(First time I've posted and not sure if I've put this query in the correct place).
I'm 59 and was diagnosed with Hypothyroidism when I was 50. I'm currently on 75mcg 4 days/wk and 50mcg 3 days/wk.
I recently visited my GP as I'd been having chest pain for a few months on & off.
She immediately said it sounds like Angina, gave me Nitroglycerin to keep in my bag for any episodes of chest pain and referred me for further investigation (ECG, Echo, treadmill etc) and blood tests.
All heart tests were considered normal, not had to use nitroglycerin, but my bloods showed that my cholesterol is at 7.3, which I'm told is high and I need to get it down.
My GP immediately suggested statins, but I was under the impression that if my thyroid meds are correctly balanced, this should keep my cholesterol in check?
I asked if perhaps I wasn't on enough Levothyroxine, so GP tested thyroid and my
T4 had risen to 20.5 (TSH 2.18) and despite them saying the so called 'normal range' is currently 11.9 to 21.6 ... I know I feel most comfortable around 14 or 15 for T4. So no wriggle room really to take more in order to bring down cholesterol.
I'm now trying to alter my diet to try to bring cholesterol down naturally (Only been doing a week or so).
And as my T4 is high (for me) I'm definitely getting signs of being on potentially 'too much' Levothyroxine. (Jitteriness, racing heart, anxiety etc. I also get lower back/kidney area pain occasionally too).
So have reduced meds down slightly to 75mcg 3 days/wk and 50mcg 4 days/wk to try to balance & get T4 down a bit. (As an aside, I've noticed that I've been given Teva 25mcg which are much bigger tablets than my previous 25mcg. Probably just filler, but wondering if the potency may be different).
I'm aware though that reducing thyroid meds could push my cholesterol higher. And wondering whether I should just bite the bullet and go on statins.
Bit confused and would appreciate any advice.
Many thanks 🙏
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MBMB66
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You are on rather a low dose of Levothyroxine. It averages out to 64 mcg per day which is only slightly above a starting dose. You need your dose raising.
A TSH of 2.8 is also rather too high for someone with treated hypothyroidism.
To see the TSH levels of healthy people with healthy thyroids see this link :
Most people with treated hypothyroidism feel at their best with TSH of 1 or under.
However, with your Free T4 being 20.5 it makes me wonder what your level of Free T3 is. I suspect it might be rather low, and T3 is the active thyroid hormone that every cell in the human body needs. If you had some T3 in addition to your Levo your Free T3 would rise and your Free T4 would most likely drop.
What time of day did you have your blood tested for those test results you've quoted?
...
Another effect of being hypothyroid is that it reduces stomach acid, and this disturbs the digestion. People end up with low levels of vitamins and minerals as a result. Ask your doctor for blood testing of your Vitamin B12, Folate, Vitamin D, and Ferritin (iron stores). If they are below optimal you can buy supplements to raise them to optimal. (Doctors rarely prescribe vitamins and minerals, and even when they do they often supply them for too short a time at too low a dose. And they often supply poor forms of nutrients too, so buying them ourselves online means we can do better.) If you manage to get results for these please post in a new thread and ask for advice. We need to know what was tested, the actual result, and the reference ranges to give useful help.
Low iron and/or low ferritin can cause chest pain. I know that from experience. The chest pain stopped after I took iron supplements to optimise my iron and iron-related levels.
Edit : Low iron and/or low ferritin can also cause tachycardia (fast heart rate). I know that from experience too.
There are an enormous number of causes of chest pain and tachycardia :
I've asked my GP to test my T3 in the past to be told, "we don't test that in the UK". They've only ever tested my T4 and TSH over the past 9 years. I'll definitely look into getting a private blood test, as I'm really interested to see what my T3 is.
I started on 50mcg, which has been tweaked up over the years, but I'm really sensitive to any changes in dosage. I was over-medicated in 2019, only slightly, but I was really ill for around 4 months, palpitations, diarrhoea, weight loss, lack of appetite, anxiety, jitteriness, pacing the room etc. It was awful. So I'm really nervous about altering my dose.
The blood test was at 9:20am, fasting, but I did take my Levo before going (I take it first thing).
My Ferritin was recently 58ng/ml but they didn't test B12, Folate or Vit D. My GP told me not to take supps at all as they could interact negatively with my Levo. I do take Omega 3 supplements (figuring I'd get that naturally from fish anyway).
My GP told me not to take supps at all as they could interact negatively with my Levo.
That is true but it can be avoided. For example, if you take Levo at 7am once a day, every day, but you need iron. If you take the iron four hours after the Levo it won't prevent your Levo from being digested.
The gaps required between Levo and supplements and other medications that I know of - there could be more - and I hope someone else checks my list for accuracy because I'm not confident about this list at all greygoose , SlowDragon ...
Four hour gap - Iron, Vitamin D, HRT/oestrogen, Magnesium, Calcium
Two hour gap - Other vitamins apart from Vitamin D
One hour gap - Food
greygoose Thank you for reminding me about calcium.
"We don't test that in the UK". Oh yes we do! What nonsense. I get my TSH, FT4 and FT3 tested twice a year at my surgery and have never had an issue with it.
Unless you are extremely petite you’re on a very low dose levothyroxine
Being on too low a dose leads to low vitamin levels and poor conversion of Ft4 (Levo) to Ft3 (active hormone )
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)
is this how you do your tests
Which brand of Levo are you taking
Many people find different brands are not interchangeable
is your hypothyroidism autoimmune?
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)
NHS only tests TG antibodies if TPO are high
What vitamin supplements are you taking
When were vitamin D, folate, ferritin and B12 last tested
Suggest you get these tested via GP or include in private thyroid test
Testing options and includes money off codes for private testing
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
Monitor My Health (NHS private test service) offer thyroid and vitamin testing, plus cholesterol and HBA1C for £65
Hi Slowdragon, the brand changes every time I get my meds, 'and' they give me different brands for the 50mcg and the 25mcg. I've asked them to keep them the same. I took some Teva ones back to the pharmacy today, asking for a replacement as the Teva ones were huge and clearly full of fillers.
My Ferritin was recently 58ng/ml but they didn't test B12, Folate or Vit D.
Many patients do NOT get on well with Teva brand of Levothyroxine.
Teva is lactose free, but 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
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.
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).
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
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.
they didn't test B12, Folate or Vit D.
Get these tested via GP or privately
My GP told me not to take supps at all
If not taking vitamin D or B vitamins likely levels are too low
No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.
Supplements - iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away from levothyroxine
The jittery, racing heart and anxiety can actually also be a sign of having too little thyroid hormones. Yes, your T4 might have been nearly on top of the range, but as your TSH was 2.18, this was actually asking your thyroid to produce more hormones. Have you ever had your T3 tested? This could actually be the culprit, as you need to convert T4 to the active T3 - however some people cannot do this process efficiently, hence the T4 stays high but the T3 could still be low.
As T3 is the active hormone that turns on your metabolism and gives you the energy, low T3 would fit in with your symptoms. In addition, high cholesterol is a recognised side effect of hypothyroidism. T3 is needed in sufficient amounts for lipid (fat) metabolism in the liver. If you have too little T3 available, this process cannot efficiently run and as a result cholesterol levels rise, as they cannot effectively be dealt with. High cholesterol in under-treated hypothyroidism is very common, and as it is not a dietary issue, it should be resolved with treating the underlying cause, which is too little thyroid hormones.
Do you have the possibility to do a private thyroid function test, where you can check your TSH, T4 and T3? This way you can see clearly what your level of the active hormone T3 is. And if you are not converting well, you may need to add some T3 medication to sort out the problem.
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