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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]

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.

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

[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.

[CLKD]

Setraline (sp) can be a life saver.  Many women find that they require both ADs as well as HRT.  There are a few ADs that can ease panic attacks and anxiety. 

Your breast tenderness may be cyclical.  Even now, years after my last period, occasionally I feel an 'ouch' in one or both so my ovaries are probably muttering in the background. 

Any oedema should be investigated as it may be linked to heart disease or a reaction to some of the medication: some are sensitive to fillers and/or packaging rather than the active ingredient.  It's such Trial and Error that it can become so tiring 

[Clarella]

If it’s helps I was on beta blockers (slow release ones) for years with thyroxine due to performance and social anxiety (possibly also hypermobility, it’s supposed to help) and I didn’t notice much difference. One offs when you’re bad wouldn’t much of make a difference imo, especially as you’re on T3. But if taking them causes more anxiety there’s not much point.

Sert has been the only ad that ever really worked for me (it was always that I was in the wrong level of thyroxine!) for post partum anxiety but I stuck with that and it helped really well - just takes a while. It’s got a 24 hr half life so best to stick to a time to take. (No one can agree on morning or night!) it gave me insomnia at first and sleepiness in the day but eventually sorted itself out.

I was getting painful Odema in my legs and feet when slowly upping oestrogen. Was fine on 50 but awful meno symptoms.  the issue started as I raised to 75. I had to go more slowly up to 100; it’s taken 5 months.

Continuous utro definitely helped this but also persevering- I think bodies take a long time to adjust both with thyroid and hormones. I had to wear support socks on my work days for a while but seem fine now. I think some gym sessions helped too - really pushing on a bike.

Gp just agreed I can do 2x utro on a 25/3 regime. I have been before I see her but one tablet vaginally. So I’ll tell you how I get on.

Only issue might be that this means I have to lower T4 as I believe utro increases t4 - I’ve been feeling buzzy and hyped she also agreed to a test .

[FAB-jellybean]

Thanks CLKD and Clarella. It does indeed seem that it's cyclical breast tenderness as my period appears to be starting again. Only 3 weeks since the last one which is typical of my undermedicated hypothyroidism (I'm normally every 32/33 days). But jeez oh they are more painful than they've been since I was last pregnant 21 years ago. And I'm definitely not now. It would have to an immaculate conception the way I'm feeling these days. My libido has well and truly left the building. My partner is currently reading the Advice for husbands and partners that I emailed him so he has a better understanding of what's going on. It definitely seems to be the oestradiol that's causing the oedema (whether the patch or excipients) but it's not as bad as it was in Nov at the height of my problems so I'll continue to persevere with it. Being tested again for prolactin in a couple of weeks along with TFTs so that will hopefully show what's going on and why. I do realise that I might never know though. I've stuck a 50 patch back on today because the night sweats over the last 2 nights on the half patch have been awful, as well as hot flushes through the day. Which also makes me think I've overdone the Thyroxine dropping - I get this worse when I'm undermedicated. Oedema not as bad tonight as it was last night or Saturday night. I've also realised I'm my own worst nightmare, I'm not leaving things long enough to settle before changing things around. And I should know better because I take longer to settle on new thyroxine doses, so other hormones are likely to be the same. I still haven't plucked up the courage to take the sertraline yet but thanks for your advice, I'm a bit less anxious about it now, just want to give things another couple of weeks before I start them. I have a uni assignment due in next Tuesday and I can't do that while feeling worse than I already do given how much I tend to react to medication and the slower time it takes for my body to get used to it. I also have a bit of hypermobility noted by the rheumatologist and have a fibro diagnosis although quite convinced that was caused by poor T4 to T3 conversion. My fT3 was never routinely tested so Clarella if you can get your doctor to sign off on that test as well as TSH and fT4 you'll get a better idea of what's going on with you. I've just had a copy of my medical records and my rheumatologist tested my fT3 (which was under range) and asked for my bloods to be retested along with Vit B12 and D, as he felt that was probably my problem. Sadly, although tested again and still below range nothing was done. I wasn't referred to an endocrinologist until 18 months later after I'd argued my case to be referred for a T3 trial (again after fighting my own corner). I haven't looked back since although getting there was no walk in the park. One of the letters to my GP from a junior doctor who didn't want me to have the T3 at my second appointment and was an arrogant twat, stated that although my bloods showed a TSH of 6.89 and low fT4 and fT3 (no wonder really when they dropped me 50mcg T4 and replaced with only 10mcg of T3), he wouldn't increase my dose because he was sure I wasn't taking them appropriately. He basically accused me of not taking the tablets at all to get a higher prescription. All I wanted was to feel better so why would I mess about when I had finally got the trial. Thankfully at the next appointment I took a friend for support and saw the head guy himself, who sorted everything out for me. That's my main reason for wanting to see someone privately, but if I decide against the private route just now, I'm going to try to talk the GP into referring me to the NHS menopause clinic to see what they have to say at least. Thanks again for your help, much appreciated.

[Helly1977]

Hi everyone, I’m so thrilled to find this thread. I have never felt alone as I have the past few years navigating hypothyroid and menopause symptoms.
I’m 44 and been told I am in early menopause. I’ve been on cerezette for years and so no periods to monitor etc. the last 2-3 years I have been struggling with dreadful anxiety, panic attacks, brain fog, poor concentration, night sweats, hot flashes, no libido etc. I was told repeatedly that it was my thyroid. It was so different to any anxiety or panic I had before though. I was fearful for my life. Petrified of most things and couldnt function properly at all. Scared of everything and crushed to version of myself i didn’t recognise. I was too long for it to be menopause. Then I couldn’t have an fsh test because I was on cerezette. Finally had one and it was 56.4 but my TSH was 0.03 and so it was likely my TSH that was the problem. They messed about my my thyroxine, dropping it every 6 weeks until I was at half my dose. My TSH didn’t change. My t4 fell to bits just as I did- I was utterly broken. Happy to consider death as my only option out of it (not sucidal, despairing).they refused to consider anything else and I had to have a second fsh for it be a firmer diagnosis but they wouldn’t do the test as it was just my thyroid…. I decided to go to a private endocrinologist. They did all my bloods and found my fsh was 56.4, lh 31, oestrodiol <18, and so on. They upped my thyroxine and started me on hrt. That was revolutionary. I felt a short period of time where I was how I used to be. Sadly since then I have yo-yo’d a bit. Started t3, brilliant. Given the mirena, Lenzetto and tostran. Amazing! Problem is it seems everytime I have an adjustment on one- it tips the balance of the other. So I go up on thyroxine- it then depletes my oestrogen and then I chase my tail playing tag with my doses. I am feeling pretty beaten at the moment if I’m honest. any ideas on how to manage this any better?

[CLKD]

   peri-menopause can be debilitating, throw in thyroid function disorders and 1 hormone seems to upset others.

Hopefully some1 will be along.