I've have an underactive thyroid and been on medication Sept 2023, I ended up on 100mg but in July 2024 this was brought down to 75mg as my results were 0.09 for TSH. Since being on 75mg my results have been:
TSH - 4th Sept 2024 - 8.35
TSH - 26th Oct 2024 - 2.37
So felt like this was the right medication level.
My blood pressure has always been optimal around 108-110/78, when it was last tested in December it was 110/78.
Through January I've started to feel rubbish and getting headaches and increasing fatigue - I've seen the doctor today and my blood pressure has rised to 124/83. They are rechecking my thyroid and iron levels.
Has anyone seen their blood pressure rise with UAT and is it generally when you're TSH levels are increasing if so?
Thanks in advance for any experience / advice.
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Shoesy99
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TSH over 2 very likely too high for someone on Levo
Which brand of Levo is 75mcg
Which brand was 100mcg
Exactly what vitamin supplements are you taking
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
Presumably you have Hashimoto’s?
Also both TPO and TG thyroid antibodies tested at least once to see if your hypothyroidism is autoimmune
Very important to test vitamin D, folate, ferritin and B12 at least once year minimum
Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease
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
20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis
In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)
Essential to test vitamin D, folate, ferritin and B12
Lower vitamin levels more common as we get older or after dose reduction
For good conversion of Ft4 (levothyroxine) to Ft3 (active hormone) we must maintain GOOD vitamin levels
VERY important to test TSH, Ft4 and Ft3 together
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
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
assuming you have Hashimoto’s are you on strictly gluten free diet
Thanks for this I have my antibodies done privately
TPO - was 233 (range should 0-34)
TGab - was 168 (range should be 0-115)
I've never had an Goitre so I guess this means Autoimmune - Ord’s thyroiditis.
My iron and vitamin levels dont get tested often by my GP last test they were in range but not optimal more at the lower end, but I've got a private test on Tuesday to check all these levels as well as T3 (my GP will only test T4 and TSH). Last time T4 and T3 were tested they seemed be bang in the middle of the range but I'll know more next week.
Even if we frequently start on only 50mcg, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or somewhere near full replacement dose (typically 1.6mcg levothyroxine per kilo of your weight per day)
Adults usually start with a dose between 50 micrograms and 100 micrograms taken once a day. This may be increased gradually over a few weeks to between 100 micrograms and 200 micrograms taken once a day.
Some people need a bit less than guidelines, some a bit more
If symptoms of hypothyroidism persist despite normalisation of TSH, the dose of levothyroxine can be titrated further to place the TSH in the lower part of the reference range or even slightly below (i.e., TSH: 0.1–2.0 mU/L), but avoiding TSH < 0.1 mU/L. Use of alternate day dosing of different levothyroxine strengths may be needed to achieve this (e.g., 100 mcg for 4 days; 125 mcg for 3 days weekly).
Hypertension (high blood pressure) is associated with both hypothyroidism and hyperthyroidism. Often there are no symptoms although, if present headaches are often described as severe and persistent.
I'd be happy to have your recent reading, without wishing to deny your symptoms and concern. My hypertension is labelled "essential" i.e. of unknown cause, despite having commenced on treatment for hypothyroidism shortly after diagnosis (my TSH was 14 when in hospital due to hypertensive urgency). Fourteen years earlier, when undiagnosed hyperthyroid, I visited my GP about chest pain. My blood pressure was high and I was sent for an ECG and my first thyroid test. I got hold of my medical record more recently, and the thyroid test was either botched or the results were lost, and I didn't get another until six years later, with a different doctor. Nothing was done about my blood pressure but I was prescribed Gaviscon (which I didn't take) as GERD and silent reflux were trendy diagnoses for causes of chest pain.
Hello Shoesy. I had life-long lower BP (systolic 100). Once I started levothyroxine, my BP began steadily rising and it didn't seem to matter what my tsh was. A metabolite of levothyroxine, 3t1am, causes hypertension, but apparently not in everyone. I suspect the brand/formulation may matter here. I can post research links if there is interest, or complaints!
3-T1AM (3-iodothyronamine) is a thyroid hormone metabolite and a rapid acting derivative of thyroid hormones. It is involved in energy metabolism and also thermoregulation, but I could not find any clear evidence that it is involved in hypertension - would you be able to share the research links you have mentioned?
I don't think that the brand or formulation will be of much importance, as they all contain thyroid hormones, which will be metabolised into the active metabolite, irrespective of the chosen brand. It might be that with certain brands, depending on the excipients, you will perhaps have a bit more free hormones available which could be converted in slightly more of the active metabolite, but I doubt that this difference would have a significant influence on blood pressure?
I forgot to say--3t1am also causes fatigue and a lower threshold to pain. It lowers insulin and raises blood sugar, although that happened more slowly to me.It's not all bad though--it lowers LDL cholesterol. Such consolation.
My blood pressure usually takes 15 ~ 20 minutes to come down when taking a set of readings, but I did notice it increased when once, on a whim, I took it within an hour of my dose of levothyroxine. I told my GP, and it was a case of the lesser of two evils.
Thanks - I guess i might have to take a closer look at the brand of Levo I'm being given. My pharmacy always seems to be switching the brands and it hadn't really had any impact on me so I didnt really pay attention to the brands.
Thanks for your reply. I guess it might just be my new normal then!
Information about the thyroid hormone products you will find in the UK.
helvella - Thyroid Hormone Medicines - UK
The UK document contains:
Up-to-date versions of the Summary Matrixes for levothyroxine tablets, oral solutions and liothyronine available in the UK. These include declared ingredients for all UK-licensed products.
Details of every dosage of each medicine include PL numbers, PIP numbers, tablet markings, product history and links to:
Patient Information Leaflets
Summary of Product Characteristics
Product Assessment Reports
Dictionary of Medicines and Devices (dm+d) entry and current prices
Document has links to:
British National Formulary
NHS Drug Tariff, etc.
PLUS how to write prescriptions in Appendix F.
Also includes links for anti-thyroid medicines (but not product details).
I'll flag up looking into your sex hormone levels as these could well be a symptom of lowering estradiol levels, balancing thyroid and sex hormones is important
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