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Thyroid issues & support

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dibradley:
Hi ladies,
I’m taking 0,25mg of levothyroxin for an Underactive thyroid. Since starting HRT I had a blood test a week ago and my level was 3.6…. But my heart is racing and I can feel it pounding in my chest…. It’s driving me mad. Could this be the medication ? The doc said it’s unlikely as I am on such a low dose. But that I could try cutting my tablet in half and taking that for a while. I’m worried…. I don’t want to mess things up even more. I take 3 sprays of Lenzetto each day and 12 days of urtogestan. Any advice would be appreciated.

FAB-jellybean:

--- Quote from: dibradley on December 05, 2022, 05:58:12 AM ---Hi ladies,
I’m taking 0,25mg of levothyroxin for an Underactive thyroid. Since starting HRT I had a blood test a week ago and my level was 3.6…. But my heart is racing and I can feel it pounding in my chest…. It’s driving me mad. Could this be the medication ? The doc said it’s unlikely as I am on such a low dose. But that I could try cutting my tablet in half and taking that for a while. I’m worried…. I don’t want to mess things up even more. I take 3 sprays of Lenzetto each day and 12 days of urtogestan. Any advice would be appreciated.

--- End quote ---

Hi dibradley, sorry to hear you're having issues. It's likely to be a combination of being on the basic starter dose, which is never enough and needs to be increased again quite quickly, and the HRT, which despite supposedly not affecting levothyroxine levels if it's topical/transdermal but many of us realised that we do need to tweak our doses. It's also a bit of an unknown fact by doctors that being undermedicated can cause similar symptoms to being overmedicated. I personally wouldn't cut the thyroxine dose as it's going to make you feel worse, but you could take it in 2 doses (morning and bed-time). Cut your tablet in half and take half when you wake and half before bed, but you need to bear in mind that it needs to be taken on an empty stomach so 2 hours after, and 1 hour before any food or coffee, which affects absorption. You can keep the other half in a pill box and mop up any crumbs with a damp finger. I personally find my tablets easier to cut if I take them out the packet a few hours before cutting but not sure if that's just the brand I use. You do need a dose increase though, as when you're taking thyroxine, your TSH levels should be 1 or under for you to feel well. You're aiming to get to 50 mcg a day in the first instance but that is still considered to be a starter dose and you'll likely end up with at least 75mcg daily. You'd be best to try 25mcg in the morning and 25mcg at night or if that feels too much for you at one go, you could take 3/4 of a tablet morning and night so you would be increasing by 12.5mcg a day to 37.5mcg rather than 25mcg. The heart issues you've described can also be caused by poor conversion of T4 to T3 and you need optimal iron/ferritin, folate, B12, Vit D and magnesium for that. If your GP won't check them for you, Medichecks do a Thyroid panel with vitamins/minerals and Thyroid UK have discount codes for members. If you're not already a member of the Thyroid UK Health Unlocked forum, you should consider joining for information on all things thyroid. They don't know a great deal about HRT issues along with thyroid though, hence my joining here. I now already know a lot more than I did previously. We also need an adequate supply of selenium, I take 200mcg daily. I also take iron, vit C, Vit D and K2, magnesium glycinate, a good B complex (with methylfolate and methylcobalamin), Co enzyme q10, omega 3 fish oil and a probiotic but they need to be taken at specific times away some away from others, and a minimum of 2 hours away from the thyroxine for some and 4 hours for others. I can give you more information on that if you need it but it's important not to take iron without checking your blood levels regularly (too much is as bad as too little). Hope this helps, let me know if you have any questions.

Wrensong:
Hi fabjellybean, I will try to come back to the detail of your latest posts later.  An unexpectedly difficult weekend means I am struggling somewhat at the mo.  But for now, just a few thoughts, having only read through quickly once.

1) when I read up on prolactin the other day to try to get a better idea of your situation I also came across the GP notebook article among others.  The suggestion that prolactin can be raised in hyperthyroidism made me wonder is it possible your thyroid replacement dose is a bit high as I imagine over-treatment could have the same effect?  I don't think you posted your recent TFT results - sorry no time to reread the posts just now, but from memory had the impression you didn't think you are over-medicated.  It just seemed worth asking what you thought about that possibility given the high prolactin. 

2) If not Hashimoto's, then do you know the cause of your thyroid condition?  Sorry if I have missed this.

3) You're taking quite a few supplements & whilst I absolutely understand why, have also taken some in the past & still take Vit D (on Endo advice, due to proven deficiency with levels now monitored), I've increasingly found that our reactions on thyroid replacement can be very sensitive & that various supplements can be problematic.  For me, frustratingly since peri began, those now include B vits, magnesium & selenium, the latter two I suspect because of their involvement in conversion of T4-T3.  It would be hypocritical of me to say to anyone please don't supplement & feeling rotten we naturally want to do all we can to help ourselves, but I always suggest that anyone struggling with their thyroid be very vigilant as to the possible effects of any supplementation, as I would hate for anyone to come to any harm. 

My feeling is that our thyroid replacement (& HRT if we are on it) is not only essential to keep us alive & feeling as well as our compromised health permits, but that it makes sense to ensure it's optimised beyond further improvement before adding other potentially interacting substances that could then be unnecessary, or worse prevent us getting the most out of those meds we cannot live without. 

I just feel there can't be research into what happens to our precious & very complex bodies on long term thyroid replacement under the influence of any number of combinations of other supplements & though we can read about & become very knowledgeable in what each supplement does in theory, there is less certainty as to what may be going on in reality for those of us with complex health conditions that have profound systemic effects.  That makes me very wary & increasingly so as I get older & the body becomes less agile in its ability to adapt to what we throw at it.  I hope that makes sense!

As I said, I will try to come back & look again at your 2 recent posts in case anything else leaps out that we might be able to explore together.
Wx

Wrensong:
Hi dibradley, your TSH suggests you are not having too much thyroid replacement so on its own I would not expect that dose to cause your heart to race/pound.  But it can take a while for our bodies to adjust to thyroid replacement & as you're also on HRT that's a second hormonal hit to get used to.

Two thoughts about the HRT.

1) I find Utrogestan causes palpitations, not only an uncomfortably increased rate, but irregularity & indeed ECG has shown it brings back the ectopics I had for many years during perimenopause when I was not on HRT.  If your racing heart happens during the Utro phase of your cycle the two could be related.

2) Some women find oestrogen stimulating & if you don't know how well you are absorbing the Lenzetto, whilst it's generally considered to provide lower levels than other methods, it depends on individual absorption, so seems possible 3 sprays might be too much for you at the mo.

That said, palpitations are also quite common in menopause whether we are on HRT or not & during peri the erratic hormonal fluctuations can give rise to this.

Sorry, fabjellybean posted while I was writing this so I haven't taken account of any advice she's given.

I will reply to your PM too.
Wx

FAB-jellybean:
Word of warning for those contemplating using Ashwagandha to balance your hormones when you have thyroid issues.

I have been doing lots of research on Ashwagandha since my issues multiplied 100 fold and it seems that I should have been doing this research before trying it, and at least keeping a better eye on it. I feel rather foolish now but please let my mistake be your warning so you can avoid this misery. 

I started taking one capsule (500mg) every morning 2 months ago (dose suggested 1-2 capsules daily), and then promptly forgot to keep an eye on things between brain fog and being very busy. Forgot about it to the point that I literally only realised when I was writing everything down in a reply to Wrensong. That the only difference in my diet/environment was the Ashwagandha. So I've spent the weekend researching it, and it seems to be very much marmite. If it works for you, it will work well, and if it doesn't... oh my!

There are very mixed messages with Dr Isabel Wentz advocating it's use for Hashimoto's patients while others advise against using it at all if you have autoimmune diseases. It turns out, it is about the immune response and whether it mediates a TH1 response or TH2 pathway response. If you are TH1 dominant Ashwagandha will help you whereas if you are TH2 dominant, it works against you. And given my response to it, it seems I am TH2 dominant (although from the symptom list that wasn't particularly obvious to me). There are articles here that go into it in greater detail for anyone that's interested in reading further: https://drknews.com/are-you-th-1-or-th-2-dominant/ and https://drdechickerand.com/2017/balancing-th1-th2-immune-function/.

I have stopped taking it obviously and will need to wait for things to settle again before attempting to reintroduce HRT. The doctor that wrote the second article went on to say that people who are TH1 dominant can use progesterone to help balance the TH1/TH2 pathways so I'm wondering if the combination of my HRT with the ashwagandha has caused most of my issues. I'd been using HRT for 2 years with only mild side-effects prior to introducing the ashwagandha but now I'm reacting wildly to it. Hopeful that my stupidity won't cause long-term issues with it, and that everything will settle in time. Not expecting anything to happen very quickly though!

So moral of the story, if you are going to try Ashwagandha, make sure you aware of the issues and how you may react to it. Ashwagandha itself is known to increase fT3 and fT4 levels so even if you react well to it, you will likely have to decrease your medication. It didn't do that to me and if anything has reduced my fT3 and fT4 levels and I've had to increase my doses to try to keep it up (last test fT4 only 20% through the range and fT3 54%). I'll probably have to decrease my meds again. I test my thyroid levels and all supplement levels regularly because I'm usually so vigilant, so more than a bit annoyed at myself just now!

FAB x

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