non-acid GORD

[Murphea]

does anyone else experience non-acid reflux? I was diagnosed with GORD a year ago and was prescribed a high dose of omreprazole. Managed to wean myself off as soon as I could (aware that it doesn’t work well with levothyroxine - I take 75mg daily). I recently restarted omreprazole as I had heartburn whilst on holiday, but am cutting it down now as I have developed a persistent cough, and watery mouth, and am wondering if Omreprazole is causing this. . I’ve always been aware that hashimotos carries a high chance of low stomach acid and, as such, PPIs aren’t much help but I can’t find any doctors who are interested in a dialogue about this. Anyone in the same boat?

[RedApple Administrator]

Could it be Laryngopharyngeal reflux aka silent reflux? en.wikipedia.org/wiki/Laryn...

[Murphea in reply to RedApple]

Thank you. I have been wondering about that. I have a ventolin inhaler for use for my allergy to cats etc and I’ve wondered if that might help the endless coughing and throat clearing.

[RedApple Administrator in reply to Murphea]

This article is worth checking out. britishvoiceassociation.org...

[Murphea in reply to RedApple]

Thank you. That’s interesting reading

[Anthea55]

You may find this helpful

drmyhill.co.uk/wiki/Hypochl...

Most doctors know nothing about low stomach acid. It's not mentioned on the NHS website.

[Murphea in reply to Anthea55]

thanks very much. That’s what I’ve found, nhs professionals don’t seem to countenance it

[SlowDragon Administrator]

75mcg levothyroxine is low dose

Acid reflux due to LOW stomach acid is common hypothyroid symptom

There’s no information on your profile

What are your most recent thyroid and vitamin results

Do you have autoimmune thyroid disease, also called Hashimoto’s usually diagnosed by high thyroid antibodies

About 90% of primary hypothyroidism is autoimmune

Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins

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

Persistent cough is frequently dairy intolerance, very common with autoimmune thyroid disease (hashimoto’s)

As is gluten intolerance

Approximately 86% of Hashimoto’s patients find gluten free diet helps or is essential

About 50% find dairy free beneficial

any PPI will lower vitamin levels, especially B12 and magnesium

[Murphea in reply to SlowDragon]

Thank you. I don’t have my most recent results to hand but can confirm that I have hashimotos and follow a gluten-free diet. I have given up on my gp testing regime and am seeing an endocrinologist (next appt due January).

[SlowDragon Administrator in reply to Murphea]

Strongly recommend you get FULL thyroid testing done now

You then have plenty of time to improve low vitamin levels and get Levo dose increase and retest again before January

Approximately How much do you weigh in kilo

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.

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 weekl

[Batty1]

cough and watery mouth is stomach acid buildup.