Thyroid and HRT- help please

[Gertrude7]

Hello everyone,

This is the first time I've posted. I have been taking Thyroxine for underactive Thyroid for around 10 years now. My dose is currently (and has been for the last 3.5 years) 87.5mg per day and I suspect I am undermedicated. I am also taking HRT (Evorel 25 patch (change twice weekly) and Utrogestan 100 daily). I feel symptomatic and hope that someone may be able to make some sense out of my symptoms and blood results. My GP surgery seems to always consider my thyroid blood results "normal" and HRT as a separate issue. Results as follows:

12/07/23 - TSH 1.55 (0.35-5.50) and Serum free T4 11 (7.0-17.0)

31/05/23 - TSH 0.76 (0.35-5.5) and Serum free T4 11.3 (7.0-17.0) repeat test requested

10/01/23 - TSH 2.75 (0.35-5.5) no T4 done

20/07/22 - TSH 1.73 (0.35-5.50) and T4 10.7 (7.0-17.0)

04/05/21 - TSH 2.74 (0.35-5.50) and T4 11.0 (7.0-17.0)

18/03/20 - TSH 0.94 (0.35-5.50) and T4 12.9 (7.0-17.0)

21/11/19 - TSH 0.75 (0.35-5.50) and T4 13.2 (7.0-17.0)

12/09/19 - Thyroxine dose reduced from 100mg to 87.5mg on change of GP practice.

My query is whether symptoms are due to being undermedicated, for either Thyroid or Menopause symptoms as I understand many of the symptoms are the same. I am extremely tired/fatigued most of the time, struggle with breathlessness walking up hills (well actually any incline), brain fog and word finding difficulties, itchy shins, often low mood.

If anyone could throw any light on this/offer advice I would be very grateful. It would be lovely to feel "normal" again!

Many thanks

p.s. The GP who deals with HRT is due to ring me tomorrow for a phone appointment.

[Regenallotment Ambassador]

hey there good luck with your call.

My GP would say thyroid first then HRT.

I’d push for an increase to 100. I felt more like me when my TSH went under 1.0 and my T4 was at the top of the range. You don’t have any FT3 results there, worth testing privately, when this is low we feel dreadful, same with vit D, folate, B12 and ferritin.

Also when you test is it early morning, fasting with no dose beforehand 24hours?

If not you could have false high results there, a possibility.

Hope you get fuller answers in the morning and your call goes well.

🌱

[Gertrude7 in reply to Regenallotment]

Good morning Regenallotment, and thank you for your reply. I don't think i've ever had FT 3 tested as I ask for a print out of my results at the GP surgery and this only has TSH and (not always) T4. I do always ask for the first available blood test appointment, usually 8.30am and therefore 24 hours after last dose and fasting.

I will look at private testing. Hopefully the GP will be open to an increase in thyroxine dose.

Thanks again for the advice 😀.

[Flamingo60]

You are on the lowest dose of oestrogen. You could try going up to 50mg but as with all hormones it can take up to 3 months to feel the difference. As already commented it is probably best to get your thyroid sorted first then if your symptoms remain try increasing your HRT.

[Gertrude7 in reply to Flamingo60]

Thank you for your reply Flamingo60. All advice is gratefully received as I try to make sense of how I'm feeling. I had mentioned to the GP who deals with HRT (who I have a phone appointment with later today) an increase in Oestrogen but she was reluctant because I am 60 and she said that we should be looking at decreasing at my age(!) not increasing😐.

I will push for an increase in Levo today.

Thank you 😊

[Flamingo60 in reply to Gertrude7]

unfortunately your GP is not up to date with current HRT knowledge. I’ve just increased my dose to 75mg from 50mg and I’m 63. It should be symptom led and you can stay on it for life if you wish. It is well documented that there are other benefits of oestrogen replacement such as maintaining bone & heart health. Like you I am in the process of trying to get my thyroid meds at the right dose and find the whole hormone balance issue really confusing. I’m looking for a private specialist at the moment to try and make sense of it all. Many of the symptoms of hypothyroidism are the same as menopause which doesn’t help!!! The members of this forum seem really helpful and knowledgeable which is a useful resource. I hope you get sorted soon.

[Gertrude7 in reply to Flamingo60]

Thanks for that. It's comforting to know that others are struggling with the same issues. Good luck with your quest for clarity too!

[TiggerMe Ambassador]

Sound advice from Regen, I'd push to get as many blood tests as you can from your GP, they should at least be willing to do ferritin, B12 and folate which can all be responsible for breathlessness, lightheadedness and generally crappy... should also do full blood count, liver, eGFR (kidney function), HbA1c (diabetes) unlikely to do Vit D... but all the others are pretty standard offering with fatigue

Like you say you have been under medicated for a while and this can also knock you sex hormones lower, I'd aim for getting rise in your levo and if you can afford a private blood test get one that covers thyroid and sex hormones so then you can really see where you are, also Vit D and if you are really flush zinc, copper, magnesium etc

If your sex hormones are low (now post meno should be pretty stable) and need a little more HRT is can mean you'll need a small increase in levo... but you really want to see how well you are converting to fT3 as like you say it's all a balancing act 🤗

[Gertrude7 in reply to TiggerMe]

Thanks for your advice Eeyore100. I will push for the blood tests from the GP and find out what they will/won't do. I'll also look at private tests.

I've found some results from 12 months ago with Ferritin - 57 ug/L (15-300); Folate - 11.2 ug/L (>3.0); vitamin B12 - 237 ng/L (150-900). All these are "Normal" result. I have to admit I don't understand these.

I will go down the route of pushing to increase Levo first and see how I get on.

Thank you all again for your advice.

[TiggerMe Ambassador in reply to Gertrude7]

Hopefully they will retest and then pop your results up for further advice, all of those 'normal' are well below optimal, generally looking for mid range or above 😉

[Gertrude7 in reply to TiggerMe]

Many thanks for your time and excellent advice 👍

[samaja in reply to Gertrude7]

For all purposes, nothing about these results is normal and they place you quite firmly in the deficient category and no doubt you would have symptoms. You should be additionally tested for pernicious anaemia as some of your symptoms are neurological and that might mean the need for B12 injections. Not to scare you but doctors are completely and woefully ignorant about vitamins and hormones and their role in general health and if you wait for them to act before you are on your last legs - well, it doesn't happen very often. HRT puts even more demand on the system which at the moment needs all the support you can give it.

[serenfach]

The latest thoughts on HRT is to keep going no matter what the age, and not tail if off like they used to. A simple blood test can show if you are getting enough hormones in the HRT. Maybe ask for this test next time you see your GP?

[Gertrude7 in reply to serenfach]

Thank you 😊. I don't know why didn't I think of that !

[TiggerMe Ambassador in reply to serenfach]

I'm not sure that they will... it's much like being given levo and then only testing TSH they sling some HRT at you and 🤷‍♀️they don't seem bothered about where it puts you.. except testosterone

I certainly shan't be giving it up... it's like not putting oil in your car or filling the washers bottle after 80,000 miles 😵‍💫😆

[Sneedle]

Hi there,

A quick glance on my gp's screen and I saw 800 for oestrogen - I don't know what it's measured in. He said that seemed good. Can you find out your level? Then maybe someone here could look at that for you.I'm on 200mg patches, I'm 54 and plan to keep going as well.

Either way, your symptoms are what matters and stick to repeating that.

If they say all is normal, ask what's wrong with me then? (Nicely, deep breaths😀).

Detail how it affects your daily life, what you could do but now can't, how you want to get your health back, can they help you with figuring it out?

I was very confused too about menopause and thyroid symptoms. You can always ask for trial hrt if thyroid increase is a no. Or the other way round.

Good luck with it all.

[Gertrude7 in reply to Sneedle]

Thank you for the sound advice everyone, I will be assertive but polite ... if the GP rings (it was meant to be between 12 - 3pm). 😊

[TiggerMe Ambassador in reply to Sneedle]

800 pmol/L is top end but if it works for you... I think they say to mimic Follicular phase 45 - 854.... we love a nice wide range don't we 🙃 I tick over at 150 pmol/L if I go too high it really messes with my thyroid levels

femhormones.co.uk/Menopausa....

The dose of estrogen should take into account expected benefits and known risks of such therapy. The aim of oestrogen replacement should be to achieve blood levels, which correspond to those of the early follicular phase in pre-menopausal women. Indeed, blood levels of estradiol associated with the standard dose of HRT (1 mg of oral estradiol or 50 mcg estradiol patch) are between 150-370 pmol/L. It is therefore accepted that blood levels greater than 700 pmol/L should be avoided.

[Sneedle in reply to TiggerMe]

Oooh I'm so glad you sent me this, I'll look through and ponder it tomorrow. Because I've been wondering about the dose I'm on, especially since I read it could affect the thyroid.Thanks again that's awesome.👍

And. How wide is that range!? 🤔

[TiggerMe Ambassador in reply to Sneedle]

I swapped from patches to body identical transdermal (I use Lenzetto spray or there's the gel option) and you can then be a little more in control of the dosing, I prefer to be just symptom free... I feel it if I've missed a dose which seems like a good gauge? 🤷‍♀️

[Sneedle]

80 000😂

[FoggyThinker]

Hi Gertrude,

Hope your call happened and went well! Just to add to the advice above: if you do go for private bood testing there are links and discounts on the ThyroidUK website.

Do you get on OK with the Utrogestan? Most people seem to but I reacted very badly to it, it made my brain fog so bad I could barely operate at all; there are a few of us on here that found the same but, assuming you take it for only about half the month, you'd know if that was the problem I think.

Hope you're feeling better soon!

[Gertrude7 in reply to FoggyThinker]

Good morning FoggyThinker

The call did happen but the GP would only discuss HRT (not Thyroid) as that was her specialism. Anyway, she agreed to a small increase in HRT dose. We'll see if that makes any difference to symptoms.

Thanks for the tip about private testing links. I think I'm OK with the Utrogestan. I was advised when I started taking it to take in the evening as it can cause problems for some people. The label on the packaging is somewhat confusing advising to take on an empty stomach, an hour before food or two hours after food ... and two hours before bed. Since I am asleep most of the time before 10pm it is virtually impossible for me to comply with all these instructions! I take it just before bed and seem to be OK with this. I take it every day.