Hi
It’s me again. I’m currently on 75mg of Levothyroxine and am still symptomatic but my GP won’t increase my Levothyroxine and has attributed my symptoms .. weight gain , aching joints, dry hair and brain fog down to hormones and has suggested HRT patches
Does anytime have any advice regarding HRT patches and Levothyroxine
Have you just tried one doctor so far for an increase or several? Some GP's are more open minded than others and when you last posted results your TSH was above 2. It needs to be at 1 or lower.
Have you got the vitamin results yet as they play an important part of your wellbeing and help your thyroid hormone work well.
HRT can increase the need for more thyroid hormone.
If you believe (as I do) your symptoms are due to low thyroid hormone levels you need to be persistent and try a different doctor for n increase. Ask for it as a trial.
Last results from 2 months ago
TSH 2.440 mIU/L (Range: 0.27 - 4.2)
FT4: 15.8 pmol/l (Range 12 - 22)
Ft4 only 38.00% through range
FT3: 3.5 pmol/l (Range 3.1 - 6.8)
Ft3 even worse at only 10.81% through range
Most people when adequately treated will have Ft3 at least 50-60% through range and Ft4 (levothyroxine dose) often needs to be a bit higher at 70-80% through range
So you are not on high enough dose levothyroxine
Request 25mcg dose increase in levothyroxine as “trial”
If GP still won’t increase dose ….insist/Request new test
Book early morning, ideally 8.45am, only drink water between waking and test and last dose levothyroxine 24 hours before test
ESSENTIAL to test vitamin D, folate, ferritin and B12 at least annually
What vitamin supplements are you taking
I have had my vitamins and iron levels taken but she keeps telling me all is normal
I had another blood test on Friday so am going to make another appointment today to discuss results .
I’m getting really frustrated with all this as I’m sure you can understand
Thank you for your good advice as usual
she keeps telling me all is normal
Print out guidelines. Point out exactly how low through range Ft4 and Ft3 are
Request 25mcg extra per day in levothyroxine as a “trial” increase
TSH should be under 2 as an absolute maximum when on levothyroxine
gponline.com/endocrinology-...
Graph showing median TSH in healthy population is 1-1.5
web.archive.org/web/2004060...
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).
from PULSE magazine for GP's... The article is available from ThyroidUK
If you want a copy of the article then email tukadmin@thyroidUK.org
and ask for a copy of the Dr Toft article in Pulse magazine. The quote is in answer to question 6.
Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine:
"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.
In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l.
Most patients will feel well in that circumstance.
But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.
This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."
if she still refuses, say you will be seeing endocrinologist of your choice
You will have to see one privately if you don’t want to wait at least a year for consultation
Some on list are private and NHS
See endocrinologist privately initially and then transfer to NHS
List of thyroid specialists and endocrinologists
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.
hi my latest results
TSH 2.31
B12 383
Vit D 75.7
Magnesium 0.69
Serum Ferritin 47
Serum iron level 14
Transferrin Saturation index 25.2%
Do these results support an increase in Levothyroxine to 100 mg
Both 🤗 adding HRT will likely help with those things and also highlight that a rise in levo is needed.... have you got enough wiggle room in your prescription timings to add another 25mcg a day or even alternate days? Perhaps request an early repeat due to holidays plans? 😏
You could always agree to the patches and not use them just to show willing 🙂 it's often a silly game of ego stroking we have to play with GP's to get what we need
Being under replaced leads to vits /mins and other hormones to crash
Hi I have been on HRT patches for years, wouldnt do without them! Am also on thyroxine and yes some symptoms can be either but worth a try! Note patch strength can be based on weight- i didnt know this originally as when i put weight on needed stronger patch! Good luck and worth a trial!
Not discounting the advice of others which is good but you could try the HRT to see if there is an improvement in your thyroid levels. Oestrogen in HRT helps the thyroid. I took both HRT (Tibolone which is a chemical that stimulates the body to manufacture its own oestrogen as I was allergic to all other oestrogen even natural), and I also took Chinese tablets containing large doses of Dong Quai which is highly oestrogenic. While taking the Dong Quai, my TSH dropped from 6.5-7.5 to about 3.5 which was considered by the NHS to be within range. When I stopped taking the Chinese tablets my TSH rose to over 7 and later reached 9. Oestrogen is good for the brain as it staves off dementia so I would not discount it if you are offered it.
I would accept the HRT as it may help, but ensure your thyroid levels get the increase they need to better place in range too (need to check after starting HRT which may affect thyroid levels).
Hi. I am currently on 75mg of levothyroxine and also use Evorol 50 patches hrt. I had pains in my hip and general aches that did improve with Hrt. If you have other symptoms of Menopause it may be worth trying. If it doesn't suit you or you don't feel Amy benefits, you can always stop using them.
Hi Gyp, I am on hrt patches. I also take NDT, 12 months ago I reintroduced levo, last week I changed my hrt patches to combined due to my coil now at its life end, was no benefit to me at all, I have done better on the hrt patches than oral, I can forget about them for a few days before they need changing so with the brain fog, remembering to split my thyroid meds twice daily it's an added bonus I don't have to remember to take another pill.
Anything else you want to know just ask.
Have a lovely evening.
Take care
Thank you so much
hii,
I was exactly the same, so I went on the HRT, no change in most symptoms after 3 months, so I went private and he put me up to 100 Levo and it definitely did the trick. I feel more like myself then I have in years.
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