Menopause Discussion > Other Health Discussion

Thyroid issues & support

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sheila99:
Great idea, I'm sure many people will find it useful, I'm sure I will. I have Hashimoto's though not at a level that needs treating yet. If you think posting personal info on a public forum will put people off you could consider posting it in Private Lives.

Wrensong:
I just thought if something thyroid comes up on an unrelated thread that needs addressing, rather than carry on taking that thread off topic it would give us somewhere to suggest we continue.  Also I think sometimes it can be a bit daunting for newbies to start their own thread & it's not obvious how to do it, so again a thread like this would give them somewhere to post thyroid related stuff where it's more likely to get answered by other thyroid members.  Good point about the Private Lives section.

FAB-jellybean:
Hi everyone, I'm a newbie here and was recommended to ask my question here as well as in the Newbie thread. There's a lot of background info here, my main question is at the bottom if you don't want or have time to read it all.

Quick Background - diagnosed hypothyroid (NOS) in Feb 2003 after the birth of my daughter and having been investigated for subclinical for a few years prior to that). All good on levothyroxine (T4) until Jan 2012 when I had an accident and was consequently diagnosed with fibromyalgia. Ended up bed and wheelchair bound for about 5 years during which I did a lot of research (when my brain allowed) and discovered that my fT3 levels were consistently lower than normal range and suspected poor T4>T3 converter so was given a trial of liothyronine (T3) on top of my T4 and it took a while to find the right levels but it changed my life completely. I was functional again and even managed to start strength training at the gym 3 times a week (which further helped with my pain levels).   

In August 2020 (height of lockdowns) my GP (who has been very supportive) prescribed Evorel Sequi for my suspected menopausal symptoms - irregular periods, night sweats, unrefreshing sleep, mood swings, fatigue and brain fog. I seemed to getting on ok with it, most of my symptoms lessened/resolved although I have had non pitting oedema in my hands/ankles along with a puffy face from time to time. By June of this year, my hypothyroid symptoms had returned (having very gradually got worse for at least 18 months looking back now) - fatigue, increased pain, puffy face, brain fog, hair loss and loss of the outer third of my eyebrows. Problem being the cross over in my hypothyroid and menopausal symptoms so hard to tell what is causing which symptoms at times. My thyroid tests showed I was undermedicated - TSH 4.76 (0.27-4.20), FT4 9.1 (10-22), FT3 2.9 (3.1-6.8) despite being told that the transdermal HRT shouldn't affect my thyroid function. I increased my T4 and my latest results are now looking better although still not optimal with my T4 20% through the range and T3 54% through the range. I tend to feel best when my T3 is in the top third and T4 about 50% through the range. I'm making minor tweaks in my T4 doses to try to get there but I understand that things may have changed with regards to where I feel best now that my sex hormones are changing.

However, now that my thyroid levels are much better, I seem to be having major issues with the HRT. I had bloods done privately in August through Medichecks and discovered that my oestradiol was very high. I know that blood tests for oestradiol are not very useful as the levels can fluctuate wildly during perimenopause, but it did make me wonder if my initial symptoms were due to my thyroid levels being off so I decide to remove the patch to see how I felt without it.
Blood test 24th Aug
FSH 8.4IU/L
LH 17.5IU/L
Oestradiol 1,139pmol/L
I was ok for about 3/4 weeks and then the initial symptoms started again. Restarted the patches and started to feel better again within a couple of weeks but started to get mild oedema in my ankles/legs again. At my annual review in October, my GP changed me from the cyclical patches to continuous combination patches (Evorel 50 Conti) and that's when things started to go really awry. Symptoms as follows:
Constipation
Difficulty passing urine at times along with bladder and vulval pain (using tampons can be torturous)
Fatigue
Non-pitting oedema ankles/legs
Puffy face
5kg weight gain
Increased allergy symptoms
Lack of appetite
Nausea
Non existent libido
Low mood
Anxiety
Lack of concentration/memory
Increased generalised pain
Non restorative sleep
Return of occasional Benign Paroxysmal Positional Vertigo

When I was getting my thyroid levels checked I thought it might be a good idea to have my my sex hormones rechecked while I was at it. There are 2 sets of results (2nd and 10th November) because of an issue getting some of the results, at which point I was in the luteal phase of my cycle (period started on 13th Nov). Both tests show high prolactin. 1st test shows high LH and FSH. 2nd test shows high oestradiol and testosterone. I'm led to believe that oestradiol meds and being hypothyroid can cause high prolactin - I don't think it's high enough to be pituitary tumour but need to talk to the GP about it next week.

Blood test Nov 2nd

Albumin 36g/L (35 - 50)
SHBG 111nmol/L (27.1 - 128)
FSH 19.2IU/L (1.7-7.7)
LH 29.9IU/L (1.0-11.4)
Oestradiol 1,051pmol/L (82 - 1251)
Testosterone 0.97nmol/L (0.29 - 1.67)
FAI 0.9% (0.2 - 7.1)
Prolactin 1,370mIU/L (102 - 496)

Results 10/11/22

Albumin 38g/L (35 - 50)
SHBG 114nmol/L (27.1 - 128)
FSH ***
LH ***
Oestradiol 1,660pmol/L (82 - 1251)
Testosterone 2.23nmol/L (0.29 - 1.67)
FAI 2% (0.2 - 7.1)
Prolactin 858mIU/L (102 - 496)

The symptoms have got so bad I've had to stop using the patches (now day 6 and symptoms have improved a bit but still there to varying degrees). I know chopping and changing so much won't be helping but I just want to try get some sort of hormonal balance. I believe that it's the progestin in the patches that I'm reacting badly to as the symptoms were less severe, coming and going when I was using it cyclically. I think I'd like to try body identical progesterone as well as oestradiol. Not sure of I'd be better using it cyclically or continuously. I've had a look and it would seem that my options are Utrogestan oral tablets (the vaginal capsules seem to be for fertility issues??) and Bijuve combination oral tablet but I have just done an IgG food intolerance test that shows I have issues with peanuts and soy (along with cows milk, whey and egg!) and am considering cutting them out my diet for a few months to see if my symptoms improve but there is a warning on the Utrogestan capsules saying they contain soya lecithin. Soy products can also cause issues for hypothyroidism. I was wondering if I was also perhaps showing signs of oestrogen dominance and the Bijuve contains 1mg oestradiol (double that of the Evorel 50) along with 100mg progesterone. I feel as if I'm stuck between a rock and a hard place. Having taken so long to get my hormones balanced enough to feel well, perimenopause has thrown everything into turmoil again.

Has anyone here with hypothyroidism and/or food sensitivities had success with the utrogestan capsules? And other body identical oestradiol products?

Wrensong:
Hello fabjellybean  :welcomemm:  It's good to have you with us but I'm sorry you've been having a difficult time of it.  Thank you for supplying the detail as it helps us to get a better idea of what might be going on.  That said, there is a lot to get to grips with  :o, so first I'll try to answer your bottom line question about Utrogestan & body identical oestrogen as that's more straightforward.  I'm also hypothyroid - nearly 30 years on replacement, currently T4 & T3, because of a conversion defect.  Also on HRT for a few years, but postmenopause & still working on balancing the two.

I really struggle with progesterone in all its forms, but for me Utrogestan is the worst, I sense because it's too strong for me.  That doesn't mean it won't suit you & many women on here get on well with it.  Some use Utrogestan vaginally to minimise side effects but I can't answer your soy allergy question I'm afraid.  There are also Cyclogest pessaries but I'm not sure how easily available these are, or of their ingredients other than progesterone.  I think one member has had them prescribed recently, but privately.  You could google them to see what exipients they contain.

The progestogen in Evorel Sequi & Conti, Norethisterone, is one of the more androgenic (testosterone derived) forms & many women find they don't feel good on this.  I used Evorel Conti for a couple of years as my first HRT postmenopause & was OK on it in terms of side effects, but didn't get good absorption & consequently poor symptom relief.

As for the oestradiol products, I find I get on best with the gradual release of patches, rather than once a day application methods like Oestrogel/Sandrena & Lenzetto (spray) which can give rise to peaks & troughs in levels.  We are all different in our responses, though my feeling is that hypothyroid women need as much stability as we can get in terms of other interacting meds.  I also find cyclical HRT harder to combine with thyroid replacement, for the same reason, but you may have no say in that until you are postmenopause.

The fatigue, oedema, hair loss inc outer third of eyebrows, are classic for low thyroid as you know.  Brain fog too, though of course this is also a meno symptom & I can't think there can be a more confusing combination than having a thyroid condition during menopause.  So yes, your being undermedicated on thyroid replacement at that time could explain all those symptoms.  To complicate matters I find oestrogen causes me to retain fluid, but progesterone is highly diuretic for me, again possibly because of their different effects on thyroid status, oestrogen effectively lowering active thyroid hormone & progesterone thought to boost it.  So times of high oestrogen may explain the intermittent oedema.

Unfortunately even transdermal oestrogen seems to mess with thyroid levels for those of us on both T4 & T3 - we have a few members here who have experienced that, including me & my bloods demonstrate it, not just symptoms.  You'll know that oestradiol causes an increase in TBG as the possible mechanism behind this situation.  Though most of the scientific literature states that only oral oestrogen has this effect, it seems likely that not enough research into the complex interactions between sex hormones & thyroid status has been conducted.

The constipation, weight gain & low mood that you experienced more recently also point to low thyroid, though again all can come with menopause too. 

I was found on pelvic scan to have urinary retention (as opposed to generalised fluid retention) in early peri while off T3, that resolved on restarting it, so your difficulty passing urine may be another feature of low thyroid.  It can also sometimes be a consequence of constipation (hypothyroid-related or not), due to the resultant bloating affecting the mechanics of emptying the bladder.  So it may help to do all you can to optimise bowel function.  Unfortunately both progesterone & it's more recently been recognised - oestrogen, can slow bowel function.

The bladder & vulva pain & difficulty with tampons are suggestive of the dryness & inflammation of GSM that happens to so many of us as sex hormone levels decline, but perhaps also an indication of infection.  A UTI could also cause urinary retention, so I'd speak to your GP about both bladder & vaginal symptoms if you haven't already & before you consider using progesterone vaginally.  Many of us find we need both topical (vaginal) & systemic oestrogen, so I would also ask about Vagifem (tiny pessaries) or Ovestin (cream) for internal use & the weaker Estriol cream (0.01%) for external application if you opt for Vagifem internally.  Sorry if I've missed mention of this in your post - I keep rereading but get sidetracked tackling something else!

Yes, I had high prolactin levels long before peri, though no one linked it with being hypothyroid at the time.  I believe you are right that the two can go hand in hand.  Don't quote me on that though - long time since I looked into it.   I would definitely still ask your GP about it as your level is really quite high, as you say.

Low libido can be helped by getting the right balance of oestrogen & testosterone, but again this can be more complicated for hypothyroid women because of the influence of SHBG.  It's also not surprising your libido should be low with all you are coping with in terms of other symptoms.

It's a long time since I was in peri & I'm hoping one of the members who's more up to speed about that stage will be along to advise on how best you can manage your HRT needs accordingly, but we are usually advised to use cyclical regimens until postmenopause. 

High oestrogen will almost certainly not be helping your thyroid situation & I found the erratic fluctuations of peri to be really very difficult with the thyroid complication, so you have my sympathy.

I'm sorry this doesn't answer all you need to know, but one of the great things about the forum is that someone else will almost certainly come along to help out with the bits I haven't addressed.  And perhaps with differing views on the bits I've tried to!

Meanwhile  :hug: for all you are coping with.
Wx

Wrensong:
Hi again fabjellybean, a couple more thoughts. 
--- Quote ---the Bijuve contains 1mg oestradiol (double that of the Evorel 50)
--- End quote ---
  The chart in the attached BMS link shows the equivalent HRT doses for oral & transdermal products.  As you'll see 1mg oral oestradiol is considered a lower dose than that given by a 50mcg patch, but it will vary according to how well you absorb from the various products. 

https://thebms.org.uk/wp-content/uploads/2018/08/HRT-Practical-Prescribing-AUG2018.pdf

I would think it's possible that the often stated increase in TBG caused by oral oestrogen could have a greater effect on your thyroid status than oestrogen from transdermal methods, but as I mentioned earlier, from what's been reported by hypothyroid members on here, this relationship seems to be less typical in women on both T4 & T3 like you & I.

I'm not sure why your testosterone is raised, though hypothyroidism is said to cause this in some women (postmenopause), being hypothyroid can also lead to low T levels.  I don't know how high it would need to be before PCOS might be considered.  It's a condition I know very little about & I can't find anything very useful on it this morning.  Maybe talk to your GP to see what she thinks about your raised testosterone level.

As your endocrine situation is quite complex I wonder whether a menopause clinic or endocrinology referral might be helpful if you & your GP feel this could be worthwhile.
Wx

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