Bloatedness and levothyroxine

[Greenhouse71]

Dear all, is there any evidence that levothyroxine tablets can cause bloatedness? I would greatly appreciate any support with this.

And if it does, what would be any potential remedy?

thanks

[Lalatoot]

Going gluten free even though I am not coeliac fixed it for me.

[Hidden in reply to Lalatoot]

Same for me

[greygoose]

More likely to be due to low stomach acid, caused by being hypo.

[Greenhouse71 in reply to greygoose]

Thanks iwill look into it.

[SlowDragon Administrator]

Looking at your profile your male and on 125mcg levothyroxine after RAI

Absolutely essential to get FULL thyroid and vitamins tested

Do you always get same brand of levothyroxine at each prescription

How long have you been on 125mcg

What vitamin supplements are you currently taking

[Greenhouse71 in reply to SlowDragon]

No vitamin supplement but see other reply. B12 ferritin and serum ok. Don't know vit d though. I have been on 125 mcg since 2019ish. Can't remember exactly. Thanks

[SlowDragon Administrator in reply to Greenhouse71]

B12 and folate are very likely too low. Please add ranges

Typically B12 range is 180-680

Folate range can be 3-20 or 5-60

Improving low B vitamins

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

This can help keep all B vitamins in balance and will help improve B12 levels too

Difference between folate and folic acid

chriskresser.com/folate-vs-...

B vitamins best taken after breakfast

Igennus Super B is good quality and cheap vitamin B complex. Contains folate. Full dose is two tablets per day. Many/most people may only need one tablet per day. Certainly only start on one per day (or even half tablet per day for first couple of weeks)

Or Thorne Basic B is another option that contain folate, but is large capsule

IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

Low B12 symptoms

b12deficiency.info/signs-an...

If serum B12 result below 500, (Or active B12 below 70) recommended to be taking a B12 supplement as well as a B Complex (to balance all the B vitamins) initially for first 2-4 months, then once your serum B12 is over 500 (or Active B12 level has reached 70), stop the B12 and just carry on with the B Complex.

B12 sublingual lozenges

amazon.co.uk/Jarrow-Methylc...

cytoplan.co.uk/shop-by-prod...

healthunlocked.com/thyroidu...

[Greenhouse71 in reply to SlowDragon]

Dear SlowDragon, as requested, I have completed the TSH, FT3 and FT4 tests (monitor my health). I have done these early morning, before breakfast and before taking levothyroxine as instructed.

Test Results:

TSH 0.78 mu/L (normal range given is 0.27-4.2 mU/L)

FT4 level 17.8 pmol/L (normal range given is 12-22 pmol/L)

FT3 level 4.4 pmol/L (normal range 3.1-6.8 pmol/L)

so the conclusion is that it is all in range, although TSH seems to be on the low side of the normal range. This is interesting because I take 150 mcg of levo (Teva UK, lactose intolerant) which is relatively high to what I used to take in the past (125 mcg).

I am puzzled as FT3 and FT4 are in normal range so it appears that the hormone is synthesised properly?

Do you think I should I increase levo even further?

Does it have side effects if I take too much of it?

Vitamins: On a different note, I have also started taking vitamin B12 and B complex as instructed. what kind of level should B12 and B complex be? and do you think I should get it checked perhaps in the next 1-2 months to see if levels are up where they should be?

thanks again for all your help.

Best wishes

[SlowDragon Administrator in reply to Greenhouse71]

Ft4 is only 58% through range

Ft3 only 35% through range

Helpful calculator for working out percentage through range

chorobytarczycy.eu/kalkulator

Most people when adequately treated will have Ft3 at least 50-60% through range

So you likely have room for small dose increase in levothyroxine…perhaps 167.5mcg 2 or 3 days a week

Improving low vitamin levels should improve conversion levels so that Ft3 improves

So you are now improving low B12 and folate

Getting vitamin D tested is next

If under 80nmol will need to supplement to maintain at least around 80nmol and around 100nmol maybe better

Gluten free diet often helps or is essential too

Lactose intolerance often is result of being gluten intolerant

[SlowDragon Administrator]

Do you have copies of most recent thyroid results you can add?

For full Thyroid evaluation you need TSH, FT4 and FT3 tested. Also EXTREMELY important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common on levothyroxine, especially after Graves’ disease

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .

Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Is this how you do your tests?

Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins

List of private testing options

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Thriva Thyroid plus antibodies and vitamins By DIY fingerpick test

thriva.co/tests/thyroid-test

Thriva also offer just vitamin testing

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code

thyroiduk.org/getting-a-dia...

monitormyhealth.org.uk/

NHS easy postal kit vitamin D test £29 via

vitamindtest.org.uk

[Greenhouse71 in reply to SlowDragon]

Results as requested 22nd march 2021 but done after breakfast and after taking tablets. I am still on 125 mcg daily. Brand teva uk because lactose free. Tsh level: 0.50 mu/L

No ft4 and no ft3. They say it's not necessary.

Folate is 4.0 ug/L

B12: 342 ng/L

Ferritin: 167 ug/L

Serum: 23 u/L

Thanks x other info much appreciated

Best wishes

[SlowDragon Administrator in reply to Greenhouse71]

If you are lactose intolerant likely to need higher dose levothyroxine than typical and/or likely poor conversion of Ft4 to Ft3

Obviously it’s essential to test Ft4 and Ft3...especially as all your vitamins are very low and therefore suggests under medicated

ALWAYS test as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

Suggest you test thyroid levels now

Only do test early Monday or Tuesday morning and post back immediately

cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code

thyroiduk.org/getting-a-dia...

monitormyhealth.org.uk/

Come back with new post once you get results

Meanwhile starting work on improving low vitamin levels

[SlowDragon Administrator in reply to Greenhouse71]

Folate is 4.0 ug/L

B12: 342 ng/L

Ferritin: 167 ug/L

Serum: 23 u/L

Please add ranges on these vitamin results Presumably last one is vitamin D. Is that ng/ml or nmol

Low vitamin levels affect Thyroid hormone working

Recommend coeliac blood test done BEFORE considering trial on strictly gluten free diet

Poor gut function on levothyroxine 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.

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps, sometimes significantly. Either due to direct 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 slowly lower TPO antibodies

While still eating high gluten diet ask GP for coeliac blood test first or buy test online for under £20, just to rule it out first

healthcheckshop.co.uk/store...?

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 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse

chriskresser.com/the-gluten...

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

Lactose intolerance often improves after year or two on strictly gluten free diet, wether coeliac or “only” gluten intolerant

coeliac.org.uk/information-...

coeliac.org.uk/healthcare-p...

[Greenhouse71 in reply to SlowDragon]

Hi SlowDragonall vitamin values were in range.

B12: 342 ng/L (180-999)

Ferritin: 167 ug/L (30-400)

Serum Gamm GT level : 23 u/L (<64 for normal range)

Gluten intolerance test was negative.

I will do test for T3 and T4 and report back.

thanks again.

greenhouse

[SlowDragon Administrator in reply to Greenhouse71]

B12 too low

What's range on folate

[SlowDragon Administrator in reply to Greenhouse71]

Only 5% Coeliac

Over 80% find gluten free helps

[vienna2010]

I was terribly bloated on levo.... because the drug did not agree with me and was not working.

[Greenhouse71 in reply to vienna2010]

Thanks. I will have a look at alternatives but am lactose intolerant which makes it more difficult.

[Hookie01]

I find it bloats me but I think its the lactose. Accord was the worst for me, was so painful and bloated, currently on mercury pharma. Trying to get the new lactose free brand Aristo but when I tried the chemist said its more expensive so no one will order it for me, I will have to get it stated on my prescription.

[Greenhouse71 in reply to Hookie01]

The brand 'Teva uk' also sells lactose free levothyroxine tablets. You can get these through your gp if you have been diagnosed with an under active thyroid.

[crimple]

Greenhouse71 which brand of levo are you taking and have you always had the same brand? The fillers used to bind the tablet together can have very adverse effects.I cannot tolerate any levothyroxine that has acacia powder, severely reduces my choice to Actavis/Almus or Accord.

[Greenhouse71 in reply to crimple]

I am taking teva uk as it is lactose free. Difficult to change brand if you are lactose intolerant. I used to take actavis. I will check about acacia powder in teva uk. Thanks

[SlowDragon Administrator in reply to Greenhouse71]

Many people find Levothyroxine brands are not interchangeable.

Many patients do NOT get on well with Teva brand of Levothyroxine. Teva contains mannitol as a filler, which seems to be possible cause of problems.

Mannitol apparently changes flora in gut biome

Teva is the only brand that makes 75mcg tablet. So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half

But for some people (usually if lactose intolerant, Teva is by far the best option)

Teva, Aristo and Glenmark are the only lactose free tablets. Glenmark is impossible to get

Most easily available (and often most easily tolerated) are Mercury Pharma or Accord

Accord is also boxed as Almus via Boots, and Northstar 50mcg and 100mcg via Lloyds ....but doesn’t make 25mcg tablets

beware 25mcg Northstar is Teva

List of different brands available in U.K.

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

Teva poll

healthunlocked.com/thyroidu...

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.

New guidelines for GP if you find it difficult/impossible to change brands

Including trialing patients on liquid levothyroxine if necessary

healthunlocked.com/thyroidu...

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).

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

verywellhealth.com/best-tim...

No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.

Some like iron, calcium, magnesium, omeprazole or vitamin D should be four hours away

(Time gap doesn't apply to Vitamin D mouth spray)

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

REMEMBER.....very important....stop taking any supplements that contain biotin a week before ALL BLOOD TESTS as biotin can falsely affect test results - eg vitamin B complex

[pennyannie]

Hello Greenhouse and welcome to the forum :

Were you originally diagnosed with Graves Disease and the reason for the RAI thyroid ablation.

Primary hypothyroidism caused by RAI can be more " challenging " to treat :

RAI is a slow burn and your own thyroid can take months or years to be fully disabled :

Your feeback loop, the HPT axis is now broken - and it's essential that you are dosed and monitored on your T3 and T4 levels and not a TSH blood test and if now being looked after in primary care and just having the yearly thyroid function test, is all you maybe getting.

RAI can trash your vitamins and minerals and primary hypothyroidism can result in low stomach acid and compound issues of digestion and your own abilty to extract key strength nutrients from your food.

No thyroid hormone replacement works well if you key strength vitamins and minerals, namely ferritin, folate, B12 and vitamin D are not maintained at optimal levels so this is another area that you need to look into.

A fully function working thyroid would be supporting you on a daily basis with trace elements of T1. T2 and calciton plus a measure of T3 at around 10 mcg plus a measure of T4 at around 100 mcg.

T4 - Levothyroxine is a storage hormone that needs to be converted by your body into T3 that active hormone that the body runs on which is said to be about 4 times more powerful than T4 with the average person needing to find / utilise around 50 T3 daily just to function.

I was diagnosed Graves in 2003/4 and had RAI thyroid ablation in 2005 :

You may like to read up a bit on Graves and hypothyroidism ?

Can I suggest you visit the Thyroid uk website who are the charity who support this amazing forum and read up on the symptoms of hypothyroidism. and you might like to purchase a couple of books that I found invaluable, and now can be found in the Thyroid uk library :

Elaine Moore's first book Graves Disease A Pratical Guide : there is also now a website :

Elaine went through RAI and finding no help with her continued symptoms started researching this poorly understood and badly treated auto immune disease herself.

Barry Durrant-Peatfield was a doctor and who had hypothyroidism himself and his relatively easy read in Your Thyroid and How To Keep It Healthy is essential reading so to understand what this major gland does so you can try and compensate for it's loss as best as you can.

I'm with Graves post RAI in 2005 and found this amazing forum in around 2016 and have put myself back together again as best I can.

I do need to increase my stomach acid and take organic, raw, apple cider vinegar and I still do need to supplement core strength vitamins and minerals, ferritin, folate, B12 and vitamin D on a daily bass and I also supplement adrenal glandular and self medicate with Natural Desiccated Thyroid and am much improved.

[Gingernut44]

What brand of levo are you taking? Northstar (Actavis/Accord) caused me extreme bloating, along with continual headache, stomachache and constipation. Mercury Pharma gave me continual headache so now I stick to Wockhardt which has fewer excipients. If I were you, I would try a different brand until you find one that suits.

[helvella Administrator in reply to Gingernut44]

Just so that it doesn't get misunderstood - Northstar 100 and 50 microgram tablets are, as written, Accord (formerly branded Actavis). But their 25 microgram tablets are Teva.

[Gingernut44 in reply to helvella]

Yes, thanks for that. Of course, when I was taking Northstar they didn’t “do” 25 mcg tabs, that’s why I had Wockhardt “left over” from moving up from 75 to 100 which enabled me to try Wockhardt on its own 😊. I really think it’s a bad move on Lloyds/Northstar to use a different brand for its 25mcg as it’s very confusing to those not in the know.

[helvella Administrator in reply to Gingernut44]

So do I!

I believe it is entirely wrong that it is allowed.

[shaws Administrator]

The following link may be helpful:

The Gut-Thyroid Connection: Breaking the Hashimoto’s Cycle

avivaromm.com/gut-thyroid-c...