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[Barbara Louise]

I've been taking thyroid replacement hormone (Levothyroxin) for almost 30 years since just after my first pregnancy. I've been taking transdermal estrogen (Estrogel) for about 1.5 years. Lately my TSH has been creeping up. Normally it's about 0.5 mIU/L but my last two tests have been 1.0 and 2.02 (a couple of months apart) and my free t4 has fallen from 14 to 12 pmol/L. These levels are still "normal" according to the lab's reference range so my doctor gets the results and thinks everything is fine, but the changes are worrying me, especially since I've gained weight and have not been feeling well: fatigue, disturbed sleep, hot flashes worse. My questions are 1) have others had issues with estrogen affecting their thyroid replacement hormone? 2) Can reduced thyroid hormone in the body make hot flashes and other menopause symptoms worse?

[CLKD]

Thyroid function, as with many hormones, can be altered by adding replacements.  GPs don't seem to realise that even a result 'within normal limits' might not be correct for sufferers.

I'm sure that someone will be along with more info.  Maybe ask for a referral to an endocrinologist with knowledge of peri-menopause?

[Wrensong]

Hi Barbara Louise, like you I've been on thyroid replacement for nearly 30 years & latterly on HRT.  Although it's documented that transdermal oestrogen is less likely than oral to affect our thyroid levels, a number of us on this forum have found we have had to tweak our thyroid dose in response to transdermal HRT.

Wrt to your 2nd question, if your thyroid levels are not optimal for you, your body may struggle to utilise your HRT as well as it might, meaning symptom relief could be compromised.

If your GP is not receptive to the possibility your feeling unwell could relate to a thyroid-HRT interaction & you sense it is, then as CLKD suggests you may have to ask to see an endocrinologist, though another option first is perhaps to try a different GP.  Your FT4 is certainly on the low side according to the ref range for the lab I use, though your TSH looks OK-ish, but of course may not be optimal for you.  I take it they don't test your FT3?

We have a thread called Thyroid Issues & Support you may like to have a look at some time.
Wx

[CLKD]

 

[Barbara Louise]

Wrensong, thank you! You have confirmed what I suspected. The labs here (Canada) have a very large "normal" reference range that doesn't differentiate between people already taking thyroid replacement and those who are not, which makes a difference to the optimal TSH. I am going to pursue this further with my doctor. I do feel like the HRT is not particularly effective anymore. Thanks again!

[Wrensong]

It's a pleasure. 
I hope you manage to make good progress.
Wx

[Jillyboo]

I had been stable on a 75 mcg dose of levothyroxine for over 25 years but after the second Covid vaccination my TSH shot up and I was told by my GP to increase to 100 mcg daily immediately.

Now over a year later my TSH is lower than it's ever been and I do wonder whether I could reduce my medication again although my GP (who I never actually see in person any more) hasn't made any comment. 

I've been on oestrogel for years and never noticed it made any difference to my TSH levels.

Hormones! Hope you find the answers you're looking for.

[Kathleen]

Hello ladies.

I just wanted to add that a post meno friend of mine has been on Levothyroxine for thirty years and she has had a few occasions when her dose has been increased. I think she is on 100mcg at the moment. My friend has never been on HRT so that is not a factor for her and suggests that requirements may change as we age anyway.

I was diagnosed with Hashimotos  a few years ago. I was already post Meno and on HRT. The only treatment I have had is regular blood tests from my GP. The tests always come back in the normal range so there is never any follow up action.

I think seeing an Endocrinologist is a great idea but probably easier said than done.

Wishing you well ladies and take care.

K.