Thyroid UK
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Is it ok to take the pill and levothyroxine together?

Have had undwractive thyroid since March 2012 and after a number of changes in dose am on 50mcg levo. My major symptom without doubt is anxiety and althoug it has slughtly lessened recently with my change in dose, it still awful.

Have thought for a long time that it may be related to my female hormones as i also have other symptoms which match a list for being in the stage of perimenopause. Have persuaded my doctor to test my female hormones which i am having this week but during recent discussions, he suggested that depending on the results then one option could be the pill.

I asked him if this would be alright to take with my levo and was told yes. Something in the back of my kind however thinks there may be issues.

Can anyone give me some advice or first hand experience at all.?

Many thanks

3 Replies

First before dealing with the pill issue the 50mcg is a remarkably small dose and it may well be this small dose is responsible for your anxiety. Most people are started off on 50mcg, then after about 4 weeks another blood test is run and an increase in dosage is undertaken, and so on until the optimal dosage is reached. Doctors treat by the TSH and this should be at 1 or under when treated, certainly at or near the bottom of the reference range. It is very likely you need an increase in levo from your current low dose and this increase might alleviate your anxiety.

Your doctor is wrong in asserting estrogen therapy (ET) does not affect thyroxine levels in hypothyroid women, oral ET increases the need for thyroxine as oral ET raises levels of thyroxine binding globulin so increasing the bound fraction of Thyroxine (T4) and decreasing the FT4, which is the bio-active fraction of thyroxine, so the TSH is raised. It is to be hoped that he is not in charge of any woman taking oral ET who has had thyroid cancer as in that case the TSH absolutely must be suppressed, yet he appears not to know that oral ET will alter thyroxine levels whereas transdermal ET does not. He needs to read these papers.

Here is a reference from an impeccable source, the text might be hard work but the important bits are in the final Discussion.

and one also from an impeccable source which recommends transdermal ET as this delivery method does not affect the thyroxine binding globulin, please note the last sentence saying this. I say "impeccable source" as many doctors feel entitled to sneer at info from the internet but these are completely sneer-proof.

You do not quote any test results so please be aware that you are perfectly entitled to ask for and be given without demur printed out copies of any blood test. Sorry if you are aware of this. It is really advisable to start a file of blood tests, and record symptoms and drug dosages. Honest. I speak from two experiences of medical neglect.


Thanks for replying and for the information.

In terms of my levothyroxine levels - I originally started on 50mcg of levo and was on it for 6 weeks from diagnosis. I felt great but my doctor at the time didnt like my TSH level of 4 and said he would like it to be lower. He doubled my dose to 100mcg which didn't agree with me and was too high. I lowered my dose to 75mcg but still felt ill and at this dose it actually increased my anxiety to panic attack levels. Went to see an Endo who advised going back to my 50mcg as he thought I was only subclinical and that the dr had originally prescribed it to stop the onset of further problems.

My highest TSH level was 7.29 and my lowest in the summer was 1.18 on the 75mcg but I still felt rubbish. Recently had a test after 9 weeks at 50mcg and my TSH was 4.4 - rising but classed as within range (1.0 - 5.0).

The reason for checking the hormone situation was because I wondered if they had perhaps come at the same time and my change in hormones was being worsened by my starting to fail thyroid. It appears at the moment that anything more than 50mcg of levo doesn't make me feel better but worse and one thing remains constant - think I am going mad however as I personally am not anxious about anything but my body is giving me the symptoms.

I may be clutching at straws but to be honest, the faith I have in a doctor after reading some of the items on here is not high and so I agree you have to do things for yourself and keep records so you can try and help yourself.


Yes, definitely a very good idea to keep detailed records. Your TSH fluctuates a lot but apart from varying dosages that is all we know, no FT4 of FT3 figures.

Has either doctor or endo suspected Hashimoto's which goes hyper and hypo and eventually results in permanent hypothyroidism, and tested your antibody levels, both TPO Ab (thyroid peroxidase antibodies) and TG Ab (Thyroglobulin antibodies) and TSI Ab (thyroid stimulating immunoglobulin antibodies)? If they are going to test them make sure they do at least both TPO Ab and TG Ab. You can be high in one and low in the other, and if they test only one and it ihappens to be the low one then this affects interpretation.

Read these:


and have a good look around the rest of the thyroid UK site which has loads of info

Also visit:

and you can find your way to the info re antibodies there also. There is an excellent book "Stop the Thyroid Madness", Amazon again.

I always advise buying "Understanding Thyroid Disorders" by Dr Anthony Toft, £5 from chemist/Amazon as it is so clear and succinct, and has a section on sub-clinical hypothyroidism and the desirability of treating s-c hypothyroidism. Believe me, you were lucky in your doctor treating you and referring you to an endo, at least he is concerned and active on your behalf. Unlike some thickos who would not mind if some of us just died quietly behind a rock somewhere.

Sub clinical means a raised TSH with an in-range T4 and NO symptoms.

Thyroid UK has a symptoms list you can check out just to see if in fact you have more symptoms than you realise.

Unfortunately you do not give any info beyond TSH and dosage fluctuations.

I know this sounds kind of preachy, but when you post always put the item tested; your own result; and the all-important reference range, usually enclosed in brackets by the lab. Reference range is important as "newbies" might not realise that reference ranges differ from lab to lab so that a result that might be high in one range could be rock bottom in another, but if the ref range is left out, potential commentators are lost!

By the way, you are also entitled to copies of endo's blood tests plus, if you want, copies of any correspondence about your case.


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