I just wanted to check if anybody has had acne develop not long after starting Levothyroxine?
I was diagnosed in December 2022 and in mid March 2023 I started to get bad cystic acne and unfortunately it is still on my face. There have been no other changes to my diet or routine so I am assuming it is my medication or maybe inflammation from consistently high antibodies.
I am taking 75mcg of Levothyroxine and my bloods have all come back as normal but my antibodies remain quite high.
My Thyroid peroxidase antibodies came back as 158.4
My Thyroglobulin antibodies came back as 384.7
I am wondering whether the inflammation of high antibodies is coming out on my skin and whether this has happened to any of you? and if so, have you any tips?
Any advice appreciated!
Thank you!
Emma
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3mmarose
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In my late 20s I suddenly developed terrible cystic acne and water bloating. I had an adenoma removed along with half my thyroid and the cystic acne went away. If I lower my thyroid meds I start breaking out in acne and cystic acne on my back, neck and chest. I was given spironolactone years ago when I had the cysts and it completely cleared it up. I read that it affects androgens but of course the reason I had the acne in the first place was due to low thyroid hormone. You could alternate some days on 100mcg to see if it clears up. When I increase my Levo it clears up within days.
If you increase your Levo and that was the cause then you won't need the spiro most likely. Spiro will lower blood pressure so it's not something you want to take unless necessary. I didn't have any side affects on 25mg per day but if you already have lower blood pressure it can cause some dizziness.
That’s good to know because my blood pressure is generally low so I should probably avoid it then. I’ll still look to increase my Levothyroxine dose and some others have mentioned my T3. Thank you for your help!
Not sure if this will help you but, since things with my thyroid have gone awry, it seems that certain seeds (perhaps due to their phytoestrogenic content?) can trigger deep nodular acne for me, which is something I never previously experienced. It took me over a year of getting one or two deep nodular cystic acne spots almost every month to sort that connection out. I’ve noticed this pattern with fenugreek seeds and flax seeds for sure. Maybe chia, not sure. Pumpkin seeds do not cause me any issues.
I’m lazily speculating that, in my case, it has something to do with the interaction between thyroid hormones and estrogen (haven’t looked it up and am not knowledgeable about sex hormones - I just avoid those seeds and that solves the problem for me). If it matters, my thyroid hormones are low in range (due to tolerance issues which I’m working on) and I still get regular periods (in my mid 40s).
I know how horrible it is to deal with that and hope you’re able to figure out what’s triggering it for you!
Thank you for sharing! I don’t eat too many nuts and seeds so I doubt it is that for me but it may be something else in my diet that is triggering it. I just wish it was easier to pin point.
I am currently on gluten and dairy free diet which has completely taken the love out of food for me but if it clears my skin it’s worth it!
Ugh yes it’s definitely not fun to have to restrict one’s diet! 😕 But hope that avoidance does the trick!
If not, would wonder if raising your FT3 levels and/or figuring out if something else might be affecting your sex hormones ( diet/ meds/ supplements/ body products/ etc) - or if they’ve naturally changed - would help. You’re right, not easy to pinpoint triggers as so many things can affect hormones. Even essential oils in body products can have an effect!
One other thought: Not sure if you’re taking biotin but biotin can also cause acne in some people, and taking a balanced B complex (which includes B5 along with the biotin, and also includes other B vitamins like B3 which have skin health benefits) instead can help avoid that issue.
Hi 3mmarose .wondering how you are getting on. Having read your posts about acne,, I wanted to advise about the antibiotic treatment you were offerred. I know someone who sufferred badly with acne rosacea similar to yours and she was prescribed antibiotics which cleared it up very quickly. Don't be afraid that it is patching over the problem as you say. It's a common problem and antibiotic treatment is standard. It may have been triggered by the upsurge in hormones when having a baby/autoimmune condition or other. Yes, diet is also important and identifying triggers takes ages. The person I know also limits dairy because of gastro reasons, and has a very thorough facial cleansing regime but her skin is now totally clear, bar the occasional spot. Vitamin levels and iron are also important too of courss. Maybe try the antibiotic treatment though?
My skin has got a lot better thank you. I went to a dermatologist and they prescribed me ivermectin cream and Azaleic acid which seems to have done the job. I still have post acne scarring and a few spots come and go but my face is miles better and if I wear makeup, no one would know.
if I had taken the antibiotics I’m sure my skin would have resolved a lot quicker but I was worried about my gut. I heard a lot about the gut microbiome and skin being linked and heard antibiotics may disturb the gut further. In the end, it took 8 months with creams. Not ideal but we got there!
I am not sure if it is a coincidence or not but my skin also got better around the time I switched from Teva to Mercury Pharma. I also noticed much less palpitations.
I am taking 75mcg of Levothyroxine and my bloods have all come back as normal but my antibodies remain quite high.
Please add most recent TSH, Ft4 and Ft3 results
Plus B12, folate, vitamin D and ferritin results
ALWAYS test thyroid levels early morning, ideally just before 9am, only drinking water between waking and test and last dose levothyroxine 24 hours before test
75mcg is only one step up from starter dose
What brand levothyroxine are you taking
What vitamin supplements
As you have Hashimoto’s, have you had coeliac blood test done
Are you now on strictly gluten free diet and/or dairy free diet
would suspect you might need dose increase in levothyroxine
My latest results are attached. My Ferritin levels were 27 which is low but my GP then wanted me to take another blood test and it came back as normal and so she said not to worry about supplements. My diet is low in Iron if I am not supplementing.
I take the following:
9am - Levothyroxine - Mercury Pharma 50mcg and Wockhardt 25mcg. I was previously taking Teva.
1pm/2pm- Vitamin D (1000iu) and Vitamin K2 (75ug)
6pm- Spatone Iron sachets with Vitamin C - 5mg. (I take a cereal in the morning with 4mg).
I’m not sure if it necessary for me to space my vitamins out across the day but that’s what I’ve been doing to date for absorption.
Ever since I got the bad acne in March, the first thing I did was reduce Gluten and almost Dairy. Every now and again I have a small amount but for the most part I’ve been pretty good about it.
At present, my acne is not as aggressive but it’s still pretty persistent. I went to a dermatologist who recommended antibiotics but I refused these because it’s not sorting the root cause and I don’t want to harm my gut in case it’s linked to my acne and making things worse. So she prescribed me Azaelic Acid and Solantra in June and sometimes I feel like it works but other days it looks worse.
Something tells me that I did do it before I took my Levothyroxine because I saw a blog on Invisible Hypothyroidism that mentioned it but I will be getting my bloods checked again soon so will keep in mind to do the test before 9am and before taking Levo.
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
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
In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate folate supplement (eg Jarrow methyl folate 400mcg) and continue separate B12
Post discussing how biotin can affect test results
After I showed my GP the Medicheck results I shared with you, she tested me for pernicious Anaemia and she said that my bloods came back normal but low side of normal. She didn't recommend any supplements at all.
I saw somewhere about taking vitamins 4 hours after Levothyroxine - what would you recommend in terms of timing of vitamins such as Vit D, B12, Iron & B Complex? I also saw some people mentioning taking Iodine, Selenium, Zinc and Magnesium - Do you think this is necessary?
So only add one supplement at a time and wait at least 10 days to assess before adding another
Vitamin D mouth spray can be an hour away from levothyroxine, but tablets need to be 4 hours
Iron at least 4 hours from levothyroxine and 2 hours from any other supplements apart from vitamin C
B12, vitamin B complex and folate at least 2 hours away from levothyroxine. B vitamins best taken in morning
Magnesium at least 4 hours away from levothyroxine. Best taken afternoon or bedtime
Many (most?) members take vitamin D, vitamin B complex and magnesium daily.
Initially common to need separate B12 first before starting vitamin B complex
If you take levothyroxine early morning …..B vitamins after breakfast with mouth spray vitamin D with k2
Iron at lunchtime
Magnesium at bedtime
If taking levothyroxine at bedtime
Same regimen but magnesium early evening at least 4 hours before levothyroxine
retest full thyroid and vitamins 8 weeks later
You might eventually in 3-4 months consider testing zinc and selenium…..
Never supplement iodine when taking levothyroxine, Levothyroxine contains all the iodine you need
Rare case ….long term vegan who hasn’t been taking any supplements might possibly be deficient…..but even then essential to test…..if found to be deficient and under care of an iodine specialist…..even then rarely is iodine supplement given. Frequently makes situation worse
Serum ferritin level is the biochemical test, which most reliably correlates with relative total body iron stores. In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency.
Never supplement iron without doing full iron panel test for anaemia first and retest 3-4 times a year if self supplementing. It’s possible to have low ferritin but high iron
Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption
This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.
We have received further information the lab about ferritin reference ranges. They confirm that they are sex dependent up to the age of 60, then beyond the age of 60 the reference range is the same for both sexes:
Males 16-60: 30-400 ug/L
Female's: 16-60: 30-150
Both >60: 30-650
The lower limit of 30 ug/L is in accordance with the updated NICE guidance and the upper limits are in accordance with guidance from the Association of Clinical Biochemists. ‘
I was tested for Celiac disease and it came back negative but I got a food intolerance test and Gluten and it came back high on the iGA antibodies and Dairy was through the roof.
I would suggest it is more likely to be imbalanced sex hormones than elevated thyroid antibodies.
Acne is a classic symptom of elevated testosterone, and the trouble with increasing metabolism (via Levothyroxine ) is it can increase unwanted hormone levels as well as beneficial ones. Your GP should be able to test sex hormones.
Being under medicated for thyroid will lead to low vitamin levels, especially low Ft3
Low vitamin levels leads to poor conversion of Ft4 (levothyroxine) to Ft3 (active hormone)
Your Ft3 is far too low
If you’re lactose intolerant you need lactose free levothyroxine
And gluten free does need to be absolutely strictly gluten free
Lactose free brands - currently Teva or Vencamil only
Teva makes 25mcg, 50mcg, 75mcg and 100mcg
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
Teva is the only brand that makes 75mcg tablet.
So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half
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.
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.
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).
Thank you so much! I will absolutely try things in that order and hopefully will see some difference in my symptoms. You have been really helpful! Can't thank you enough.
Not yet but I will do now. I feel like my GP doesn't support me enough on my Thyroid Journey. My endocronologist is also not very helpful either. I went to her about my Acne and Palpitations are neither of them suggested any of this stuff or took a closer look at my bloods.
I feel like I may need to pay for everything on Medichecks or via at home testing which is a shame because it's going to cost me a fortune to figure out a way to feel myself.
Hi, just searching old posts for help. Did you ever manage to resolve the acne at all? I have also been getting acne since starting Levothyroxine in June, and am trying to work out whether to lower my dose / adjust diet / take t3 instead.
To be honest not really. I mean the pustules on my cheeks have died down, they were really awful and aggressive looking but as you can see from the photo, I’m still pretty covered. I am taking B12, Iron and Vitamin D3 and K2.
I am currently on dairy and gluten free diet and taking 75mcg of levo. I am not on T3 and I did change brands to Mercury Pharma and Wockhardt. What brand are you currently using?
Argh, it’s so difficult to try and work out which variables are causing which side effects isn’t it. I’ve tried Teva, Wockhardt and Mercury Pharma, but didn’t notice any difference really.
My acne seems to get worse the higher the dose of Levo I try. I was on 75mcg Levo (briefly tried 100mcg for a bit and I felt great but spots worse) but endocrinologist suggested reducing to 50mcg and adding 20mcg to try and improve the acne problem. The spots are perhaps not as bad as they were, but still massively embarrassing. I’m thinking of reducing again to 25mcg Levo and increasing the t3 to 40mcg? 🤷🏼♀️
The only other thing I have changed in the last few months has been including cashew milk and tiger nut milk in my diet (not wanting to have dairy with Levo). Have you been using any milk alternatives since starting Levo?
I keep seeing posts about taking B vitamins with hypothyroidism, but this also seems to be linked to acne, so am a bit wary to do so. 😐
It is so frustrating. My GP and Dermatologist just want to patch over the issue with antibiotics. My Endo says my acne has nothing to do with my thyroid as my blood levels are normal. So I have been trying to navigate this myself and spending a fortune on products, tests etc.. I've got my Wedding next year so I'm desperately trying to fix my skin beforehand!
That is interesting you were on the same dose and same brands as me. I started off on 50mcg Teva from November 2022 to January 2023 then increased to 50mcg Teva and 25mcg Wockhardt. My skin issues started in March 2023. I swapped out Teva for Mercury Pharma in May. I am starting to wonder if it is Wockhardt or not.
How did you manage to get a T3 prescription? I am struggling to get one from my Endo and GP.
Yes, I started drinking almond, oat and coconut milk. Mostly coconut milk as I was cutting out Oats and Almonds after a Food Intolerance Test.
I have been told that diets high in white rice, potatoes and pasta can spike blood sugar which can cause breakouts. My diet is quite high in these things as I don't eat a lot of meat and had been cutting out gluten not sure how to fix this but also, this has been my diet for years so I doubt it was because of these foods suddenly.
I have been taking a B12 supplement spray every other day - the methylcobalamin version. The brand I am using is BetterYou. I have only started incorporating this and I am doing so slowly so I will let you know how this goes!
Interesting that you’ve been using milk alternatives too, and I think some of the ones I use have a lot of rice content too. I’m going to go back to normal milk for a few weeks (same as pre-levo diet) and reduce levo to 25mcg (and add more t3) to see if it makes a difference.
My private Endo has been great - listened to my skin concerns and thought that it was definitely possible that the levo was causing the spots, so agreed to me trialling a reduction in levo and adding in t3. Had to pay for private prescription - I think it’s much more difficult to get it prescribed on the nhs because of the cost. Thybon Henning very reasonable though, so I’m more than happy to fork out if it will improve quality of life. Maybe worth requesting a t3 trial from your Endo if no improvement?
I developed spots at puberty. I finally got rid of them in my 50s when I increased my vitamin B12 to high levels.
There are multiple forms of B12 available for supplementation. The only one that works for me in keeping the spots at bay is methylcobalamin.
A few years before I took methylcobalamin I had taken high doses of cyanocobalamin and it did nothing for my spots at all, so for me the type definitely matters. High levels of methylcobalamin also 95% cured my eczema as well.
That’s interesting - thank you. Hopefully I will be able to get the spots under control some time soon, and will be sure to get methylcobalamin as opposed to the other form of B12 - clearly lots of benefits. I am loathe to throw any more variables into the mix just yet though - I’ve always been pretty lucky with my skin and didn’t have acne problems until starting Levo. 😫
Thanks for your message. That is interesting. I have started taking Vitamin B12 spray by BetterYou which is the methylcobalamin form. I have only been taking one spray (300ug) every other day but I will increase this to see if it helps much!
With a level of 41 for Active B12, taking a dose only every other day isn't nearly enough. I would suggest taking 5000 mcg every day, although before supplementing I would have said you should be tested for Pernicious Anaemia.
Optimal levels for vitamins and minerals often tested by members on the forum are suggested to be :
Active B12 --- 100+
Serum B12 --- Upper half of the reference range and a minimum of 500+. See this link for more info on levels of serum B12 :
When supplementing B12 because of low B12 it starts off a frenzy of red blood cell creation in the body. In those cases the body can run low in potassium. This is something best improved by eating potassium-rich food e.g. bananas, coconut milk/water. You can buy potassium supplements but if you do, do not exceed the stated dose.
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