Thyroid problem

[lelapin]

I visited a hospital today and after a high blood test reading - TSH - 8.91 (normal  0.27 - 4.2) I was told by the Dr that I had a thyroid problem and he would prescribe generic Levothyroxine - Euthyrox.

When I got home, for general info I checked it on the internet and was horrified with what I read.

Euthyrox User Reviews for Underactive Thyroid - Drugs.com

I am 80 years old with several medical problems and I am most concerned that if I start taking this medicine I could cause serious problems to myself.

Some knowledgeable, helpful responses would be much appreciated.

 

[Sheryl]

Many, many people take this brand with no difficulty.  I have taken it myself - sometimes I take Euthyrox, sometimes levothyrxoine GPO. No difference in effect.

 

I have no idea what was going on in the people who posted in that site but I note all seem to be in the US so it would have been a US-manufactured formulation.  Euthyrox sold in Thaland is manufactured in Germany.

 

But of concerned, simply use a different brand of levothyroxine.

 

However if you are asymptomaric (normal energy levels, no trouble getting going in the morning etc) you might want to get a repeat blood test before starting treatment. Lab errors can happen.

 

 

[lelapin]

Just now, Sheryl said:

Many, many people take this brand with no difficulty.  I have taken it myself - sometimes I take Euthyrox, sometimes levothyrxoine GPO. No difference in effect.

 

I have no idea what was going on in the people who posted in that site but I note all seem to be in the US so it would have been a US-manufactured formulation.  Euthyrox sold in Thaland is manufactured in Germany.

 

But of concerned, simply use a different brand of levothyroxine.

 

However if you are asymptomaric (normal energy levels, no trouble getting going in the morning etc) you might want to get a repeat blood test before starting treatment. Lab errors can happen.

 

 

Many thanks for your comments. I will try it for a week or so and see how I feel.

[lelapin]

4 hours ago, Sheryl said:

Many, many people take this brand with no difficulty.  I have taken it myself - sometimes I take Euthyrox, sometimes levothyrxoine GPO. No difference in effect.

 

I have no idea what was going on in the people who posted in that site but I note all seem to be in the US so it would have been a US-manufactured formulation.  Euthyrox sold in Thaland is manufactured in Germany.

 

But of concerned, simply use a different brand of levothyroxine.

 

However if you are asymptomaric (normal energy levels, no trouble getting going in the morning etc) you might want to get a repeat blood test before starting treatment. Lab errors can happen.

 

 

I see on the internet the following re dosage

 

Euthyrox works best if you take it on an empty stomach, 30 to 60 minutes before breakfast

 

Euthyrox: Side Effects, Uses & Dosage - Drugs.com

 

 

 

On the package I got from the hospital it says take one tablet daily after breakfast.

What would you recommend?

Edited October 15, 2021 by lelapin

[lopburi3]

38 minutes ago, lelapin said:

I see on the internet the following re dosage

 

Euthyrox works best if you take it on an empty stomach, 30 to 60 minutes before breakfast

 

Euthyrox: Side Effects, Uses & Dosage - Drugs.com

 

 

 

On the package I got from the hospital it says take one tablet daily after breakfast.

What would you recommend?

30 min before breakfast for me using Vejthani Hospital.  Have been using for about a decade as Thyroid is mostly removed and remaining not working.  

[Sheryl]

4 hours ago, lelapin said:

I see on the internet the following re dosage

 

Euthyrox works best if you take it on an empty stomach, 30 to 60 minutes before breakfast

 

Euthyrox: Side Effects, Uses & Dosage - Drugs.com

 

 

 

On the package I got from the hospital it says take one tablet daily after breakfast.

What would you recommend?

Levothyropxine - regardless of brand - is best taken fist thing i nthe morning on an empty stomach for optimal absorption.

 

This drug is readily bought at a pharmacy without prescription, no need or reason to get from a hospital and will be much cheaper at a pharmacy. (but should be followed periodically for blood test to determine if dosage is correct and having desired effect. Preferrably follow up by an endocrinologist).)

[Sheryl]

13 hours ago, lelapin said:

Many thanks for your comments. I will try it for a week or so and see how I feel.

 

I take it then that you are symptomatic.

 

It might take more than a week, but symptoms that could be expected to improve on this medication would be:

 

- fatigue

-being slow/having trouble getting going i  the morning

- "brain fog", forgetfulness, etc

-sensitivity to cold

-muscle aches and pains (at age 80, don't expect miracles but might improve a little)

- depression

- dry skin

 

[thaiclan]

Never treat on a TSH reading alone. Yes your TSH is far too high, but you also need to know what your T4, T3, FT4 and FT3 is (the F stands for 'free'). Even better would be to also have your RT4 and RT3 measured (R stands for reverse). 

 

The TSH is just the amount of hormone your pituitary is sending to your thyroid to stimulate thyroid hormone (T4 and T3). The T4 and T3 however cannot be used by your body until converted (FT4 and FT3). 

 

So basically a stand alone high TSH says that your thyroid is not producing enough hormone and in turn sends a message back to your pituitary to make more TSH because it needs more T4 - this negative feedback loop will make you feel quite ill with many 'vague' symptoms.

 

Get yourself a good endocrinologist and find out WHY your TSH is so high.  

You would do well to get an ultrasound of your thyroid too as this may show up any damage to the gland.

 

Many people with low thyroid (hypothyroid) have a condition called Hashimoto's. This is the most common reason for a low thyroid problem.   It is easy to test for with an anti - TPO blood test.

 

Good Luck! I have been through this myself and it is not easy to get a great endocrinologist here in Thailand. If you find one then let me know! 

Edited October 16, 2021 by thaiclan
mispelling

[Sheryl]

26 minutes ago, thaiclan said:

 

Good Luck! I have been through this myself and it is not easy to get a great endocrinologist here in Thailand. If you find one then let me know! 

Excellent endocrinologists:

 

https://www.bumrungrad.com/en/doctors/Jun-Srimanunthiphol

 

https://www.bumrungrad.com/en/doctors/Rosanee-Valyasevi

[thaiclan]

2 hours ago, Sheryl said:

Excellent endocrinologists:

 

https://www.bumrungrad.com/en/doctors/Jun-Srimanunthiphol

 

https://www.bumrungrad.com/en/doctors/Rosanee-Valyasevi

Thanks for the links. I am a patient at Bumrungrad endo dept (for the past 8 years)  but haven't found them to be very helpful or modern in their approaches.  Like many 'old style' endo's they treat the numbers and not the patient, they also don't use any of the newer research which links nutrition (leaky gut) with hormone production and uptake. Most infuriatingly they do not use optimal levels of hormones when assessing deficiencies. 

However on the positive side they have been very open to guidance from overseas endo's when I received advice from them and relayed back to Bumrungrad.

Seems like the best endo's and the most progressive thyroid doctors are based in the US. There is some fascinating research being done there.

[41632584]

3 hours ago, Sheryl said:

Excellent endocrinologists:

 

https://www.bumrungrad.com/en/doctors/Jun-Srimanunthiphol

 

https://www.bumrungrad.com/en/doctors/Rosanee-Valyasevi

Agree. Dr. Jun has always been very kind, helpful and caring. She runs all tests needed, but also takes the time to listen carefully and explain if there are any questions.

 

Of course, I am not in a position to evaluate her medical expertise or comparing her to other specialists.

[lelapin]

I am now taking my Euthyrox tablet 1 hour before breakfast and my Omeprazole 20mg tablet 30 minutes before breakfast every day.

After reading some information on a website today I have 2 queries.

It says that to be affective, these 2 medications should be taken at least 4 hours apart.

It says that Omeprazole should not be taken on a continuous basis and recommended 14 days and then stop for 4 months unless experiencing digestive problems.

Anyone have any useful advice to give me.

[Sheryl]

What website was this?

 

I have never heard of an interactrion between omeprazole and levothyroxine and am unable to find this anywhere in the literature.

 

Many people take omeprazole (and related drugs) long term, some for years. Long term use  does have its down sides,  but for some people it is unavoidable. By definition, anyone taking it has "digestive problems", why else would it be prescribed?  Even when taken short term (e.g. for healing an ulcer or gastritis) the necessary duration is much more than 14 days. As to whether you should be taking it long term, depends entirely on what it was prescribed for.

[lelapin]

13 hours ago, Sheryl said:

What website was this?

 

I have never heard of an interactrion between omeprazole and levothyroxine and am unable to find this anywhere in the literature.

 

Many people take omeprazole (and related drugs) long term, some for years. Long term use  does have its down sides,  but for some people it is unavoidable. By definition, anyone taking it has "digestive problems", why else would it be prescribed?  Even when taken short term (e.g. for healing an ulcer or gastritis) the necessary duration is much more than 14 days. As to whether you should be taking it long term, depends entirely on what it was prescribed for.

Euthyrox: Side Effects, Uses & Dosage - Drugs.com

 

 

 

 

Omeprazole Uses, Side Effects & Dosage Guide - Drugs.com

 

 

 

 

 

 

Edited November 12, 2021 by lelapin

[Sheryl]

This is referring to when it is bought over the counter/self-prescribed. The guidelines for when it is prescribed by a physician are quite different.  They just caution against people self-treating for simple heartburn for more than 14 days straight because if it persists that long, something else may be going on.

 

That said, there are potential pitfalls to long term use of omeprtazole and similar drugs (include increased bone loss and Vit B12 deficiency and their sequelae) . Certainly should not be taken regularly long term if not absolutely necessary.

 

Some studies have shown that there is no problem with co-administration of both levothyroxine and omeparazole, see here  https://pubmed.ncbi.nlm.nih.gov/25372582/

 

Other studies have found that a slightly increased dosage of levothyroxine was needed in people taking PPIs like omeprazokle, this would become obvious on repeat blood work and your doctor will adjust as necessaey

 

The potential issue is not any dangerous interaction but rather that the reduction in gastric pH caused by omeprazole (and similar drugs and antacids) might decrease absorption of levothyroxine i.e. you might need a higher dose to get the desired therapeutic response. Your dosage will in any case be adjusted based on your labs so that will take care of it. 

 

A 4 hour time gap is unlijley to make much if any  differnce

 

 

[lelapin]

2 hours ago, Sheryl said:

This is referring to when it is bought over the counter/self-prescribed. The guidelines for when it is prescribed by a physician are quite different.  They just caution against people self-treating for simple heartburn for more than 14 days straight because if it persists that long, something else may be going on.

 

That said, there are potential pitfalls to long term use of omeprtazole and similar drugs (include increased bone loss and Vit B12 deficiency and their sequelae) . Certainly should not be taken regularly long term if not absolutely necessary.

 

Some studies have shown that there is no problem with co-administration of both levothyroxine and omeparazole, see here  https://pubmed.ncbi.nlm.nih.gov/25372582/

 

Other studies have found that a slightly increased dosage of levothyroxine was needed in people taking PPIs like omeprazokle, this would become obvious on repeat blood work and your doctor will adjust as necessaey

 

The potential issue is not any dangerous interaction but rather that the reduction in gastric pH caused by omeprazole (and similar drugs and antacids) might decrease absorption of levothyroxine i.e. you might need a higher dose to get the desired therapeutic response. Your dosage will in any case be adjusted based on your labs so that will take care of it. 

 

A 4 hour time gap is unlijley to make much if any  differnce

 

 

Thanks for all the info