Help scheduling medications

[Habibi87]

Hi all,

I have acquired hypothyroidism (post subacute thyroditis). I am currently 27 weeks pregnant and I have just been told that based on my last blood tests I need to take ferrous sulfate 200mg on alternative days. I also need to take 75mcg of levothyroxine daily, 400 mcg folic acid combined with vitamin D and C and, as the pregnancy is causing heartburn, gaviscon at least before bedtime… I know that they all interact with each others (though none of the healthcare professionals have commented on this) and was hoping you might be able to help me create a schedule?

thanks in advance

[TiggerMe Ambassador]

Let's start first thing with Levo taken an hour before food water only, if you are up in the night you can take it then

Ferrous sulphate needs to be 4 hours away from Levo and half an hour before food or 2 hours after, take the Vit C with it

We don't recommend folic acid as it needs converting to folate before it is any use so if you can but some 400mcg methylfolate which you can take with your Vit D again 4 hours away from Levo

Magnesium before bed would help with the Vit D uptake

Do you have your latest results as your heartburn could be due to being under-replaced 75mcg is a small dose?

Gaviscon will inhibit uptake of T4 so keep at least 4 hours apart

Hope that doesn't totally confuse you 🙃 best to decide when you are going to take your Levo and go from there

[Habibi87 in reply to TiggerMe]

thank you so much for your help . Do you have any recommendations on what brand to use for the iron and the rest of the vitamins ?

I have been battling with the gp forever on the dose of Levo.

My results on the 10th of August done privately when I was still on 50 levo where:

-tsh 2.09 (0.35-5.5)

- t4 12.5 (11.9-21.6)

-t3 4.69 (3.1-6.8)

negative TPO and Tg (as expected as my hypo is not autoimmune but acquired).

After these results, I managed to convince my gp to increase the Levo to 75 mainly because he wanted the TSH to be close to 1 in pregnancy and not because of the low t4.

23rd September 2024 nhs resulst after a month on 75 (gp couldn’t see me for weeks)

Tsh: 0.49 (0.35-4.94)

T4: 11.3 (9-19.1)

No T3 done

Consultant obstetrician happy with results and said to continue on 75

Results on 31st October showed TSH at 0.97 (0.35-4.94). But test was done without telling me in advance by the midwife so I had taken Levo a few hours before the test…

I will be booking a new private one shortly.

Thank you

[TiggerMe Ambassador in reply to Habibi87]

Sorry for the delay...

Do you know your B12 level? Many of us use a good B complex, these are all good ones that will boost B12, folate and some contain Vit C... healthunlocked.com/thyroidu...

Vit D & K2 I personally like a sublingual like Nature Provides

Iron, I'm a fan of threearrowsnutra.com/en-uk/...?

Terrible website but a great product in the right form to absorb easily, save 10% FRANKLIN

I thought during pregnancy you were referred to an Endo?

[Habibi87 in reply to TiggerMe]

Hi Tigger me,

NHS111 has just sent me to A&E as I have been vomiting (first red and brown, then bile) and I am extremely thirsty but I have pain, cramps, nausea as soon as I sip water. It all started within an hour of taking the iron supplement. I haven’t been able to take levothyroxine either. Anything I should be flagging to them ?

[helvella Administrator in reply to Habibi87]

I have no helpful advice or suggestions but I very much wish you well.

[TiggerMe Ambassador in reply to Habibi87]

Sorry to hear this! The heme iron will be why it’s red/ brown, bovine spleen, L-leucine in a gelatin capsule... It'll also make your poo darker

[SlowDragon Administrator]

Which brand of levothyroxine is 75mcg

September test was too soon after increase in dose for TSH to start to climb back

TSH in October starting to increase

September Ft4 very low

Free T4 (fT4) 11.3 pmol/L (9 - 19.1) 

Ft4 only 22.8% through range

Would expect new test will show TSH increased further

Test early morning and last dose levothyroxine 24 hours before test

[Habibi87 in reply to SlowDragon]

Hi SlowDragon,

I am on two brands of levothyroxine. The 25 mcg is mercury and the 50 mcg is Accord.

I am doing a private blood test today with no levo for 24h and will post the results as soon as I get them.

I was already surprised the gp agreed to up my dose to 75 as they kept on writing no action needed based on the results!

[Habibi87 in reply to SlowDragon]

Hi Slow Dragon

Here are the results

Tsh:1.02 (0.39-5.5)

T4 11.30 (11.9-21.6)

T3 3.91 (3.1-6.8)

all ok on antibodies.

How do I get them to up my dose ???

[SlowDragon Administrator in reply to Habibi87]

Make appointment with GP

How long have you been on 75mcg

Ft4 is below range

[Habibi87 in reply to SlowDragon]

GP said that 11.3 for fT4 would be within range according to his system… I argued that we have to use the ranges used by each lab and so at the end he decides to do a new blood test for TSH and T4 (no T3) on the NHS. I have also written to the midwife asking she seeks the opinion of the consultant obstetrician but no reply yet .

How come if fT4 is low, that TSH isn’t higher ?

I started the 75mcg dose at the beginning of September.

Thanks again

[SlowDragon Administrator in reply to Habibi87]

How come if fT4 is low, that TSH isn’t higher

Common problem when taking levothyroxine.

[Habibi87 in reply to SlowDragon]

NHS results:

TSH: 1.22 (0.35-4.94)

fT4: 10.9 (9-19.1)

GP said no action

I’ll chase the midwife but I doubt I’ll get anywhere

[SlowDragon Administrator in reply to Habibi87]

Free T4 (fT4) 10.9 pmol/L (9 - 19.1) 

Ft4 only 18.8% through range

So you need 25mcg increase in dose Levo

Retest in 8 weeks

If midwife won’t increase dose get appointment with GP

[humanbean]

Ferrous Sulfate 200mg is one of the iron salts which is beloved by doctors because it is really, really cheap. It is also very poorly tolerated.

Ferrous Fumarate and Ferrous Gluconate are both better tolerated than Ferrous Sulfate.

All the iron salts can be bought without prescription from pharmacies in the UK without prescription.

.

There are three iron salts that doctors can prescribe :

Ferrous Sulfate 200mg : bnf.nice.org.uk/drugs/ferro...

Ferrous Sulfate 200 mg is equivalent to 65 mg elemental iron

.

Ferrous Fumarate 210mg : bnf.nice.org.uk/drugs/ferro...

Ferrous Fumarate 210 mg is equivalent to 69 mg elemental iron

.

Ferrous Gluconate 300mg : bnf.nice.org.uk/drugs/ferro...

Ferrous Gluconate 300 mg is equivalent to 35 mg elemental iron

.

The links above give you the information you need with reference to dosing.

When I was taking ferrous fumarate 210mg I was taking these - note that brand of the iron salts listed don't really matter :

expresschemist.co.uk/pics/p...