I underwent a total thyroidectomy in May this year and was put on 100 mg of Levo (Accord brand) on leaving hospital. I have recently obtained a further supply through my GP, this time Aristo brand. I have now had 2 weeks of awful acid reflux - a recurrence of a condition I have had for several years that has been mainly well controlled by the PPI, Lansoprazole (caused by a hiatus hernia).I leave a gap of 4 hours between taking the Levo and the PPI, as recommended, and am following a low acid diet, but all to no avail.
I have read that changing Levo brands can cause problems due to the different fillers used, so I wondered if anyone has experienced this and has any advice regarding acid reflux in particular?
Thank you.
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EnglishPatient52
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It could be excipients in the different brand or quite possibly you are undermedicated. In hypothyroidism there is reduced lower oesophageal sphincter pressure which allows acid to reflux into the oesophagus. Using a PPI can reduce the absorption of levothyroxine creating a vicious circle.Do you have some recent blood test results? A dose of 100 mcg levothyroxine is a little low for someone with a total thyroidectomy. If you have some spare tablets your could try increasing your dose to see if it helps. Otherwise ask your doctor for an increase.
Thank you for your reply. After years of being hyper, it seems I may need help with the possibility of now being hypo.I am seeing my GP this afternoon and will get the latest test results. I wondered if you have any other suggestions for questions I might ask him please.
Sometimes people need a specific brand of levothyroxine but I wouldn't go down this route until you know you are on the correct dose. Being hypo can have two effects, the lower oesophageal sphincter pressure is reduced and the gut slows down. So, first rule out under treatment.
acid reflux is often a sign of dose of levothyroxine not being high enough
100mcg is quite a low dose
Approximately how much do you weigh in kilo?
You need FULL thyroid and vitamin testing
Especially as you are taking PPI which almost always results in low vitamin levels
What vitamin supplements are you taking
What was reason for your thyroidectomy
Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine
For full Thyroid evaluation you need TSH, FT4 and FT3 tested
Very important to test vitamin D, folate, ferritin and B12 at least once year minimum
Low vitamin levels are extremely common on levothyroxine and on PPI
Request/ politely insist GP tests TSH, Ft4 and Ft3 together and all four vitamin levels
For good conversion of Ft4 (levothyroxine) to Ft3 (active hormone) we must maintain GOOD vitamin levels
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)
Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins
Thank you so much for your very detailed reply. In answer to your questions:
I had surgery because I had a multi nodular goitre with a retrosternal extension, which was causing some swallowing difficulties. I was also advised that being hyper for several years had contributed to a diagnosis of osteoporosis last year, following two spinal fractures.
My current weight is approx 66kg.
Vitamin supplements: I have a quarterly B12 injection as I have pernicious anaemia (due today coincidentally); I was on daily ADCAL tablets for the osteoporosis, but they were stopped as the hospital put me on high dose calcium post op. I am no longer taking the calcium so need to ask the GP about resuming ADCAL.
Other conditions: Addisons Disease (daily Hydrocortisone and Fludrocortisone tablets); high cholesterol (daily Atorvastatin); lichen sclerosis (skin condition requiring Dermovate and Estriol creams).
As you will note, I have mainly autoimmune conditions, which can make it difficult to manage timing of medications.
Thank you for your patience on wading through all of this!
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 5-7 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
Lichen sclerosis and autoimmune thyroid disease patients frequently find it beneficial to be on strictly gluten free diet
You need coeliac blood test via GP first before considering trial on GF
When to take levothyroxine
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
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
Hi that’s interesting because years ago when I was given levothyroxine when first diagnosed with thyroid issues I had terrible acid reflux for the first time no one would believed it could be the tablets so after a long time of reflux and constant coughing I went to see an endo eventually and he tried me on solution and that seemed to do the trick. I think it’s the fillers in the tablets that cause this.
Hi I take Zentiva 100mcgs per 5ml. I did have another make to start with Eltroxin I think it was called but that was discontinued I felt more well on that and there is a brand of solution that makes me cough abit but all in all its fine. Good Luck
Hello English Patient 52 - and welcome to the forum :
Do you have Graves Disease and the reason for your thyroidectomy ?
It is essential that you are dosed and monitored on your Free T3 and Free T4 blood test results and we generally feel best when the T4 is up in the top quadrant of it's range with the T3 tracking just behind at around 60/70% through it's range - at around a 1/4 ratio T3/T4 :
though fully understand that in primary care you may well be dosed and monitored on the TSH which is seen as the most reliable measure of your dose of thyroid hormone replacement.
Having had a medical intervention and your thyroid removed - your HPT axis - the Hypothalamus - Pituitary - Thyroid feedback loop - on which the TSH relies on as working well - is now broken and this feedback loop open ended - and why a TSH must not be the deciding factor in your treatment with thyroid hormone replacement.
No thyroid hormone replacement works well until your core strength vitamins and minerals - those of ferritin, folate, B12 and vitamin D are up and maintained at optimal levels - which we can advise on if you have any readings of same.
A fully functioning working thyroid would be supporting you on a daily basis with trace elements of T1. T2 and calcitonin + a measure of T3 at around 10 mcg + a measure of T4 at around 100 mcg. - with T3 said to be around 4 times more powerful than T4.
T4 - Levothyroxine is a pro-hormone and needs to be converted in the body into T3 the active hormone that runs all body with the thyroid responsible for the full synchronisation of ones physical ability and stamina, ones emotional, psychological , mental clarity and spiritual well being, ones inner central heating system and ones metabolism.
Down regulation of T4 to T3 can also occur because of inflammation, any physiological stress ( emotional or physical ) depression, dieting and ageing - so these are more difficult to manage on a day to day basis with some issues appearing out of one's control.
Some people can get by on T4 only medication - Levothyroxine.
Others find T4 seems to stop working for them at some point in time and find they need to add back in ' a little bit of T3 ' - probably at a similar level to that their thyroid once supported them with - and this then restores thyroid hormonal balance - and they feel better.
Others can't tolerate T4 and need to take T3 only - Liothyronine -
as you can live without T4 - but you can't live without T3 :
Whilst others find their health improved taking Natural Desiccated Thyroid which is derived from pig thyroid dried and ground down into tablets referred to as grains and contains all the same known hormones as that of the human thyroid gland.
Currently in primary care your doctor can only prescribe T4 - Levothyroxine with the back up of anti depressants if T4 monotherapy does not restore your health and well being and you need a referral back to the hospital to be assessed as to if you need any treatment option other than Levothyroxine.
Hello, I have Hashimotos and over the years have developed acid reflux. I was given omeprazole many years ago, but was appalled by the list of possible interactions and side-effects. Dr Peatfield suggested it might be a consequence of low stomach acid, as a consequence of being hypo. Being on T3 only has helped, but I'm still basically hypo and have all the other symptoms to manage through the ups and downs of ordinary life, some days/weeks better, others worse: dry skin, constipation, feeling the cold, brain fog, fatigue etc Taking HCl and Betaine before every meal involving protein is a great help, and also Aloe Vera if the reflux becomes worse-either as a drink or more often Aloe Pura tablets, which soothe the Oesophagal lining. Best Wishes for finding your best way forward.
I'm very sorry that your experiencing acid reflux. In my experience when I have acid reflux or burning feeling is one of my signs that I am under medicated.
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