I havent posted on here for a long time but have been feeling rough for quite a while, so here I am again. I have been taking 75mcg Levothyroxine for about 2 years and it wasnt easy getting my gp to even increase it to that. I have recently had a private advanced thyroid test, the results are back and they recommend I see my GP. They were fasting tests and done at 7am. I would be grateful for your thoughts and advice on my results, so I can get my case together in readiness for GP appointment.
Thanks in advance.
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Juddie
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Hi there, its no wonder you're feeling awful. Your vitamins and your thyroid hormones are woefully low. I'm sure someone will be along detailing the vitamins you need. Pernicious anaemia was mentioned when my B12 was low, so you might want to get the GP to test for this, along with iron, plus the other ones you've already had tested. As for the thyroid hormones, they are rock bottom. Go with a list of all your symptoms and ask for an increase in levothyroxine. Be firm, don't take no for an answer.
I concur with what forest garden has said but you need to get your vitamins up before your Thyroid meds will feel the benefit of any increase even if you get one. Your Vit D needs a loading dose it’s so low for a start. Your Folate is also deficient so you need to be supplementing with folate too.
I’m not sufficiently up on B12 except yours needs boosting so others will say what you need to do there. I’d say injections but how regular I’m not sure. If I were in your shoes I’d start there before doing the thyroid but I might be shot down in flames for saying that!
this one has lots of references to show GP ~ all recommend they keep TSH below 2/ 2.5 ish in all patients on levo ... so use these to get a dose increase if they say 'you don't need one because your TSH is in range' healthunlocked.com/thyroidu.... my-list-of-references-recommending-gps-keep-tsh-lower-in-range
This one is a simple explanation of why TSH 'in range' is not the same as 'optimal for the individual' healthunlocked.com/thyroidu... the-shoe-size-analogy.-
Assuming test is negative you can immediately go on strictly gluten free diet
(If test is positive you will need to remain on high gluten diet until endoscopy, maximum 6 weeks wait officially)
Only 5% of Hashimoto’s patients test positive for coeliac but a further 81% of Hashimoto’s patients who try gluten free diet find noticeable or significant improvement or find it’s essential
Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse
The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported
In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned
Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.
Similarly few months later consider trying dairy free too. Approx 50-60% find dairy free beneficial
With loads of vegan dairy alternatives these days it’s not as difficult as in the past
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
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
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.
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).
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
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.
Some people need a bit less than guidelines, some a bit more
With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a separate B12 supplement
A week later add folic acid prescribed by GP
Once the folic acid prescription is finished
Look at taking a daily vitamin B complex
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
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 can be difficult to find at reasonable price, should be around £20-£25. iherb.com often have in stock. Or try ebay
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
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
Told me to take multivitamin for d3 and folate issues. Wouldnt perscribe anything
So, I Have bought my own folic acid and some BetterYou 3000 vitamin d spray.
I have had hypertension for about 8 years, normally well controlled, but that's elevated at the moment. My pulse is also very slow for me. I have also suddenly developed diabetes and high cholesterol. They said it could all be connected to my thyroid issues and will hopefully improve. I also have gut issues and they are gonna investigate that too.
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