Suggestions please

[haggisplant]

I’ve been having irregular heart rate issues for 2 months. Lots of infections and it was a month after covid. And upping to 125 oestrogen and starting testosterone. I’d started x2 Utrogestan daily a month before.

I posted a couple of weeks following feeling horrific after tonsillitis and antibiotics. I queried if there were drug interactions. As I felt thyroidy.

Last week I saw Gp about heart but then started to feel so much better the days afterwards. Just in time for a really hectic few days at work. But wiped on the Friday. Which can happen if I’m on too much thyroxine as well as too little! I had blood tests on the Friday.

My thyroid test has come back 0.05 tsh and t4 23.7. This was 9:00 am morning and I hadn’t taken thyroxine that day . The last time I may have taken biotin was the Monday, the test being at 9 am on the Friday.

Previous tests - only in jan- were 0.29 and t4 17.

I had a text today that said Due to heart palpitations the Gp wants me to reduce to 100, currently 125 and retest in 3 months. 

- did I leave enough time off biotin before test? Bit worried about reducing so much but I feel I have to. To then argue to go back up to alternating days! The irony is that I’m feeling less foggy headed now. Argh.

[haggisplant]

a year ago I had similar results on 125 x4 days a week and 150 x 3 days a week. So I only reduced by 75 per week.

This brought me down to roughly 17-19 t4 and 0.2-0.3 tsh. (Had several tests) I’m not sure if I felt great though - potentially due to long covid and not enough hrt.

I think I’m within my rights to ask for alternating day dosing? 100/125?

[SlowDragon Administrator]

Never agree to dose reduction without getting FULL thyroid including Ft3 and vitamin D, folate, ferritin and B12

Get private testing if GP won’t

Test early morning and last dose levothyroxine 24 hours before test

Do you always get same brand levothyroxine at each prescription

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 and includes BOTH TPO and TG antibodies -£29 

randoxhealth.com/at-home/Th...

If you do need to reduce…..only try SMALL reduction

Eg 125mcg 4 days and 112.5mcg 3 days……wait 6-8 weeks then retest

[haggisplant in reply to SlowDragon]

Thankyou

vitamin D, folate, ferritin and B12 - these are all good based on blood in the autumn, unsure ferritin but I’m taking iron again.

“Test early morning and last dose levothyroxine 24 hours before test” - yes I do this.

“Do you always get same brand levothyroxine at each prescription” - yes I insist after TEVA debarcle, I was pregnant too. It was a nightmare.

I thought slow titration would be a good idea. However I’m hoping they’ll agree to alternate days.

Although, tsh this time was 0.05 and t4 24 (125 daily thyroxine) whereas tsh was 0.22 and t4 24 a year ago (125/150 alternate and much less hrt). So I do agree I’m likely on too much. But such a big reduction is is I feel knee jerk.

[haggisplant in reply to haggisplant]

pleased to report that the GP apparently said “oh yes that makes sense.” Phew!!

Will drop to 125 x3 and 100 x 4. After tests will decide if x4 125 is better!

I get very anxious dropping. To their credit, they’ve allowed tsh 0.2 and even tsh 0.16 in the last year because t4 was in range. I actually think they’re looking more at the t4 at the moment.

[haggisplant in reply to SlowDragon]

slow, is it possible that being on testosterone has improved my thyroid levels? Only thing is that I’ve been asked to reduce that too…

drugs.com/drug-interactions...

[SlowDragon Administrator in reply to haggisplant]

Sorry ….no idea

[haggisplant in reply to SlowDragon]

I think there’s more info and research needed there. Utrogestan has been proven to improve t4 levels. The link above indicates there’s also a recorded change with testosterone (somewhere said something about D1) but likely an observation from men. However could have impact in women.

It’s important as it may help explain why so many women go hypo in peri menopause and also what treatments may be best for helping level their thyroid.

[Trina64]

Whoa, that is a lot of hormonal changes in a short period of time. It is going to be hard to tease out what is what. This happened to me by a naturopath doctor and it didn't end well. So, here I am starting all over, but one hormone at a time.

A lot of women struggle with progesterone and too much testosterone can definitely cause issues. Why are you on testosterone when it sounds like you haven't settled on a dose of estrogen yet? Low estrogen can cause heart palpitations.

Personally (and please work with your doctor) I would take as little progesterone as needed and get my estrogen where it needs to be before even considering testosterone. I fortunately don't need progesterone because of having a hysterectomy. Progesterone is not my friend. I am on a high dose of estrogen now and working on getting my thyroid in an optimal place. I still feel like crud, but would probably be worse without the estrogen. I stopped the testosterone a few months back because I felt aggressive and felt no benefits from it. It only complicated things.

Also, many times hypothyroid women on estrogen need more thyroid. Since you just increased your estrogen, I would be reluctant to decrease thyroid unless free T3 was over range. Your body does not need another change unless absolutely necessary. A 25mcg drop is significant too.

The antibiotics definitely didn't help either, but you didn't have much choice there. I think they can lower the effects of estrogen, but that should works itself out.

Hang in there. It takes a while to sort out and it seems to have a lot of ups and downs along the way. I am in the middle of sorting it out myself with the occasional good day here and there.

[haggisplant in reply to Trina64]

I’d been on oestrogen since 2021. I went to 100 patches in October 22. Went to 125 patches and added testosterone based on blood tests - both were low.

Ive been told this morning to drop testosterone to alternate days as it’s 2.2; 1.7 is the ideal. Previously it was below range. Oestrogen is now 580, up from 189 in jan!

[haggisplant in reply to haggisplant]

I’ve found progesterone wonderful - it’s also been shown to increase t4 which may be what’s happening here? But lowering by 25 daily thyroxine I feel is too much. Can’t get an appt for a month. (My Gp till a year ago was much easier to reach.) Tempted to drop to x4 100 and x3 125 per week.

Theyve offered the pharmacist to give me a call to ok this plan.

[Trina64 in reply to haggisplant]

My current gynecologist doesn't test my estrogen because the range is so huge that it is hard to know what is the right spot for a person. I just want to stay out of the menopause zone. I am not sure about testosterone testing. I have had it tested twice, but I don't think levels have really been established for women. I am in the U.S and our estrogen test ranges are different. Estrogen in the 500s would be incredibly high for a postmenopausal woman.

I have been at the hormone game for about 18 years after a hysterectomy. I did well on estrogen only for a while and then my thyroid gave out. Unfortunately, I didn't have a doctor who was competent with hormones and I crashed pretty hard. I have been to several doctors trying to sort this out. I think I have more capable doctors now, at least I hope so.

Maybe lowering the testosterone will help with the heart palpitations. I am having them right now, but I am only on 50mcg of levothyroxine. Fortunately I test in a few days, so I hope I can increase it soon.

Are you postmenopausal?

[haggisplant in reply to Trina64]

no I’m late peri. The oestrogen level is almost perfect for mood; here they’d allow much higher. There’s a document I can show you. I’ve been on thyroxine for 26 years and only had these palpitations when underactive but they could be over active obviously. They started a month after covid infection. I’m due an ect too. I had symptoms of low testosterone, I had a private test and then the Gp test confirmed it.

[haggisplant in reply to haggisplant]

chelwest.nhs.uk/professiona.... 500-600 for mood.

[Trina64 in reply to haggisplant]

I understand needing estrogen for mood. I take more than most doctors are willing to give here. Hopefully you get it all sorted out. Out of whack hormones are no fun.

[haggisplant in reply to Trina64]

it’s shit - sorry you’ve been struggling!

[Trina64 in reply to haggisplant]

Thanks! I am trying to just hang in there. I am wondering if I can test at 5 1/2 weeks instead of 6 weeks. My dose is so low that I wonder if it really matters.