Hi all. I've had a regimen change in the past 3 weeks to alternate 150mcg and 100mcg of levothyroxine on alternate days to get an average of 125mcg over the course of a fortnight. It's like this because I'm on the Accord brand and they don't do a 25mcg dose. Previously, every time I got a different brand for the 25mcg dose, it sent my levels all over the place, hence I requested a trial to do it this way. In the past few days however, I've had prolonged palpitations, a faster heartbeat and a general anxious feeling (lump in throat type). My at home BP monitor flagged up an 'irregular heartbeat' warning a few times this weekend and I'm seeing the doctor this afternoon to be on the safe side.
I guess I'm wanting to know if this is a typical initial reaction to this type of regimen of levo, or, do I need a reduction to 112.5mcg? I'm aware that 3 weeks isn't quite long enough for it to have settled yet. It's a very uncomfortable feeling. Thanks for reading.
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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)
Hi, thanks for the reply. It turns out the antibiotic I'm on atm is the likely cause of ectopic heartbeats, ecg was clear. I had palpitations only randomly before this regimen change and the ABs, unfortunate coincidence I think.I've attached below the latest bloods (14th May) since working on vitamins etc (I'm on B12 injections now) and all have improved nicely. Ferritin has a wee bit to go, but it's increased markedly taking it EOD from daily.
I was gluten free for a long time years ago but didn't feel any different. Maybe it's worth another go now I'm older and the B12 deficiency has reared it's head, something has obviously changed in my gut. Nearly dairy free as more than a splash of milk inflames my sinuses and upsets my tummy, lactose is not my friend.
CRP presumably high because of recent issues that you are prescribed antibiotics for
Retest in 6-8 weeks
Ferritin on low side, especially as high CRP can increase ferritin
Look at increasing iron rich foods in your diet
Retest once CRP is normal
Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption
This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.
Never supplement iron without doing full iron panel test for anaemia first and retest 3-4 times a year if self supplementing.
It’s possible to have low ferritin but high iron
Test early morning, only water to drink between waking and test. Avoid high iron rich dinner night before test
Are you taking daily vitamin B complex? one with folate in (not folic acid). This can help keep all B vitamins in balance and will help improve B12 levels too
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
As you have B12 injections it’s recommended also to supplement a good quality daily vitamin B complex, one with folate in (not folic acid) may be beneficial.
This can help keep all B vitamins in balance
Vitamin D on high side …perhaps reduce dose a little
Currently Teva (with much controversy) or Aristo (only 100 microgram dosage at present - other dosages hopefully in a month or two).
I am glad you found some sort of an answer.
When I look back over records, I can see that my heart rate was very often higher on a lower dose of levothyroxine. That was, 112.5 as against 125 now. Over many months, other factors can also be important. But I am pretty sure that more levothyroxine has actually helped a little. (There again, my heart rate is always crazy. So not an ideal example. )
I never twigged the Accord brand had lactose in it 🤦🏼♀️ I've not got an allergy or known intolerance, but I do know when I've had too much dairy 😳 Teva has mannitol in it, although I'm assuming it's pretty much insignificant amounts (unless a person is sensitive to artificial sweeteners)? I think I'll need to eliminate one thing at a time, starting off with seeing how I'm doing on one brand only for 2 months. I'm glad I found this group and not just listened to the various doctors.
I have no known issue with lactose. But, for whatever reason, have found the best levothyroxine products - for me - are lactose-free. However, the reason might not be the lactose - that could just be chance.
I did not get on with even a tiny dose of Teva levothyroxine. And we seem split into those who like it and those who cannot tolerate it. Mannitol is suspected but not proved to be the cause.
helvella's medicines documents (UK and Rest of the World) can be found here:
helvella - Thyroid Hormone Medicines
helvella has created, and tries to maintain, documents containing details of all thyroid hormone medicines in the UK and, in less detail, many others around the world. There is now a specific world desiccated thyroid document.
I highly recommend viewing on a computer screen, or a decent sized tablet, rather than a phone. Even I find it less than satisfactory trying to view them on my phone.
helvella - Thyroid Hormone Medicines - UK
The UK document contains up-to-date versions of the Summary Matrixes for levothyroxine tablets, oral solutions and also liothyronine available in the UK. Includes descriptions of tablet markings which allow identification. Latest updates include all declared ingredients for all UK products and links to Patient Information Leaflets, etc.
Contains details of all levothyroxine, liothyronine and combination products - excluding desiccated thyroid products. Details available vary by country and manufacturer.
The link below takes you to a blog page which has direct links to the documents from Dropbox and QR codes to make it easy to access from phones. You will have to scroll down or up to find the link to the document you want.
So antibiotics and/or gluten may have reduced the absorption of levothyroxine in effect reducing your dose …..and perhaps responsible for reducing vitamin levels
Thanks for all your help and advice on this. It's a very good point re the absorption which I hadn't considered. I thought as I'd separated the meds sufficiently (several hours apart) it would be ok, but I suppose anything affecting the gut will affect absorption. Hopefully I can start from a level playing field once this course of ABs is over and my vits/ferritin are back up in the optimal range. I'll also investigate the other brand of levo too, many thanks for that.
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