Loud hiccups

[Thyroidmeg]

I’m on levothyroxine and also on bp pills. Rampril and amlodipine

I sometimes get very loud hiccups can that be related to my pills?

[Judithdalston]

On 2 out of 3 of these ( and take other BP pills) never had any problems with hiccups. Does it occur after taking pills with water? I have previously wondered whether under treatment of thyroid hormones contributed to weakened diaphragm as used to get ‘stitch’ type pain; are you adequately treated with levo according to blood results?

[Thyroidmeg in reply to Judithdalston]

They are random not after any pills and usually just a loud one . I don’t feel adequately treated but I’m taking all the great advice on here .

I do sometimes get a twinge and feel maybe slightly constipated when that happens Ie it goes away when I’ve been to toilets it’s not sore just almost bloated feeling

I don’t think it’s related to the hiccups tho

I want energy again !

[SlowDragon Administrator]

your previous post shows high Ft4 and extremely low Ft3

Also you say you have low ferritin

healthunlocked.com/thyroidu...

Was test done as recommended, early morning, ideally before 9am, only drinking water between waking and test and last dose levothyroxine 24 hours before test

Do you always get same brand levothyroxine at each prescription

Do you always take levothyroxine on its own at least 2 hours away from all other medications and on empty stomach, then nothing apart from water for at least an hour after

No calcium, vitamin D, magnesium, iron, HRT or PPI within 4 hours of levothyroxine

[Thyroidmeg in reply to SlowDragon]

thank you I’m getting tested today and am following your advice so it will be interesting to see if dr test same as the monitor my health one I got done. My ferritin hasn’t been done for a while so I’ll get it done it was only 11 but nurse said my haemoglobin was fine so she wasn’t concerned. My vitamin d is also very low do that’s why they gave me the d3 800iu to help the deficiency I’ll ask for that today. I am so nervous I feel I can’t lose weight so I’ll be in trouble for that. My blood pressure always makes me scared to get it tested too. ( White coat syndrome )

I don’t always get the same brand levo or blood pressure ones

I’ll try and take my levo before the bp ones in future I sometimes take them at same time .

Thank you so much

[SlowDragon Administrator in reply to Thyroidmeg]

My vitamin d is also very low do that’s why they gave me the d3 800iu to help the deficiency I’ll ask for that today

800iu vitamin D is a tiny dose and unlikely to give any improvement

Aiming to maintain vitamin D at least over 80nmol minimum and many members find it better to maintain at 100-150nmol

If vitamin D is below 50nmol you will need AT LEAST 2000iu daily for minimum of 6 months

NHS Guidelines on dose vitamin D required

panmerseyapc.nhs.uk/media/2...

GP will often only prescribe to bring vitamin D levels to 50nmol.

Some areas will prescribe to bring levels to 75nmol or even 80nmol

leedsformulary.nhs.uk/docs/...

GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)

mm.wirral.nhs.uk/document_u...

But with Hashimoto’s, improving to around 80nmol or 100nmol by self supplementing may be better

pubmed.ncbi.nlm.nih.gov/218...

vitamindsociety.org/pdf/Vit...

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

Test twice yearly when supplementing

Can test via NHS private testing service

vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function.

There’s a version made that also contains vitamin K2 Mk7.

One spray = 1000iu

amazon.co.uk/BetterYou-Dlux...

It’s trial and error what dose we need, with thyroid issues we frequently need higher dose than average

Vitamin D may prevent Autoimmune disease

newscientist.com/article/23...

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...

[SlowDragon Administrator in reply to Thyroidmeg]

I don’t always get the same brand levo

I’ll try and take my levo before the bp ones in future I sometimes take them at same time .

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

Perhaps try taking levothyroxine at bedtime (at least 2 hours after any food or drink)

verywellhealth.com/best-tim...

markvanderpump.co.uk/blog/p...

markvanderpump.co.uk/blog/p...

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

Work out which brand Levo suits you best then only get that one

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 

July 2024

Crescent levothyroxine. Dosages: 12.5, 25, 50, 75, 100

(Not yet known if all approved dosages are or will be available).

Excipients: lactose monohydrate, maize starch, croscarmellose sodium, gelatin and magnesium stearate.

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...

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How to get Vencamil stocked at your local pharmacy

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 in reply to Thyroidmeg]

Ferritin needs to be at least over 70 for levothyroxine to work well

Are you vegetarian or vegan

pre or post menopause?

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

If taking any iron supplements stop 5-7 days before testing

Medichecks iron panel test

medichecks.com/products/iro...

Look at increasing iron rich foods in diet

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

List of iron rich foods

dailyiron.net

Links about iron and ferritin

irondisorders.org/too-littl...

davidg170.sg-host.com/wp-co...

Great in-depth article on low ferritin

oatext.com/iron-deficiency-...

drhedberg.com/ferritin-hypo...

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.

healthunlocked.com/thyroidu...

Posts discussing Three Arrows as very effective supplement

Great replies from @FallingInReverse

re ferritin and Three arrows

healthunlocked.com/thyroidu......

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Great reply by @fallinginreverse

healthunlocked.com/thyroidu...

Iron patches

healthunlocked.com/thyroidu...

Thyroid disease is as much about optimising vitamins as thyroid hormones

healthunlocked.com/thyroidu...

restartmed.com/hypothyroidi...

Post discussing just how long it can take to raise low ferritin

healthunlocked.com/thyroidu...

Iron and thyroid link

healthunlocked.com/thyroidu...

Posts discussing why important to do full iron panel test

healthunlocked.com/thyroidu...

Good iron but low ferritin

healthunlocked.com/thyroidu...

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Chicken livers if iron is good, but ferritin low

healthunlocked.com/thyroidu...

Shellfish and Mussels are excellent source of iron

healthline.com/nutrition/he...

Iron deficiency without anaemia

healthunlocked.com/thyroidu...

Ferritin over 100 to alleviate symptoms

healthunlocked.com/thyroidu...

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Great research article discussing similar…..ferritin over 100 often necessary

ncbi.nlm.nih.gov/pmc/articl...

Low Iron implicated in hypothyroidism

healthunlocked.com/thyroidu...

Really interesting talk on YouTube, link in reply by Humanbean discussing both iron deficiency and inability to loose weight

towards end how inflammation can also be an issue

healthunlocked.com/thyroidu...

Inflammation affecting ferritin

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Updated reference ranges for top of ferritin range depending upon age

healthunlocked.com/thyroidu...

Thank you for your incredible patience while you have been awaiting the outcome of our ferritin reference range review. We conducted this with Inuvi lab, which has now changed the reference ranges to the following:

Females 18 ≤ age < 40. 30 to 180

Females 40 ≤ age < 50. 30 to 207

Females 50 ≤ age < 60. 30 to 264l

Females Age ≥ 60. 30 to 332

Males 18 ≤ age < 40 30 to 442

Males Age ≥ 40 30 to 518

The lower limits of 30 are by the NICE threshold of <30 for iron deficiency. Our review of Medichecks data has determined the upper limits. This retrospective study used a large dataset of blood test results from 25,425 healthy participants aged 18 to 97 over seven years. This is the most extensive study on ferritin reference ranges, and we hope to achieve journal publication so that these ranges can be applied more widely.

[Thyroidmeg in reply to SlowDragon]

Thanks you lots of stuff for me to read. I’m not vegetarian but think I’m menopausal (11.5 months since last period)

I did mention hair loss concerns about ferritin being low but dr looked at my hair for a second then looked away . I use various products to make my hair look thicker so maybe not obvious to him but I have lots of scars on my head from an operation in the past so hair loss is a worry.

[SlowDragon Administrator in reply to Thyroidmeg]

Can you add full iron panel test results from recent GP test

Thousands of U.K. thyroid patients struggle with low ferritin

Most have to manage this themselves

Get full iron panel test via Medichecks if not been tested by GP

[Thyroidmeg in reply to SlowDragon]

Thanks I will ask for a printout of todays when the come in and if possible last test too

[SlowDragon Administrator]

For good conversion of Ft4 (levothyroxine) to Ft3 (active hormone) it’s essential to maintain GOOD vitamin levels

When were vitamin D, folate, B12 and ferritin last tested

Exactly what vitamin supplements are you taking

[Thyroidmeg]

they wouldn’t test my b12 or folate but I’m going to make sure they do today and I usually ask for ferritin

Thank you

[Star13]

I was told hiccups are a form of reflux. If you can work out a pattern when you get them then you can know what the trigger is. For instance with me it’s toast, unless I drink before eating toast I get them!

[Thyroidmeg]

thanks I think it could be reflux I’ll try to figure it out