ENT Consultant advice on Thyroxine causing Tinnitus

[Dotty1340]

I would welcome any observations on the below.

For several years I have been taking 175mcg of Thyroxine. I have Hashi disease.

For several months I have had pulsatile tinnitus in my left ear. I saw the GP who referred me to a ENT Consultant.

Various tests completed including a blood test for my Thyroid levels and he stated that too high a dose of thyroxine can cause Tinnitus. I had the tests done.

Results show

T4 = 26 (8-18)

T3 = 4.5 (3.8-6.0)

TSH = 0.01 (0.38-5.33)

I had my dose set previously by an endocrinologist (now retired) who said some people needed a high dose to convert, hence the Thyroxine dose was set at 175.

I have had some heart flutters which have been checked out by a Cardiologist with nothing untoward.

I am now taking HRT for peri menopause.

ENT consultant states “”Your thyroid function tests taken on the 5th of March show a free-T4 of 26, which is significantly above the normal reference range, a free-T3 of 4.5, which is in the normal reference range, and a TSH of less than 0.01, which is in the thyrotoxic range.

I would recommend that you reduce your dose of levothyroxine from 175 mcg daily to 150 mcg daily to see whether this has a beneficial effect on your pulsatile tinnitus””

My questions are -

1. I am awaiting the GP to ring me to discuss the reduction in dosage (they do have the letter). Do I try 150 as suggested?

2. I am concerned that if I do reduce and I feel portly on the lower dose, will I have to battle to get it raised again? It took me a long time to get to 175.

3. Apart from the odd heart flutter and the tinnitus, the dose seems to suit me. ENT Consultant said I was on a very high dose for someone of my size (I am 5”4 and average weight). I wasn’t aware size came in to it?

Observations appreciated. Bloods drawn first thing after fasting as were all previous blood tests which show consistent results.

TIA.

[SlowDragon Administrator]

was test done as recommended?

ALWAYS 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)

ESSENTIAL to test vitamin levels too

Exactly what vitamin supplements are you taking

Testing options and includes money off codes for private testing

thyroiduk.org/testing/

Medichecks Thyroid plus BOTH TPO and TG antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes BOTH TPO and TG antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

Medichecks and BH also offer private blood draw at clinic near you, or private nurse to your own home…..for an extra fee

Only do private testing early Monday or Tuesday morning.

Tips on how to do DIY finger prick test

support.medichecks.com/hc/e...

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

(Doesn’t include thyroid antibodies)

monitormyhealth.org.uk/full...

10% off code here

thyroiduk.org/testing/priva...

IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 3-5 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endocrinenews.endocrine.org...

In days before blood test, when you stop vitamin B complex, you might want to consider taking a separate folate supplement (eg Jarrow methyl folate 400mcg) and continue separate B12 if last test result serum B12 was below 500 or active B12 (private test) under 70

[SlowDragon Administrator]

Also which brand of levothyroxine are you taking

Do you always get same brand

[Dotty1340 in reply to SlowDragon]

Hi, the brands of thyroxine taken has varied recently as the pharmacy said they had issues getting hold of some. Currently I am taking Vencamil. The only supplements I take now are Curcumin (for my bad knees) and a supplement called Neuaura for menopause symptoms. The last thyroxine taken before my blood test which took place on the Wednesday 5th March was on the Tuesday 4th March around 4am. The test was taken at 08.30hrs on 5th March. Many thanks.

[SlowDragon Administrator in reply to Dotty1340]

So last dose Levo was approximately 28 hours before test

So your Ft4 is too high

Do you get 100mcg, 50mcg and 25mcg tablets

Or 100mcg and 75mcg tablets

Are all your tablets Vencamil?

Lots of members find Vencamil is the best

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 prescription written for Vencamil

healthunlocked.com/thyroidu...

How to get Vencamil stocked at your local pharmacy

healthunlocked.com/thyroidu...

Posts discussing Vencamil

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu....

Suggest you reduce levothyroxine SLOWLY

Ideally by 12.5mcg daily….. retest in 8-10 weeks

Meanwhile test vitamin levels now

ESSENTIAL to maintain GOOD vitamin levels

folate, B12, ferritin here

Test early morning and avoid iron rich meal night before test

monitormyhealth.org.uk/anae...

Vit D

test via NHS private testing service

vitamindtest.org.uk

optimum levels

Vitamin D at least over 80nmol

Serum B12 over 500

Active B12 over 70

Folate at top of range

Ferritin at least over 70

[Dotty1340 in reply to SlowDragon]

Blood test - Yes around 28 hours after last dose of thyroxine.

I have 100 tablets and a 75 tablet. Good to know about the Vencamil. All the tablets are the same brand.

ENT is suggesting dropping by 25 so I’d be taking 150.

I am waiting for doctors to ring me so I can get a new prescription. In the meantime taking 175 as I don’t have anything else. I thought about chopping in to a 75 tablet to try and reduce the dose amount until GP rings me but I know that don’t be accurate. I guess I have to keep going with what I have until I can get it changed. Many thanks.

[SlowDragon Administrator in reply to Dotty1340]

If you reduced by half a 75mcg on alternate days that would be a reduction of 18.75mcg approx on average

So taking 175mcg one day and 37.5mcg on the next day

Or just 2 days a week initially taking 137.5mcg

[Dotty1340 in reply to SlowDragon]

Thank you very much for your advice.