My boyfriend is to-ing and fro-ing to a local Endo. We are trying to convince him with all the symptoms that he is low thyroid, however the Endo isn't having it. John (my boyfriend) has been self medicating with 10 mcg T3 and half a grain of Armour. The Endo knows this and told him to carry on if he wants to?? For the blood tests John came off all supps' T3/Armour for a week in the hope of a more convincing TSH and this was the result:-
Total Vit D 160 (no levels to gauge for a man)
Serum Folate 6.8 ug/l 4.6 - 20
B12 378ng/l 180-900
Serum ferritin 163 ng/ml
Free T3 4.3 pmol/L 3.1-6.8
TSH 2.39 mu/L 0.27-4.2
Free T4 *10.7 pmol/L
Cortisol 330 nmol/L 9.00hrs 17- - 540
Cortisol 400 nmol/L does not exclude Addison disease.
I watch John deteriorate each day, he really struggles to get out of bed. I am about to write to the Endo with more evidence of how ill he is. His Free T4 has dropped through the floor. Please can somebody help.
Thank you
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Margo
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Thanks for this Maddie, John had a Genova Cortisol test done in February this year, his result was he was in Exhaustion Stage. However, with the change of diet (non-gluten) Adrenal Support supps' and a lot of others I think he must have improved. I didn't register the result on the blood test in comparison to the Genova test, so thanks for pointing that out, good news methinks. It is the big drop in FT4 that really concerns me *10.7 pmol/L 12 - 22., what do you make of that please?
Margo, Don't worry about low FT4 as oral ingestion of T3 bypasses the need for T4 storage and conversion, so FT4 is often low/just under range.
John's TSH is too high for someone on medication and his FT3 is a little low, the 'ideal' being top 75% of range or >5.87. 1/2 grain + 10mcg T3 is roughly equivalent to 68mcg Levothyroxine, quite a low dose. TSH just above or just below 1.0 is usually about right although some people need it lower around 0.5 or even suppressed <0.03. John needs to raise his NDT by 1/2 grain every 2/3 weeks until his symptoms resolve.
Hi - my observation is that this low T4 is due to the thyroid gland not producing any of its own thyroid hormones due to the replacement dose of NDT and T3 causing the gland to either shut down or reduce its output. The T4 in 1/2 grain of Armour is only approx 19 mcgs so not enough to push up the T4 level. The T3 level doesn't look too bad.
I would have expected a lower TSH as the pituitary would not need to produce so much TSH with an adequate FT3 level.
It is important to provide a sufficient dose of thyroid hormone replacement, I calculate that your boyfriend is only taking 77mcg - 90mcg equavalent T4 dose which may be too low a dose.
I take NDT only and my T4 is below the range at 9.8 and FT3 only just in range. My consultant is not concerned that my T4 is below range so I don't think that there is anything to worry about.
It would be useful to know your boyfriends test results before he started to self medicate. This is the stage where secondary hypothyroidism can be considered as an option. It usually gives a low/normal TSH and a low T4.
There is also Tertiary Hypothyroidism whereby the hypothalamus malfunctions. All in all, there is a lot to consider and unfortunately many endos fail to diagnose the more complicated conditions. This link gives a simple explanation;
His folate is too low and B12 level needs increasing.
See if you can get your GP to do 8am-9am fasting cortisol blood test to check for hypoadrenalism. This advice is given on Dr Chandy's protocol. If this is low it will be easier to get some further testing eg short synacthen test. You will need to check the result of the fasting cortisol test against Dr Chandy's diagnosis table as a low result can be overlooked.
Along with the fasting glucose ask for liver and kidney function tests.
If these are declined ask if a well man health check is available.
Is there any possibility of sleep aponea?
Consider a coeliac test although this would mean eating gluten containing foods for six weeks prior to testing - Maddie
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