Correct dose and joint pain: I am 39 years old... - Thyroid UK

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Correct dose and joint pain

Zanne60 profile image
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I am 39 years old and was diagnosed with hypothyroidism just over 2 years ago after going for a blood test for fatigue. No other symptoms than that at the time.

Last July I went to the GP as felt ill- tingling in the arms, weakness, headaches- my TSH was 12.6 so the original prescription was increased from 25mg to 50mg of levothyroxine.

I went back in November for a blood test with a TSH of 5.25- despite feeling fine I was increased to 75mg. Within around 2 weeks of the dose increase I experienced lower back pain which and sore wrists which at the time I didn’t connect to this possibly being related to the dose increase. Back pain hasn’t been an issue before.

In January this year I had a Thriva blood test as just didn’t feel right with fatigue, continuing back pain, ringing ears and tingling hands and forearms. The results are attached.

In light of struggling to get an appointment with my GP to discuss the results I arranged an appointment with a private thyroid clinic who based on how I was feeling and the Thriva results increased my dose to 100mg (I take the 75mg from GP and 25mg of a different brand to make up the 100mg). They want to review my bloods in 3 months. They also suggested taking vitamin D, selenium and zinc and folate which I am implementing. I have been on the 100mg for just 2 weeks and still don’t feel great (patience is not my thing).

I have also finally managed to get a telephone appointment with my GP but really at a loss as to what I should be asking for and if my dose is too high or whether I just need to give a few months for the 100mg to kick in.

I have no other “known” medical conditions other than vitiligo which I have had since the age of 11. I am at a loss as to what I should be suggesting to the GP- is the increase in dose causing side effects/ making me feel worse? Looking for some direction.

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SlowDragon profile image
SlowDragonAdministrator

welcome to the forum

High TPO antibodies confirms autoimmune thyroid disease also called Hashimoto’s

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.

Are you in U.K.

In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)

Essential to test and maintain GOOD vitamin D, folate, ferritin and B12

For good conversion of Ft4 (levothyroxine) to Ft3 (active hormone) we must maintain GOOD vitamin levels

Exactly What vitamin supplements are you taking

They also suggested taking vitamin D, selenium and zinc and folate which I am implementing

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)

So January test results above were when on 75mcg daily

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 did this test ?

I have been on the 100mg for just 2 weeks and still don’t feel great (patience is not my thing).

No point seeing a consultant until you have new test results after 8-10 weeks on 100mcg

Which brand of levothyroxine is your 75mcg and which brand is 25mcg

Many people find different brands are not interchangeable

Teva brand upsets many people

SlowDragon profile image
SlowDragonAdministrator

Poor gut function with Hashimoto’s can lead leaky gut (literally holes in gut wall) this can cause food intolerances.

Most common by far is gluten.

Dairy is second most common.

A trial of strictly gluten free diet is always worth doing

Only 5% of Hashimoto’s patients test positive for coeliac but a further 81% of Hashimoto’s patients who try gluten free diet find noticeable or significant improvement or find it’s essential

A strictly gluten free diet helps or is essential due to gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and may slowly lower TPO antibodies

While still eating high gluten diet ask GP for coeliac blood test first as per NICE Guidelines

nice.org.uk/guidance/ng20/c...

Or buy a test online, about £20

Assuming test is negative you can immediately go on strictly gluten free diet 

(If test is positive you will need to remain on high gluten diet until endoscopy, maximum 6 weeks wait officially) 

Trying gluten free diet for 6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse

chriskresser.com/the-gluten...

amymyersmd.com/2018/04/3-re...

thyroidpharmacist.com/artic...

drknews.com/changing-your-d...

Non Coeliac Gluten sensitivity (NCGS) and autoimmune disease

pubmed.ncbi.nlm.nih.gov/296...

The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported

nuclmed.gr/wp/wp-content/up...

In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned

restartmed.com/hashimotos-g...

Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.

Similarly few months later consider trying dairy free too. Approx 50-60% find dairy free beneficial

With loads of vegan dairy alternatives these days it’s not as difficult as in the past

Post discussing gluten

healthunlocked.com/thyroidu...

Recent research in China into food intolerances with Hashimoto’s

healthunlocked.com/thyroidu...

More interesting Chinese research on Hashimoto’s and leaky gut

nature.com/articles/s41598-...

I have no other “known” medical conditions other than vitiligo which I have had since the age of 11

Vitiligo is also autoimmune

Having one autoimmune disease makes others more likely

You might also see some improvements in vitiligo on strictly gluten free diet

SlowDragon profile image
SlowDragonAdministrator

Thriva test above

No ferritin result?

Folate low

rather than just taking folic acid or folate we recommend on here to take a good quality daily vitamin B complex

supplementing a good quality daily vitamin B complex, one with folate in (not folic acid)

This can help keep all B vitamins in balance

Difference between folate and folic acid

healthline.com/nutrition/fo...

Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid supplements

thyroidpharmacist.com/artic...

B vitamins best taken after breakfast

Igennus B complex popular option. Nice small tablets. Most people only find they need one per day. But a few people find it’s not high enough dose and may need 2 per day and/or may need separate methyl folate couple times a week

Post discussing different B complex

healthunlocked.com/thyroidu...

IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 5-6 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endocrinenews.endocrine.org...

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)

SlowDragon profile image
SlowDragonAdministrator

Last point

Suggest you test selenium, zinc and copper here

bluehorizonbloodtests.co.uk...

Zanne60 profile image
Zanne60 in reply toSlowDragon

Thankyou so much for your time and informative reply; as to your questions-

1-UK based- yes although I have never discussed the condition with my GP, even when diagnosed. I was told it was as simple as take the prescribed Levo and you will be fine. This is why in Jan I got my own Thriva test and then spoke to a thyroid clinic. I wanted to be better informed.

2) Supplements- started taking Pharma Nord combined zinc and selenium about a fortnight ago , vitamin D (2000 IU) and folic acid (note you say the latter shouldn’t be needed- should I stop taking this? ).

I also periodically take magnesium and omega 3 as per Thriva’s advice and MSM. I don’t take anything within 4 hours of the levo other than lemon water and after an hour a couple of boiled eggs for breakfast. I do take the contraceptive pill about half a hour after the levo- is that a problem? Take the supplements at night after dinner. I think it is sensible what you say re B vitamins and will order some. It is strange getting used to the volume of supplements but if it helps me….

3) Timing of blood test- the last one was about 6.30am (Thriva where I screen shotted the results) and hadn’t taken that days Levo. Wouldn’t have been on any supplements other than MSM. When the GP take bloods it’s whenever they can fit me in and offer no advice re timing.

4) Brand- the 75mg are Teva and 25mg Wockhardt. I always used to request Wockhardt when I was on 25mg as I thought I got on better with that. With the 75mg it differs as to what brand I pick up from the pharmacy each month. Would I be better asking for 4x 25mg of Wockhardt?

5) Diet- my husband eats a dairy and gluten free diet and I eat what he eats save for the odd slice of cheese. I would say I have a healthy diet.

6) Ferritin- I didn’t get that tested with Thriva (I was trying to best work out what I needed to test for) but my July 2024 GP result said this was low and to eat more red meat etc. The NHS app doesn’t give a figure.

Again Thankyou so much for your time and help- if there is anything you can add to the above please do.

SlowDragon profile image
SlowDragonAdministrator in reply toZanne60

I would change the Teva brand

Teva badly upsets many people

Either get 4 x 25mcg Wockhardt

Wockhardt currently only make 25mcg tablets

But would suggest you try other brands that offer 100mcg

Vencamil often very well tolerated as lactose free and mannitol free

alternative options

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 Vencamil or Teva

Vencamil is lactose free and mannitol free. originally only available as 100mcg only, but 25mcg, 50mcg and 75mcg tablets became available Sept 2024

Prior to March 2023 Vencamil was called Aristo

Vencamil often very well tolerated/best option for many people

How to get Vencamil stocked at your local pharmacy

healthunlocked.com/thyroidu...

Posts discussing Vencamil

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu....

Teva makes 12.5mcg 25mcg, 50mcg, 75mcg and 100mcg

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 

Helpful post about Teva

healthunlocked.com/thyroidu...

Posts that mention Teva

healthunlocked.com/search/p...

Teva poll

healthunlocked.com/thyroidu...

Relatively new ……Hillcross brand

This is a box, rather than a brand.

50mcg and 100mcg are Accord brand….

but beware 25mcg is Teva brand

Helpful post about different brands

healthunlocked.com/thyroidu...

List of different brands available in U.K.

thyroiduk.org/if-you-are-hy...

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 profile image
SlowDragonAdministrator in reply toZanne60

1-UK based- yes although I have never discussed the condition with my GP, even when diagnosed. I was told it was as simple as take the prescribed Levo and you will be fine.

Well that’s what many of us were told

You were started on too low a dose and left far too long on only 25mcg Levo

Standard starter dose is 50mcg and bloods retested every 2-3 months and dose should be increased as fast as tolerated to bring TSH below 2

Most patients on levothyroxine find their symptoms improve when TSH around 1

SlowDragon profile image
SlowDragonAdministrator in reply toZanne60

I do take the contraceptive pill about half a hour after the levo- is that a problem?

Could be

Suggest you make at least 2 hour gap

Try levothyroxine at bedtime or in middle of night if always get up for the loo

Use a weekly pill dispenser so you can easily see if missed a dose

folic acid (note you say the latter shouldn’t be needed- should I stop taking this? ).

If you start taking a daily vitamin B complex this contains folate …..you won’t need folic acid as well

Generally take vitamins in morning apart from magnesium…..

Zanne60 profile image
Zanne60 in reply toSlowDragon

Thankyou, I really do hate having to medicate, it takes me all my time to take a painkiller for a headache but I understand I will need the Levo to function. I did like the Wockhardt so may try and battle to have that.

I do wonder if there is a conversion issue from T4 to T3 as Northen Light’s says as I literally feel like I am being mildly poisoned following the dose increase but I know messing around with it without supervision or making drastic changes can cause more issues.

Some useful info on the vitamins! Thankyou.

Obsdian profile image
Obsdian

Some of your symptoms sound like perimenopause and also your estrogen levels appear low.

Zanne60 profile image
Zanne60 in reply toObsdian

Thankyou, I did wonder this. I am going to try and discuss with my GP- I am not sure whether this ties in with the thyroid issues or is entirely separate.

Obsdian profile image
Obsdian in reply toZanne60

When my estrogen is too low the first symptoms I get are achy stiff joints and sore weak muscles, especially first thing in the morning or after sitting awhile.

Edited to add: early on I used to get headaches that lasted all day or a few days that coincided with hormone changes around ovulation. My body didn't handle well the more dramatic changes of early perimenopause.

Zanne60 profile image
Zanne60 in reply toObsdian

Sorry to hear that- this isn’t fun is it! If it’s a sign of peri menopause I can process that but part of me wonders if the higher dose in levo has caused more of the problems due to the timing of the increase and worsening symptoms over a period of around 3 months.

Obsdian profile image
Obsdian in reply toZanne60

You can have more than one issue at a time. It makes it complicated for sure.

Zanne60 profile image
Zanne60

That really makes sense; Thankyou - I feel like since the Levo went above 50mg in November 2024( firstly to 75mg and then 100mg towards the end of Jan 2025) I have had new symptoms and worsening fatigue. I gave the benefit of the doubt when they said they levo had to go up again; I listened to the “experts” but my gut tells me the increase in dose has created the odd sensations/ feeling rough.

Newness wise my fingers are swelling at night hence feel stiff and occasionally wrists and forearms and now the same with my toes and feel flushed/ itchy which is really strange almost like an allergy, ringing ears too. My lower back pain seems to have come about two weeks or so after the levothyroxine increase to 75mg and it’s on both sides, normally it’s just my right side occasionally when I sit dodgily on my office chair.

I felt I didn’t have enough knowledge to argue with the suggested increase in dose but other people’s experiences on here are really helping and I think the levo being too high resonates - as you say the differential between the T3 and T4 is big. I literally feel like it’s an allergy/ my body isn’t happy with the amount of Levo. I don’t normally have any health issues beyond the fatigue and a bit of a dodgy knee from years of running.

I have a Gp telephone appointment on 4th and I am going to ask for a referral to an endocrinologist and I think I will ask if I can be reduced down and supplement T3 which I didnt even know they could do. I am just hoping the side effects disappear when the Levo dose drops!

Thankyou so much for your advice.

SlowDragon profile image
SlowDragonAdministrator in reply toZanne60

Suggest you try different brand Levo asap

Get coeliac blood test done asap then trial Gluten free diet

Meanwhile improve vitamin levels

Get bloods retested 6-8 weeks after being on 100mcg

Make sure to test as recommended

Zanne60 profile image
Zanne60 in reply toSlowDragon

Agreed re the brand of levo and yes will get lined up for re testing. Thankyou again.

SlowDragon profile image
SlowDragonAdministrator in reply toZanne60

Your January results above show you had high Ft4 at 20.6 (12-22)

Free T4 (fT4) 20.6 pmol/L (12 - 22) 

that was already 86.0% through range

Free T3 (fT3) 5 pmol/L (3.1 - 6.8)

Ft3 not too bad at 51.4% though range

Get thyroid levels retested now

You may need to go back to 75mcg daily to bring Ft4 back down

Or possibly 87.5mcg daily

Or even 75mcg and 87.5mcg alternate days

Or lower

dose often needs very fine tuning

Approximately how much do you weigh in kilo

Zanne60 profile image
Zanne60 in reply toSlowDragon

About 60kg/ 9.5 stone. I didn’t realise you could go at 12.5mg intervals or even alternate doses from day to day. I thought 25mg was the lowest.

SlowDragon profile image
SlowDragonAdministrator in reply toZanne60

Levo is a storage hormone, so yes you can take different dose on different days

If need to increase dose EXTREMELY slowly…..if on 75mcg daily……you could increase by 12.5mcg to 87.5mcg just one day per week

Wait 6-8 weeks…..either retest levels…..or simply increase to 87.5mcg 2 days …….wait 6-8 weeks

Etc etc

If you are only 60kg ……guidelines are approx 1.6mcg Levo per kilo of your weight per day

Some people need a bit LESS some need a bit more

That would suggest you might be looking at dose of around 96mcg per day

Perhaps you are on slightly too high a dose …..

Or it could be Teva upsetting you

Or a mix of both

Some of us feel terrible if Ft4 is over range …..even if Ft3 is only mid range

Ideally ….only change one thing at a time or you can’t work out which is having effect

Zanne60 profile image
Zanne60 in reply toSlowDragon

I went to the pharmacy this morning to collect the next set of tablets pending my appointment on 4th March- guess what …. Teva, rejected them and asked for something else.

Zanne60 profile image
Zanne60

Thankyou, it really is much appreciated and glad you got sorted in the end- I thought it seemed more than a coincidence.

It sounds like being pro active is the way forward- the first step will be getting the GP to refer me to an endocrinologist ( I will go private if needs be) as I’m guessing the GP wont want to comment - roll on 4th March!

Take care too Northern Lights.

Beingreal99 profile image
Beingreal99

low vitamin d can cause aches all over and fatigue and it also lowers your immune system but you can only go by blood test w thyroid to actual see if the meds are pushing your higher or not and to test your antibodies . I must say the ringing in the ears is something i have struggled w for years since taking thyroid meds and it is very annoying.

Zanne60 profile image
Zanne60 in reply toBeingreal99

It seems to be the dose increased and ringing started. It seems like a process of trial and error to get what works for you. Hopefully the vitamin d will help with the fatigue and aching.

samaja profile image
samaja

When in your cycle was your test taken as your FSH is high. Also what kind of contraception are you taking as sex hormone imbalances also affect thyroid and can cause a lot of symptoms similar to hypothyroidism. It would be also really useful to check your progesterone level though might be difficult on NHS.

Zanne60 profile image
Zanne60

Hi it was taken on the morning of day 2 of my period. I take the combined pill Gedarel 20/150. The timing was as per Thriva’s recommendation. It really isn’t straightforward trying to unravel the whole balance thing with hormones. I am not sure what I would do with the pill/ balancing of sex hormones.

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