Levothyroxine and HRT

[PinkPants3]

Hi, I've just had some bloods done due to weight gain, feeling generally unwell, menopausal symptoms and also to review my underactive thyroid, I'm on 125mcg Levothyroxine. My T4 is 21 (range 11.20-20.20), TSH 0.04 (range 0.27-4.20), FSH has been measured at 55.9. My GP wants to start me on HRT. Does anyone has any experience with this, how does it make you feel?

[Buddy195 Administrator]

Can you edit your blood test results to include ranges (in brackets after results) as these can vary between laboratories.

Regarding HRT, it may be useful to have a look at Dr Louise Newson’s free Balance App, as I find it really useful for comparing HRT medications & having up to date research articles. There is also an ability to post questions.

healthunlocked.com/redirect... 

Some people have required a slight increase in Levo when taking HRT, but I’ve actually found the opposite and have needed a slight reduction. If you choose to trial HRT then do retest thyroid levels 6-8 weeks after being on a consistent dose.

[PinkPants3 in reply to Buddy195]

Thank you - I will check out the Balance app. I added the range to the original post. Thanks

[PurpleNails Administrator]

Welcome to forum.

Can you as the ranges to your results? Ranges vary between labs.

It is recommended test are taken early in morning after fasting and replacement is taken after draw. Do you remember the time of test & if you’d taken replacement.

The TSH is low & FT4 higher by most ranges you ideally need FT3 tested.

[TiggerMe Ambassador]

Hi, HRT is a certainly an essential part of the hormone puzzle for me, I would suggest looking into the body identical rather than the patches or pills which they tend to start you on as presumably cheaper?

@buddy195 suggestion of Dr Louise Newson's should answer all your questions and more 🤗

[SlowDragon Administrator]

As well as testing TSH, Ft4 and FT3 together……You also need vitamin D, folate, B12 and ferritin levels tested

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

Do you always get same brand Levothyroxine at each prescription

Do you know if the cause of your hypothyroidism autoimmune thyroid disease, also called hashimoto’s…..usually diagnosed by high thyroid antibodies

Assuming yes - have you had coeliac blood test

Are you on Gluten Free and/or dairy free diet

[PinkPants3 in reply to SlowDragon]

Thank you - these are good questions I will follow up with my GP & Consultant. I don't always get the same brand of Levothyroxine. Re diet - I haven't been told to follow specific diet, I had coeliac blood test a while ago. I also have controlled IBS which I'm managing with heathy diet.

[SlowDragon Administrator in reply to PinkPants3]

Many people find Levothyroxine brands are not interchangeable.

Most easily available (and often most easily tolerated) are Mercury Pharma or Accord

Mercury Pharma make 25mcg, 50mcg and 100mcg tablets 

Mercury Pharma also boxed as Eltroxin. Both often listed by company name on pharmacy database - Advanz 

Accord only make 50mcg and 100mcg tablets 

Accord is also boxed as Almus via Boots, 

 Many patients do NOT get on well with Teva brand of Levothyroxine.

Teva is lactose free. But Teva contains mannitol as a filler instead of lactose, which seems to be possible cause of problems. Mannitol seems to upset many people, it changes gut biome 

But for some people (usually if lactose intolerant, Teva is by far the best option)

Aristo (currently 100mcg only) is lactose free and mannitol free. 

March 2023 - Aristo now called Vencamil

healthunlocked.com/thyroidu...

Wockhardt is very well tolerated, but only available in 25mcg tablets. Some people remain on Wockhardt, taking their daily dose as a number of tablets 

 

List of different brands available in U.K.

thyroiduk.org/if-you-are-hy...

Posts that mention Teva

healthunlocked.com/search/p...

Teva poll

healthunlocked.com/thyroidu...

Once you find a brand that suits you, best to make sure to only get that one at each prescription.

Watch out for brand change when dose is increased or at repeat prescription.

Government guidelines for GP in support of patients if you find it difficult/impossible to change brands 

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

If a patient reports persistent symptoms when switching between different levothyroxine tablet formulations, consider consistently prescribing a specific product known to be well tolerated by the patient. 

academic.oup.com/jcem/artic...

Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).

Discussed here too

healthunlocked.com/thyroidu...

[SlowDragon Administrator in reply to PinkPants3]

A trial of strictly gluten free diet is always worth trying

Only 5% of Hashimoto’s patients test positive for coeliac but a further 81% of Hashimoto’s patients who try gluten free diet find noticeable or significant improvement, or find it’s essential

Hashimoto’s and 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 may slowly lower TPO antibodies 

as your coeliac test is negative you can consider trialing strictly 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.

Similarly….. few months later consider trying dairy free too. Approx 50-60% find dairy free beneficial

Hashimoto’s and leaky gut often occur together

IBS often linked to gluten and/or dairy issues

[Buddy195 Administrator]

As FT4 is top of the range. I would definitely look to test FT3 for a more complete picture of your thyroid health.

If TSH is within range, some surgeries may not be able to access FT3 tests, so you could look to do this privately, as many forum members do

thyroiduk.org/help-and-supp...