random question but is vertigo a side effect of levothyroxine?
vertigo and levothyroxine : random question but... - Thyroid UK
vertigo and levothyroxine
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Marleys_Ma
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Not sure - sorry !
Reading your last post it would seem your answer may lie there ! Have you followed the testing suggestions ? Could be low B12 - Ferritin - VitD - have you tested recently. Are you still taking Folate ?
Low T3 could also be involved.... 🌻
hmmm I had vertigo (BPPV) a few years back as a result of a car crash. The Epley manoeuvre is the only thing that helped, medication made me feel worse, a neighbour tipped me off about a close to retirement GP at the practice who helped, hubby watched so he can do it and haven’t needed it much since.
However, I can be a bit stumbly at the allotment when upside down inspecting veggies and hunting slugs 🐌 and I’m super wobbly on escalators etc. Although I have mastered getting back on my bicycle 🚴
I just assumed it was linked to the crash, which incidentally may well have contributed to triggering my Hashi’s hypo after Covid. Sorry I haven’t answered it but perhaps some parallels?
🌱
SlowDragonAdministrator
As per previous post
You need FULL thyroid and vitamin testing
You will likely need to test privately to make progress
healthunlocked.com/thyroidu...
As GP to test vitamin D, folate, ferritin and B12
If they won’t test ….include these in private test
I have been booked in for bloods on Monday at 9am. The doctor has requested thyroid testing. I’ll double check with the nurse that it’s the full test and also ask can she add vitamin testing. Do I wait until after blood test to take my daily dose of levothyroxine?
Yes… ideally earliest test possible so last dose T4 24 hours before, (here T3 often recommended split dose day before but not morning of blood test) impossible at my surgery earliest I can get is 10.30 so I’ll take T4 on the way out of the appointment and eat an hour later 😞 hope all goes well and you find out what you need to know. 🌱
It can be, very much so. Vertigo is a sign of too much thyroid hormone. You could try stopping your levothyroxine for a couple of days to see if your vertigo stops. Then resume your current dose and see if it comes back in a week or so. This would be a fairly definitive test There are other causes of vertigo, an ear infection is a common cause, especially if you go swimming. I would speak your doctor if it persists.
that’s strange I always thought vertigo was related to hypothyroidism, which is stated in this paper:
ncbi.nlm.nih.gov/pmc/articl...
It's generally listed as a sign of hyperthyroidism. I used to titrate my liothyronine by looking over the escalator in Oxford Street John Lewis, reduce it if I felt some vertigo.The best thing to do is adjust your levothyroxine up or down and see how you respond. Do it a few times to rule out random variations.
Yes it can be a symptom. I was on Levo for 6 years and then suddenly developed terrible vertigo to the point I'd almost fall down in the shower if I closed my eyes. Personally I get this when my thyroid hormone is too low but I've had it once or twice when I took too much. I'd check your ferritin and iron levels as well.
My migraines are caused by low thyroid hormones, and vertigo is a symptom of my migraines (although not everyone with migraine gets it). The solution for me is more Levo not less. Do you think you may have migraines?
I have found that a low FT3 cause me to have it. Nothing else where I am concerned.
I was only diagnosed with hypothyroidism after I collapsed with an appalling episode of vertigo I had never had before. The room was spinning and I couldn’t even stand. I thought I had had a stroke. Blood tests revealed TSH of 67. 8 months later on 75 mcg thyroxine I am much better but still not confident and hesitant when crossing the road, turning round etc. Hope my story helps ….
For me, dizziness / vertigo was a side effect of levothyroxine. It started about a week after I started my tablets (with all the other symptoms I never had before) and slowly subsided as my dosage increased. It still comes back from time to time, usually when I’m run down and need to rest.
I read on the coeliac website today that balance issues can be one of the many symptoms too.
This is by far my worst symptom, if indeed it is connected. I’ve always had motion sickness but it got much worse in the year or so before I was diagnosed hypothyroid. Instead of the usual triggers of boats, buses and other forms of movement I now had to add using a photocopier, looking at a newspaper, swimming, sewing, sorting paperwork…..an endless list of activities that if I don’t stop immediately I vomit and have to lie down for hours.
ENT was useless.
Medications are anti psychotics which inhibit thyroid hormone treatment.
I think I’ve improved as my thyroid dose has increased but it’s hard to know because I now largely avoid the triggers.
Just had my Levo reduced so I’ll see if it gets worse.
I’m also moderately deaf.
Blanchard makes the connection of motion sickness and hypo.
SlowDragonAdministrator
post 5 months ago
healthunlocked.com/thyroidu...
Did you get vitamin levels tested then
I don’t believe so
Thousands of Uk members forced to test privately to make progress if GP won’t test
I finally got a copy of my bloods after chasing doctors for a week. Can you please have a look?
page 1
1
page 2
Page 2
page 3
3
page 4
4
No vitamin D test result
NHS easy postal kit vitamin D test £31 via
come back with new post once you get results
TSH and Ft4
FT4: 17 pmol/l (Range 12 - 22)
Ft4 only 50.00% through range
No Ft3 test
Was test done early morning, ideally before 9am, only drinking water between waking and test and last dose levothyroxine 24 hours before test
Results show you need dose INCREASE in levothyroxine….but GP will only look at low TSH and want to reduce levothyroxine
Most people when adequately treated on levothyroxine will have Ft4 at least 70% through range
Approximately how much do you weigh in kilo
Low vitamin levels tend to lower TSH …..so refuse to reduce dose levothyroxine and work on improving low vitamin levels
Then get TSH, Ft4 and Ft3 retested including thyroid antibodies and retest vitamin levels privately in 2 -3 months
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...
Only do private testing early Monday or Tuesday morning.
Link about thyroid blood tests
thyroiduk.org/getting-a-dia...
Link about Hashimoto’s
thyroiduk.org/hypothyroid-b...
Symptoms of hypothyroidism
thyroiduk.org/wp-content/up...
Tips on how to do DIY finger prick test
healthunlocked.com/thyroidu...
Medichecks and BH also offer private blood draw at clinic near you, or private nurse to your own home…..for an extra fee
Test was done at 9am, I didn’t take levothyroxine until afterwards. I think I had tea and toast before though. I weighed the other day and was 85kg.
So 85mcg x 1.6mcg Levo = 136mcg as the likely eventual dose levothyroxine you might need
Obviously GP most likely going to refuse to increase dose levothyroxine while TSH is below range
which brand of levothyroxine are you currently taking
Do you always get same brand at each prescription
Your extremely low ferritin likely reducing TSH at moment
guidelines on dose levothyroxine by weight
Even if we frequently start on only 50mcg, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose
NICE guidelines on full replacement dose
nice.org.uk/guidance/ng145/...
1.3.6
Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.
Also here
cks.nice.org.uk/topics/hypo...
pathlabs.rlbuht.nhs.uk/tft_...
Guiding Treatment with Thyroxine:
In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months.
The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).
The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range.
……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.
The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.
You might request small 12.5mcg increase in levothyroxine retest in 6-8 weeks
Ferritin is extremely deficient
Other iron tests confirm anaemia
GP should be prescribing iron supplements
Low iron/ferritin extremely common when hypothyroid
Any obvious reason for anaemia?
Are you vegetarian or vegan
Heavy periods?
cks.nice.org.uk/topics/anae...
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
Medichecks iron panel test
medichecks.com/products/iro...
Look at increasing iron rich foods in diet
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
List of iron rich foods
Links about iron and ferritin
irondisorders.org/too-littl...
davidg170.sg-host.com/wp-co...
Great in-depth article on low ferritin
oatext.com/iron-deficiency-...
drhedberg.com/ferritin-hypo...
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.
healthunlocked.com/thyroidu...
Posts discussing Three Arrows as very effective supplement
healthunlocked.com/thyroidu...
healthunlocked.com/thyroidu...
Iron patches
healthunlocked.com/thyroidu...
Thyroid disease is as much about optimising vitamins as thyroid hormones
healthunlocked.com/thyroidu...
restartmed.com/hypothyroidi...
Post discussing just how long it can take to raise low ferritin
healthunlocked.com/thyroidu...
Iron and thyroid link
healthunlocked.com/thyroidu...
Excellent article on iron and thyroid
cambridge.org/core/journals...
Posts discussing why important to do full iron panel test
healthunlocked.com/thyroidu...
Good iron but low ferritin
healthunlocked.com/thyroidu...
healthunlocked.com/thyroidu...
Chicken livers if iron is good, but ferritin low
healthunlocked.com/thyroidu...
Shellfish and Mussels are excellent source of iron
healthline.com/nutrition/he...
Heme iron v non heme
hsph.harvard.edu/nutritions...
Ferritin over 100 to alleviate symptoms
healthunlocked.com/thyroidu...
Great research article discussing similar…..ferritin over 100 often necessary
ncbi.nlm.nih.gov/pmc/articl...
Low Iron implicated in hypothyroidism
healthunlocked.com/thyroidu...
Ferritin range on Medichecks
healthunlocked.com/thyroidu...
Inflammation affecting ferritin
healthunlocked.com/thyroidu...
healthunlocked.com/thyroidu...
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. ‘
Thanks for replying, no obvious reason for anaemia. I’m not vegetarian or vegan. The GP said my results were good and no further action was needed! It makes me so cross!
Print out NICE guidelines that ferritin under 30 is deficient
Be ready to push for treatment
So plan of action
1) start B12 ….week later add vitamin B complex
2) get GP to address anaemia meanwhile significantly increase iron rich foods in diet
3) test vitamin D
4) find out if thyroid antibodies were ever tested before thyroidectomy
5) get coeliac blood test done BEFORE trialing strictly gluten free diet
6) get TSH, Ft4 and Ft3 tested together privately. You could test now …..especially if GP wants to reduce levothyroxine
Just TSH, Ft4 and Ft3 test - £32
monitormyhealth.org.uk/thyr...
10% off code here
thyroiduk.org/getting-a-dia...
Likely to have very low Ft3 as your Ft4 is too low and vitamin levels are terrible
B12 and folate too low, but not low enough for GP to prescribe
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, a week later add a separate vitamin B Complex
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
natureprovides.com/products...
Or
B12 sublingual lozenges
uk.iherb.com/pr/jarrow-form...
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...
Low folate
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 folate supplement (eg Jarrow methyl folate 400mcg) and continue separate B12
Post discussing how biotin can affect test results
SlowDragonAdministrator
Low B12 symptoms include vertigo or feeling like walking on a small boat
b12deficiency.info/signs-an...
methyl-life.com/blogs/defic...
examples of Medichecks test results
healthunlocked.com/search/p...
Example of Blue Horizon test results
SlowDragonAdministrator
how much levothyroxine are you currently taking
previous post shows you were on 125mcg 5 months ago
healthunlocked.com/thyroidu...
Currently taking 125mcg. Not sure of the brand (in work so can’t check) but it tends to change from time to time.
Ok so not far under recommended dose levothyroxine
Improving low vitamin levels likely to significantly improve symptoms
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,
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
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
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...
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
I had horrible episode of vertigo before diagnosis plus some almost but not quite episodes too. After starting levo I had more. Then a useless NHS endo (very famous) told my GP to titrate my thyroxine. I was so ill in every way. Vertigo etc combined with no strength to get up anyway. I would say hypo on its own has vertigo related. Hypo with levo has vertigo related and both overdosing and underdosing levo has vertigo related. I think that covers it.
SlowDragonAdministrator
Comprehensive list of references for needing LOW TSH on levothyroxine
healthunlocked.com/thyroidu....
onlinelibrary.wiley.com/doi...
If symptoms of hypothyroidism persist despite normalisation of TSH, the dose of levothyroxine can be titrated further to place the TSH in the lower part of the reference range or even slightly below (i.e., TSH: 0.1–2.0 mU/L), but avoiding TSH < 0.1 mU/L. Use of alternate day dosing of different levothyroxine strengths may be needed to achieve this (e.g., 100 mcg for 4 days; 125 mcg for 3 days weekly
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