Menopause Discussion > Other Health Discussion

Thyroid issues & support

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dibradley:
Thanks to all of u. U have given me a lot to think about and I appreciate the time u have taken to give me such expert advice.

Wrensong:
dibradley, just a few thoughts on your last post.  (Later edit - where is it?!  Am I imagining things - the following was posted in response to a long post of yours that seems to have gone missing!)  I'll leave my reply below in here, though it will make little sense as the one I was replying to is now missing . . !

I'm afraid a resurgence of flushes & night sweats is a common temporary reaction to changes of HRT dose, up or down, so doesn't necessarily mean that in the longer term that adjustment in dose is not right for us.  It's a manifestation of the body's reaction to the instability.  You may well need 3 sprays (or a different regimen entirely), but unfortunately it takes time for us to settle & be more sure of what is or isn't suitable.  We are usually advised to give each dose change or trial of a new product 3 months unless the reaction is such that it feels unwise to persevere.

Testing sex hormone levels in perimenopause is usually considered to be not very helpful because the situation is so unstable, so unless your doctor advises this, I would not worry about not knowing your oestrogen & progesterone levels at present.  HRT adjustment is usually made according to symptoms at this stage.

I'm not surprised a 50mcg dose of Thyroxine caused palpitations if your TSH has been brought down to around 3 on 25mcg alone.  50mcg will have been too high a starting dose for you.  Adding in more Thyroxine at this stage to try to get your TSH down further may increase your palpitations, anxiety, insomnia, night sweats & flushing as these can be symptoms of too much thyroid replacement (as well as due to menopause - I know - frustratingly confusing this combination of conditions).  If your doctor advises increasing your thyroid dose now however - many like TSH to be around or a little below 2.5 - I would talk to her about making only a very slight increase as you will be less likely to become over-treated that way.  I don't know what brands are available in Holland but here we have TEVA which comes in 12.5mcg tablets that can be halved to give a very small dose of just 6.25mcg.  When making minor dose adjustments we can even add that tiny dose in every other day to be very cautious, then retest after 6 weeks to see how things stand.   I'm afraid no one can tell you for sure what is the right TSH (T4 or T3) level for you - it's very individual & may change with time.  It depends on what you feel best on.

If you have a B12 deficiency that can cause a range of symptoms, palpitations included & it's really important to address that, so with any luck the B12 injections will make you feel a good deal better.

Most hypothyroid patients, around 85% it's said, do very well on T4 alone.   Only around 15% have problems converting T4-T3, so it's very likely you will be among the high proportion that doesn't need to take T3 as well.  A good endocrinologist is invaluable in cases where patients don't respond well to T4 alone, but uncomplicated hypothyroidism is usually managed at GP level - at least in the UK.  So as you say, private healthcare can be very costly & I think in your shoes I would defer that step for now.  If your GP can test T3 that would give you an indication of how well you are converting - that may be possible in Holland, I don't know, but the NHS is usually reluctant to test it here for hypothyroid patients.

There is every chance that given time to stabilise on HRT & thyroid replacement you will feel a lot better - especially if there is currently need for B12 injections, which complicates the picture at present & makes it difficult to know what may need changing.

I would not start zinc supplements at present unless you know there is a deficiency & your doctor advises this, but this is my personal feeling based on my own experience & others may advise otherwise.  Please go with whatever you feel most comfortable with. W x :)

P.S. I see another post has been written while I was compiling this, so I have not taken account of any advice given there.

Clarella:
Following this thread as I’ve been hypo for 25 years.

Wondering about testosterone- I feel I’ve read getting that right if on thyroxine can be challenging?

Though I know Davina is on thyroxine and testosterone alongside hrt.

My testosterone level was 0.15 recently tested on medichecks.

I’ve been having issues moving up the levels of oestrogen with slightly swollen and v achey feet at times. I switched to taking Utrogestan orally (x1 continuously, was on cyclical vaginally  but Gp okayed me to try continuously.)

I’ve found that I need and respond well to oral utro and added a vaginal capsule when a friend who’s a Gp mentioned higher levels were needed for higher patches (will be speaking to my own Gp in a couple of weeks.) feet are definitely less swollen though foot joints still seem bad first thing. I’m wondering if I have arthritis or if testosterone will help.

Have I read something about utro and SHBG? Lowering?

Wrensong:
Hi Clarella, like you I've been on thyroid replacement for decades & for a few years postmenopause on HRT with testosterone.

Could your swollen feet be down to fluid retention from the increased oestrogen?  Med-high doses of oestrogen certainly make me retain fluid.  Easy to tell what does what on a sequential regimen.  If Utro has improved your swelling, I find it highly diuretic so that makes me think perhaps oestrogen dose related fluid retention could be the issue with your feet.  You'll know that hypothyroidism also unfortunately predisposes us to joint issues.

I think I remember you posting that your TFTs have not changed on HRT & that you're on Thyroxine alone?  Is your T3 level adequate?

If your testosterone is low & you have deficiency symptoms you could try it & see how you feel?  You're right, it is said that SHBG can be more of an issue for hypothyroid women, but also that levels should normalise with optimal thyroid replacement, though how well this works in reality I'm not sure, given thyroid replacement can't perfectly reproduce what happens with a healthy thyroid.  There seem to be so many factors affecting the interplay between thyroid & sex hormones, SHBG & TBG that personally I try not to overthink it.  My feeling is we can't take less or more thyroid replacement than our bodies need simply in order to manipulate SHBG levels.  There are said to be various other factors that influence SHBG that may be more within our control, such as oestrogen dose, BMI, exercise & alcohol intake, if you want & are in a position to have your level tested & try to improve it if need be.

With no ovaries I feel better for a little replacement T & though my level on T has never tested above mid-range, I've been on & off it to try to gauge effect on hair loss.  It's still a suck it & see situation for me.

FAB-jellybean:
Hello lovely people, so a wee update and a another request for your help please. I stopped using the evorel conti patches after my bad reaction to the norethisterone. My GP, who I thought was supportive has been a major disappointment like most of the others that have gone before her given my complex history. My appointment with her to finally discuss all this was on the 14th Dec because she's part-time and had been on annual leave. She was happy to change my HRT and agreed to leave me on patches because I was wary of the greater variability in dose with the oestrogel and how that can affect hypothyroid folks. She said I could try the natural progesterone as it was likely to be the progestin I had reacted to. I asked if there was an alternative to utrogestan due to the soya lecithin which I'm trying to avoid due to high iGg and was told they had no say in it, they only prescribe micronised progesterone and that's where her influence ends. I started the patches again after 3 weeks off and my oedema came back with a vengeance so couple of days later when my period started I started taking 1 utrogestan orally at night to see if it made any difference. It did, and within 3 days my oedema was completely gone and I started feeling much better in myself, and all my symptoms improved. However within a couple of weeks my anxiety was back up and I had to go back to her again when the surgery reopened on Wednesday this week, as it is really affecting my ability to function properly. My BP is good at 106/61 HR-78. She prescribed sertraline, which I'm reluctant to take if it's the hormonal imbalance that's causing these problems. She also prescribed propranolol (beta blocker) to take as and when I need them (10-20mg up to 3 times a day) as the sertraline can take up to 6 weeks to kick in and it's likely to get worse before things get better, and I have things I really need to get done over the next few weeks (a uni assignment being one of them). I took 2 of the propranolol on Thursday as I didn't want to start both at the same time in case I have a reaction to either of them. I can't say that they reduced my anxiety any and left me with what I can only describe as a sore brain type of headache as they were wearing off. BP went down to 96/55 (60) about 6 hours after I'd taken them. I then read about the effects of propranolol on T4-T3 conversion, which is my particular hypothyroid issue that has taken me nearly 5 years to manage well so I got myself into a complete state and had to go back to see a different GP on Friday who prescribed me a short course of diazepam to get me through the next few weeks. And the oedema that had settled, has started to increase again along with quite severe breast tenderness, constipation and other symptoms. I'm wondering if it's due to too much oestradiol, so yesterday I halved my patch to see if that helps. It has reduced the breast tenderness but I haven't noticed any reduction in the oedema which gets worse throughout the day but that was only yesterday. However, I woke up this morning absolutely soaked in sweat! My thyroid bloods in Nov just before the height of the anxiety were good, if anything a little low T4 -14 (12-22), T3 5.1 (3.1-6.8 ) and TSH suppressed but that's normal when taking liothyronine. I'm due to have them checked again along with my prolactin levels which have been high. I told my GP about all the bloods and the prolactin was the only one she was interested in but doesn't believe that Medichecks blood tests are accurate so wants to check that herself. But just to make sure, it isn't high thyroid hormones causing the anxiety, I halved my T4 for almost a week and haven't noticed any reduction in the anxiety and am getting my usual hypothyroid symptoms again. So back up to my usual dose today. My first question, do you think I'm right about the oestradiol being too high and should stick with the half patch for a while or should I use the whole 50mcg patch? And secondly, I'm considering seeing a menopause expert privately to see if I can get this sorted out, or a least improved. Is this something that any of you have done and is there anyone in particular that you would recommend? Dr Meyer's clinic looks good but anyone can write their own reviews so I'd like to hear from anyone who has been treated by her.

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