Iodine

[Dottie11]

I am run down and want to take a multi vitamin. I have Hypothyroid and take 75 mg a day. should I avoid Iodine in a supplement ? Thank you.

[SlowDragon Administrator]

welcome to the thyroid forum

75mcg levothyroxine is a low dose of levothyroxine

How long have you been on just this dose

Which brand of levothyroxine are you taking

Approximately how much do you weigh in kilo

ALWAYS test thyroid levels early morning, ideally before 9am, only drinking water between waking and test and last dose levothyroxine 24 hours before test

This gives highest TSH

Multivitamins never recommended on here

Request GP test vitamin D, folate, ferritin and B12

[Dottie11 in reply to SlowDragon]

My Thyroid jumps around . I started on 100mg. Then between, 50, 75, and 25. Currently on 75mg. I am told have to have two different brands due to what is available. Accord 50mg which I get on with and now Hillcross added at 25mg. I am also Celiac delayed diagnosis which might explain some of the changes to Thyroid. On Thyroid 13 years. I am 55 kilo in weight. Thank you re GP tests

[SlowDragon Administrator in reply to Dottie11]

So as coeliac it’s absolutely essential to get vitamin levels tested at least annually

You are highly likely to need daily vitamin D, daily magnesium and daily vitamin B complex

May also need B12 initially

Possibly iron supplements

Test FIRST

Dairy free diet can help too

Only make one change at a time or add one supplement at a time

Accord 50mg which I get on with and now Hillcross added at 25mg.

Hillcross is just the box …..it has Teva brand levothyroxine inside

Teva brand upsets thousands of patients

Were you on different 25mcg brand before

Get new prescription from GP

Request 25mcg by either Mercury Pharma or Wockhardt

Retest in 6-8 weeks

[Dottie11 in reply to SlowDragon]

I have been having sharp tummy pains and thinking did start on Teva being added. My old 25mg was Wockhardt. So thank you. I take Lactose tablets . I got DNA tested and have genetics for it. Plus my Celiac came back with three highest risk genetics.

[SlowDragon Administrator in reply to Dottie11]

I take Lactose tablet

You mean your levothyroxine contains lactose or you take a tablet to help improve lactose intolerance

Approximately 50% of Hashimoto’s patients develop dairy intolerance……not necessarily to lactose but to the enzyme in dairy

Strictly dairy free diet often gives significant benefits

Lot easier these days with lots of dairy free alternatives

[Dottie11 in reply to SlowDragon]

I take Lactose tablets for genetic intolerance. It is impossible to avoid in everything its even in my Asthma sprays-all of them so cannot change.

[helvella Administrator Thyroid UK in reply to Dottie11]

I think you mean "lactase" - which is the enzyme which breaks down lactose.

That is why there has been some confusion.

[Dottie11 in reply to helvella]

Yes thank you. Getting near my nap time .

[Dottie11 in reply to SlowDragon]

I use Lactose free milk and such other products too. Avoid milk etc as sinus issues all my life re dairy.

[Dottie11 in reply to SlowDragon]

Yes Gp said re test Thyroid in six weeks. I will look into other blood tests too. I do not think I will get Magnesium via Gp

[SlowDragon Administrator in reply to Dottie11]

No point testing magnesium it’s an unreliable test

We all need magnesium, especially on gluten free diet and/or when taking vitamin D supplements

theceliacmd.com/magnesium-d....

Thousands of posts on here discussing magnesium

healthunlocked.com/search/p...

Web links about taking important cofactors - magnesium and Vit K2-MK7

Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Recipe ideas

bbc.co.uk/food/articles/mag...

Interesting article by Dr Malcolm Kendrick on magnesium

drmalcolmkendrick.org/categ...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

[Dottie11 in reply to SlowDragon]

Interesting re Magnesium thanks. Yes K2 mk7 I have issues re absorption and take supplement . Could not clot and catastrophic dental extraction 2012. Dry socket to infection that spread into body. 18 Dental visits, Gps multiple ,and hospital. Hindsight - pre Celiac diagnosis which was missed and went into Malnutrition therefore body could not cope. Ended up with on going Immune system condition.

[SlowDragon Administrator in reply to Dottie11]

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

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.

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...

[SlowDragon Administrator]

as you have Sjogrens presumably your hypothyroidism is also autoimmune

For full Thyroid evaluation you need TSH, FT4 and FT3 tested

Also both TPO and TG thyroid antibodies tested at least once to see if your hypothyroidism is autoimmune

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease

About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high TPO and/or high TG thyroid antibodies

Autoimmune thyroid disease with goitre is Hashimoto’s

Autoimmune thyroid disease without goitre is Ord’s thyroiditis.

Both are autoimmune and generally called Hashimoto’s.

Significant minority of Hashimoto’s patients only have high TG antibodies (thyroglobulin)

20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis

In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)

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

Post all about what time of day to test

healthunlocked.com/thyroidu...

Testing options and includes money off codes for private testing

thyroiduk.org/testing/

Medichecks Thyroid plus BOTH TPO and TG antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes BOTH TPO and TG antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

Only do private testing early Monday or Tuesday morning.

Link about thyroid blood tests

thyroiduk.org/testing/thyro...

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

Symptoms of hypothyroidism

thyroiduk.org/signs-and-sym...

Tips on how to do DIY finger prick test

support.medichecks.com/hc/e...

Medichecks and BH also offer private blood draw at clinic near you, or private nurse to your own home…..for an extra fee

[Dottie11 in reply to SlowDragon]

Thank you I will take all this on board. I had Salivary scans done 2022 and the comment being a very shrivelled Thyroid. I think I have much more work to do on this one.

[SlowDragon Administrator in reply to Dottie11]

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

so you will see thousands of autoimmune thyroid (hashimoto’s ) patients are on strictly gluten free diet

Gluten intolerance/coeliac …..likely poor conversion of Ft4 (levothyroxine) to Ft3 (active hormone) ….resulting in high Ft4 and low Ft3

First steps

Get vitamin levels tested and improve to optimal levels by supplementing

Fine tune levothyroxine dose

Always get same brand levothyroxine

Test correctly

Trial dairy free

Aiming for Ft4 and Ft3 at least 60-70% through range and ideally at similar levels

If after all this Ft3 remains low in comparison to Ft4 ……then look at getting small doses of T3 prescribed alongside Levo. Likely to need private consultation initially

Here’s link for how to request Thyroid U.K.list of private Doctors emailed to you, but within the email a link to download list of recommended thyroid specialist endocrinologists who will prescribe T3

Ideally choose an endocrinologist to see privately initially and who also does NHS consultations

thyroiduk.org/contact-us/ge...

[radd]

Dottie11,

Yes, most definitely avoid iodine unless know you are suffering deficiency.

Multivits might not have enough to address nutrient deficiencies common in people with hypothyroidism. It’s prudent to test Vit B12, folate, Vit D and iron, and then supplement accordingly.

Also 75mcg isn’t a very large Levo dose. Could it be you feel run down because you are under medicated?

[Dottie11 in reply to radd]

Thank you . they will test again in six weeks.

[SlowDragon Administrator in reply to Dottie11]

how long have you been on 75mcg

What dose were you on before this

What were results that prompted change in dose

You must have TSH, Ft4 and Ft3 levels tested

Increasingly NHS only tests TSH which is completely useless

Change the Teva 25mcg out for different brand

Retest in 6-8 weeks

Meanwhile get vitamin levels tested via GP or privately

[Dottie11 in reply to SlowDragon]

Currently 75mg for one month. Before that, 50mg for a very long time,a few years. Ten months since last tested when advised to take 25mg as boarderline. I asked to stay on 50mg as felt too low for me and they agreed. Last month it felt off again and came in low so up to 75mg.

[SlowDragon Administrator in reply to Dottie11]

so likely low vitamin levels as been on inadequate dose long time

We need optimal vitamin levels in order to process Levo well

Guidelines of dose Levo by weight

approx how much do you weigh in kilo

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

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.

Some people need a bit less than guidelines, some a bit more

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).

[Dottie11 in reply to SlowDragon]

That is so interesting. The link with vitamins another learning curve. I have had an awful flare up with one breast swelling, fluid and pain and then became an infection I think Fibrotic breast can be linked to Thyroid. Legs full of fluid too. I have a photo taken a month ago and noticed my eyebrow very sparse on side and now thinking Thyroid ! Almost half an eyebrow. More to this than I though possible.

[SlowDragon Administrator in reply to Dottie11]

Low thyroid hormones affect every single cell in your body