Starting medication advice

[katyy94x]

Hello

Long story short, i was diagnosed Hashimoto's 2020, told to wait for TSH to rise before medication. I've been trying to conceive for years so went back to the GP this year when i found out TSH should be below 2.5 for this, not 5.

Most recent tests are:

22/02/24:

TSH - 5.01 (0.35- 5.50)

T4 - 8.90 (7.86 - 14.41)

TPO - 122 (<9)

16/01/24:

TSH - 5.65 (0.35 - 5.50)

T4 - 9 (7.86 - 14.41)

GP has agreed to prescribe me 25mg Thyroxine for 8 weeks, then to do a blood test and increase accordingly. I wondered if anyone has any advice on taking this medication and any side effects i might encounter.

I have done some private blood tests and will be supplementing B12, D3 w K2, Ferritin and Folate as required once I have the results back. I was thinking of holding off on the Thyroxine until i am supplementing adequately as I know deficiencies can impact absorbance of the medication.

Bonus question - anyone also take methylphenidate? I know I have to wait to take additional meds/supplements on Thyroxine, but i usually take methylphenidate first thing so that i have a functioning brain for work.

[SlowDragon Administrator]

Suggest you start levothyroxine now

Add vitamin supplements one at a time …..once you get results

Which brand of levothyroxine is 25mcg

Are you lactose intolerant

If yes request Teva brand

If not, better to start with Wockhardt or Mercury Pharma brands

[katyy94x in reply to SlowDragon]

Hello, i just got my medicheck results.

TSH: 6.14 (0.27 - 4.2)

T3: 4.7 (3.1 - 6.8)

T4: 15.5 (12 - 22)

Anti TPO: 124 (0 - 34)

Anti TG: 317 (0 - 115)

Folate: 11.3 (> 7)

B12: 57 (37.5 - 188)

Vit D 69.6 (50 - 250)

Ferritin: 26.6 (30 - 180)

They've suggested i speak to my GP about the ferritin deficiency and to start Vit D and B12 supplements. I was quite surprised my T4 & T3 were in ranges. They didn't comment on the folate.

I haven't started Levothyroxine yet (Medichecks needed a new sample so i waited), but picked up my 25mg Teva prescription. I will be starting it tonight before bed to avoid it interfering with my ADHD medication.

Is there anything i'm missing or am i good to go with starting Levothyroxine, introducing Vit D & B12 one at a time, and seeing what my GP says about the ferritin?

[SlowDragon Administrator in reply to katyy94x]

Teva is lactose free

Are you lactose intolerant

Teva doesn’t suit everyone. See how you get on

Also starting on only half standard starter dose can make you feel worse

stick it out ….get bloods retested 6-8 weeks later

Push to increase to 50mcg

retest again in another 6-8 weeks

Repeat again until dose high enough to bring TSH down around 1

Start vitamin D a week or so later

Yes meanwhile get Gp to run full iron panel test for anaemia

You will almost certainly need iron supplements

Aiming for Ferritin at least over 70

B12 is low

Are you vegetarian or vegan?

if not - request GP test for Pernicious Anaemia before starting separate B12

A week later add separate vitamin B complex

[katyy94x in reply to SlowDragon]

Hey, never been tested for lactose but i have always reacted badly to dairy in general so i steer clear of it. 'm not sure why 25mg, the endo said to start at that dose to my GP. I think because they are only prescribing because of TTC so TSH to be below 2.5.

I'm not veggie or vegan. Thanks so much for all of your advice, i wouldn't have pushed for them prescribing medication without all of the previous info and guidance you shared.

[SlowDragon Administrator in reply to katyy94x]

Once we start on Levothyroxine almost everyone will end up eventually on full replacement dose - approximately 1.6mcg per kilo of your weight per day

Levo doesn’t top up failing thyroid….. it replaces it

Sounds like Endocrinologist was diabetes specialist (vast majority are)

[SlowDragon Administrator]

Levothyroxine is an extremely fussy hormone and should always be taken on an empty stomach and then nothing apart from water for at least an hour after

Many people take Levothyroxine soon after waking, but it may be more convenient and perhaps more effective taken at bedtime

verywellhealth.com/best-tim...

No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.

Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away

(Time gap doesn't apply to Vitamin D mouth spray)

If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal

ADHD and Hashimoto’s

thyroiduk.org/related-condi...

medicalnewstoday.com/articl...

[Louisiana-dinosaur]

Hi! So sorry for the difficulty trying to conceive… I do know with my IVF work up they focused repeatedly on checking my thyroid function levels and other hormones as it’s difficult to conceive if your thyroid is off kilter. So with your thyroid levels off and your doctor not realizing this, are you able to see a specialist like a fertility doctor? Is that a viable option? Your Hashimoto’s will put you in a high risk pregnancy group (or it would in the US) to be monitored closely for miscarriage, preterm labor, etc. Also your thyroid labs would need to be repeated throughout your pregnancy. (I don’t have my Hashimoto’s diagnosis yet but working on it.. I had difficulty getting pregnant and delivered 4 weeks early). Good luck to you… I wish you the BeST!

[katyy94x in reply to Louisiana-dinosaur]

Unfortunately neither my doctor or the fertility specialist i am under clocked any of this! I am using the NHS, and the fertility department has been shocking. They have now announced it's closing, but haven't actually informed their patients what's going on other than being transferred (hopefully a blessing in disguise!).

It's a huge shame, but unfortunately I am very used to it. Good luck too