Jaw clenching + Levothyroxine

[Beeper1]

Hi all,

Apologies for the long post.

I'd like some advice please regarding jaw clenching when on Levothyroxine. Does anyone else have this issue?

I am currently on 87.5mic Teva levothyroxine. I have asked my pharmacy for a different brand to see if it helps, but they tell me that they can only get the 12.5mic from Teva.

I also take B Complex/Vitamin D + K2/ Magnesium/Ashwagandha, though I'm not sure the Ashwagandha is helping.

Levothyroxine is taken in the morning an hour before breakfast, vitamins in the evening before bed.

3 years ago, the private endocrinologist upped my medication from 75mic to 100mic which made me feel a bit better. However this triggered jaw clenching in my sleep. I was taking days off work due to sinus migraines caused by the jaw clenching, the migraines were so bad it was making me vomit. I got a mouth guard, which helped but didn't stop the clenching.

My GP suggested I take the meds down to 87.5mic, which I've been on for a couple of years. The jaw clenching was less severe, however persisted. I've got a different style of mouthguard now from the dentist which doesn't seem to be making that much difference. I woke up yesterday with a nauseous sinus migraine due to the clenching, and I'm feeling wiped today. I forgot to wear my mouthguard overnight a couple of weeks ago, and woke with a severe sinus migraine due to jaw clenching which made me sick.

I am tired all the time, and if I do anything more strenuous than gentle day to day activity, I utterly exhaust myself and have to rest for a couple of days afterwards. I clench my jaw in the day as well, but am able to notice and stop myself.

I feel like it's the Levothyroxine that's triggered this jaw clenching, do you think I'd benefit from a T4/T3 combo treatment? I need to up my medication to combat the tiredness, but I cannot deal with the jaw clenching which is in itself exhausting, and is now starting to cause pain down my neck. I also cannot live on Sudafed to deal with the migraines.

I don't think it's stress related, I have't been working so far this year, and it didn't calm down even when I was on holiday for 3 weeks. I have regular acupuncture, but it doesn't seem to help. I've done the jaw exercises, which help the jaw ache but not the cause. I've brought it up with the GP.

We're due to go back to the IVF clinic for a final round of IVF, but I am loathe to do this whilst everything feels so out of whack.

Below are my most recent blood tests, done first thing in the morning before breakfast, 24 hours after my last Levothyroxine dose and 36 hours after my last dose of vitamins. I had forgotten to stop the B12 complex the week before, but I was so surprised to get an almost immediate GP & blood test appointment, I thought it was better to take the appointment.

I'd really appreciate any advice anyone had, I'm utterly done with living half a life.

TSH 0.51 mIU/L

Range:0.27 - 4.2 mIU/L

Thyroxine (free) (T4) 16.4 pmol/L

Range:12 - 22 pmol/L

Tri-iodothyronine (free) (T3) 4.1 pmol/L

Range:3.1 - 6.8 pmol/L

Thyroid peroxidase abs 28.7 IU/ml

Range:0 - 34 IU/ml

Vitamin D 114 nmol/L

Range:25 - 125 nmol/L

Vitamin B12 1,107 ng/L or pg/mL

Range:197 - 771 ng/L or pg/mL

Ferritin 53 ng/mL or ug/L

Range:13 - 150 ng/mL or ug/L

Iron 8 umol/L

Range:6 - 35 umol/L

Transferrin saturation 12 %

Range:20 - 45 %

I ran the results through the thyroid.chingkerrs.online/ and the results are below:

TSH .51 mIU/L

Free T4 (fT4) 16.4 pmol/L (12 - 22) 44.0%

Free T3 (fT3) 4.1 pmol/L (3.1 - 6.8) 27.0%

T4:T3 Ratio 4.000 

Thyroid Peroxidase Antibodies (TPO) 28.7 IU/mL (≤ 34)

Vitamin B12 1107 nmol/L (197 - 771) 158.5%

Vitamin D 114 nmol/L (25 - 125) 89.0%

Ferritin 53 ug/L (12 - 150) 29.7%

[SlowDragon Administrator]

Are you lactose intolerant that you are on Teva

Teva upsets many people as contains mannitol

Your results suggest you are not on high enough dose levothyroxine

How much do you weigh in kilo?

Guidelines suggest 1.6mcg Levo per kilo of your weight per day

Most people when adequately treated on just Levo will need Ft4 at least 70% through range to get Ft3 at least 50-60% through range

Suggest that you try 100mcg daily

Perhaps try different brand

Vencamil is also lactose free but much better tolerated as doesn’t contain mannitol

Ferritin is a bit low

Iron is very low

Low iron/ferritin linked to increased risk of miscarriage

Have you tested CRP - inflammation

What vitamin supplements are you taking

No folate result?

[Beeper1 in reply to SlowDragon]

Hi Slow Dragon, thanks as always for your reply. Below are my responses.

Are you lactose intolerant that you are on Teva.

Teva upsets many people as contains mannitol

- I'm on Teva as the pharmacist says it's the only brand that does a 12.5 mcg pill. I've tried pill splitting a 25 mcg pill, it just didn't work for me. I will ask about Vencamil, but the pharmacy often tells me they can only get certain brands from their suppliers.

Your results suggest you are not on high enough dose levothyroxine

How much do you weigh in kilo?

Guidelines suggest 1.6mcg Levo per kilo of your weight per day

Most people when adequately treated on just Levo will need Ft4 at least 70% through range to get Ft3 at least 50-60% through range

Suggest that you try 100mcg daily

Perhaps try different brand

Vencamil is also lactose free but much better tolerated as doesn’t contain mannitol

- I'm 70kg, so would need 116.8 mcg. As explained, I came down to 87.5mcg from 100 mcg levothyroxine as when I was on 100 mcg it caused severe jaw clenching, and the migraines caused by the jaw clenching were unbearable.

I wondered about being able to add T3 to my my medication? Is that possible? Would I have to self souce?

Ferritin is a bit low

Iron is very low

Low iron/ferritin linked to increased risk of miscarriage

- I'm going to go back to the doctor about this

Have you tested CRP - inflammation

- No I haven't tested this

What vitamin supplements are you taking

- I take B Complex/Vitamin D + K2/ Magnesium/Ashwagandha

No folate result?

- They didn't seem to test folate

[SlowDragon Administrator in reply to Beeper1]

No folate result?

If looking to conceive the correct level of folate is critical

Nether too little or too much

[SlowDragon Administrator in reply to Beeper1]

when I was on 100 mcg

Which brand was this

Different brands Levo give different results

How long ago did you last try increasing dose

Just because it seemed to much in past doesn’t mean it will now

Adding T3 when Ft4 is low is not really recommended

A) Ft4 tends to drop when adding T3, so it needs to be at reasonable level to start with

B)taking almost any dose T3 will significantly reduce or suppress TSH

C) difficult to find any endo prepared to allow T3 during pregnancy, because it lowers TSH

D) as soon as conception confirmed you would need to increase Levo

Getting iron levels optimal will help tolerate increase in levothyroxine

Before considering TTC levels need to be stable

verywellhealth.com/infertil...

.

Pregnancy guidelines

thyroiduk.org/having-a-baby/

NICE guidelines that if hypothyroid or subclinical you should see endocrinologist BEFORE TTC

cks.nice.org.uk/topics/hypo...

Important See pages 7&8

btf-thyroid.org/Handlers/Do...

Also here - dose increase in levothyroxine as soon as pregnancy test confirms conception

cuh.nhs.uk/patient-informat...

thyroidpharmacist.com/artic...

Low ferritin, low thyroid levels and miscarriage

preventmiscarriage.com/iron...

Low iron and hypothyroid

endocrineweb.com/news/thyro...

Folate and B12 and Neural tube defects and autism

healthunlocked.com/thyroidu...

[Beeper1 in reply to SlowDragon]

I was taking Mercury Pharma at 100mcg.

[SlowDragon Administrator in reply to Beeper1]

What brand are your other tablets?

Yes Teva is only brand that makes 12.5mcg

Vast majority of people cut 25mcg in half or 50mcg into 1/4’s

Or take 75mcg one day and 100mcg the next

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 

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)

Vencamil (currently 100mcg only) is lactose free and mannitol free. 25mcg and 50mcg tablets hopefully available from summer 2024

March 2023 - Aristo now called Vencamil

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Helpful post about different brands

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.

If symptoms or poor control of thyroid function persist (despite adhering to a specific product), consider prescribing levothyroxine in an oral solution formulation.

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).

And here

pharmacymagazine.co.uk/clin...

Discussed here too

healthunlocked.com/thyroidu...

[Beeper1 in reply to SlowDragon]

This is great, thank you. I will go back to the doctor, and ask about raising my medication and getting either Wockhardt or liquid levothyroxine to see if it makes a difference.

[Marinaaa]

Hi Beeper1,

it does happen to me as well. I think it started happening two years before being medicated for thyroid. It hasnt gone away.

[Beeper1 in reply to Marinaaa]

Oh gosh, its difficult isn't it! My acupuncturist suggested melatonin, but you can't get it in the UK like you can apparently in other countries.

[N5girl]

Hi. I don’t know about the Levo but I am a long time jaw clencher / bruxism sufferer.

I went through some mouthguards and eventually got Invisalign to help shift my jaw and teeth.

My dentist also said that you can get Botox shots to help release the muscles - so that might be worth trying to help give you some immediate relief.

[Beeper1 in reply to N5girl]

Thanks for this. I spoke to my dentist about the botox, thought I'd try the mouthguard before resorting to botox.

[N5girl in reply to Beeper1]

I did ask my dentist if I would end up looking 10 years younger and she just laughed.

[Beeper1 in reply to N5girl]

😂😂 😂😂

I'd like to think any lines I've got are hard earned!

[Marinaaa]

you can press with your index finger the opposite jaw INSIDE THE MOUTH, in its further regions, press hard for a couple of minutes in different painful points (trigger points). its is pretty painful but it aleviates the muscles. You should do it lying down upright, in bed for instance. You can also make exagerated gestures as if you were making the different vowels and stay there a while. Stretching your neck as well.

I hated the mouthguard. my dentist who was a very gentle young man died of a cancer and I never put a new mouthguard myself again. He had to change it several times as it kept changing. They insist every time I go back in trying a new one.

[Beeper1 in reply to Marinaaa]

Thanks for this. I've tried all this, it helps temporarily, but then the clenching starts again.

[bluejourney]

Have you done salivary adrenal stress profile? If we’re under-replaced with thyroid medication, it can make your cortisol go up, even though we’re not in stressful situations, because the adrenals are trying to compensate. Higher cortisol might cause the jaw clenching.

[Beeper1 in reply to bluejourney]

Ooh interesting, thanks I'll look into that.