'm also trying to do a low acid diet as I have what I think is pepsin reflux so with all the dietary changes I feel I've got myself into a bit of a pickle as my diet is now very restricted and a bit miserable and I still feel unwell!

I wondering whether to not do the low acid diet and just go strictly gluten free for a bit to see if that helps. I've always had bowel problems when I eat a lot of gluten so know I have some sort of intolerance.

Any further advice is gratefully received!

[SlowDragon Administrator in reply to pancake1971]

Best to not make too many changes at once …as you have discovered

Are you taking levothyroxine on empty stomach and then nothing apart from water for at least an hour after. No other medications or supplements within 2 hours

Some like vitamin D, magnesium, iron, HRT at least 4 hours away

How much vitamin D are you taking

Is it a pill you swallow. ?

If so, must be four hours away from levothyroxine

You might find vitamin D mouth spray or drops that you absorb in mouth give better absorption and they can be taken only an hour away from levothyroxine

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

Suggest you try 3000iu as mouth spray or drops

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

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Interesting article by Dr Malcolm Kendrick on magnesium 

drmalcolmkendrick.org/categ...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

[SlowDragon Administrator in reply to pancake1971]

I wondering whether to not do the low acid diet and just go strictly gluten free for a bit to see if that helps. I've always had bowel problems when I eat a lot of gluten so know I have some sort of intolerance.

Yes I would agree…..just cut out gluten at this stage

Stomach acid levels should improve anyway as thyroid dose is increased

[SlowDragon Administrator]

B12 and folate on low side, but not low enough for GP to prescribe

In 2-3 weeks ……after getting settled on vitamin D supplements ……consider adding a separate B12 …..and 1-2 weeks later a daily vitamin B complex

Low B12 symptoms 

b12deficiency.info/signs-an...

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

With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a separate B12 supplement and add a separate vitamin B Complex after a week 

Then once your serum B12 is over 500 (or Active B12 level has reached 70), you may be able to reduce then stop the B12 and just carry on with the B Complex.

If Vegetarian or vegan likely to need ongoing separate B12 few times a week 

B12 drops 

healthunlocked.com/thyroidu...

Or

B12 sublingual lozenges 

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

Or

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...

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 

healthline.com/nutrition/fo...

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-£25. iherb.com often have in stock. Or try ebay 

Other options 

healthunlocked.com/thyroidu....

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

[pancake1971]

Thank you Slow Dragon that is all so helpful. I've been merrily taking all my medication within an hour of one another (including thyroxine, omeprazole, Vit D, Vit B6 and HRT) so I'm going to change that. I would also like to come off the omeprazole as I've been on it for 3 months with no change to my digestive/overall issues and I'm aware that it can have some negative effects on absorption of vitamins too. Are you able to comment on the use of omeprazole at all in the light of a diagnosis of Hashimoto's?