Hypothyroid / RA- IVF

[Maron007]

My symptoms started in sep 2011 with tingling and numbness in fingers. I was referred to an RA consultant while waiting for my next appointment my condition deteriorated. My hands and fingers were extremely painful and my joints swollen. I could not sleep and had no energy and fatigued.

I went private and was given a steroid injection and 5mg daily. My symptoms calmed down, however I could not sleep and did not feel myself. So in the October with my symptoms manageable I decided to stop the steroids. I gained weight and still felt weak with no energy and my hair had been falling out since July. My RA consultant decided to check my thyroid and said my TSH was to high and started me on 25mcg of thyroxine in Nov 2012 I felt a slight improvement but still nowhere able to do the things I used to. I had an increase to 50mcg in feb.

In august I had pain in wrists and tingling in my fingers like a cramp in my hands. I was told I was presenting carpal tunnel syndrome however can be associated with under active thyroid. So thyroxine increased to 75mcg to see if it settled. It did settle no more tingling but still have one permanent swollen finger and always weak hands and wrists. Sometimes have swollen feet too ! I have had two increases this year am currently take 125mcg thyroxine.

After joining this site is I have read through all the different posts and advice given and realise how complexed the thyroid is. I have had recent blood tests which I would appreciate any advice on. I am currently taking the nasal spray suprecur and will have a scan and blood test tom am to see if I am ready for the next stage on my journey of ivf. Also I have read that you should not take your thyroid tablets until after b/t, why ? The docs do not know when I have asked.

April blood test/ taken in morning

TSH 3.03 ( 0.27-4.20) mu/L

Free T4 22.9 ( 12.0-22.0) pmol/L

free T3 4.2. ( 3.1-6.8) Pmol/L

Th1:Th2 cytokine Ratio

TNF-a:IL10(CD3+CD4+)

24.4 (13.2-30.6) ratio

IFN-g: IL10 (CD3+CD4+)

13.6 (5.8-20.5) Ratio

Thyroid peroxidase antibodies

144 IU/mL ranges <50 50-75 >75

Anti thyroglobulin antibodies

380 IU/ml <100 100-150 >150

11 July b/t 1630

Serum Vit D 87 nmol/L 75.00-200.00

Serum Ferritin 26ug/L 15.00-250.00

Serum free T3 3.9 pmol/L 3.50-6.50

Serum free T4 20.4 pmol/L

9.00-24.00

Serum TSH 0.21 mu/L 0.35-5.00

Serum folate 11.4 ug/L 2.00-17.00

Plasma Vitamin B12 level 308ng/L

200.00-900.00

[Clutter]

Maron,

Your July TSH and FT4 look good but your FT3 is a little low indicating you may not be converting efficiently and might benefit from a little Liothyronine (T3) added to a reduced dose of Levothyroxine (T4).

Ferritin is low and is optimal at 70-90. Take each iron tablet with 500-1,000mg vitamin C to aid absorption and mitigate contstipation.

B12 is also low and may have been partially responsible for the tingling in your hands. Check out this link before supplementing. b12deficiency.info/what-to-...

Your vitamin D is in the optimal range 75-200 and doesn't need supplementing now but you should supplement vitamin D3 October to April when the light spectrum is too low to allow absorption via the sun on skin.

Thyroxine (and other medications) should be taken after blood tests otherwise the test reports levels of medicine which peak 2-6 hours after ingestion rather than the normal serum levels.

I hope the IVF treatment is successful.

[Maron007 in reply to Clutter]

Thanks Clutter, that's really helpful and was on the same lines as I was thinking. Will talk to my doctor about supplementing with T3 and optiomising my iron and b12. x

[Clutter in reply to Maron007]

Maron, because your results are in range your GP may tell you they are fine. They aren't, and you should self supplement if the GP does not prescribe.

[Maron007 in reply to Clutter]

Hi Clutter

I saw an Endo last week who wants to run some more blood tests.

Short synacthen test, coeliacs and magnesium. If they are negative she suggested a supplement of T3 ? If this happens is it better to opt for the NDT rather than t4 & t3 is one better than the other ?

Forgot to ask her if my blood test confirm hashimotos disease ? Any knowledge you can share would be greatly appreciated. Many thanks x

[Clutter in reply to Maron007]

Maron, your thyroid peroxidase and thyroglobulin antibodies are positive for autoimmune thyroid disease (Hashimoto's). You may find a gluten free diet helps reduce antibodies even if you aren't positive for coeliac but don't give up gluten until after your coeliac screen.

I doubt your endo will prescribe NDT on the NHS as it isn't licensed for UK use. T4+T3 combination suits me well so I haven't tried NDT but if you don't get well on T4+T3 then it is certainly worth trying it.

[helen642]

Hi again, now I have seen all of your post. have you had your adrenals tested? Maybe start with a 9am cortisol test, if you have low cortisol you will feel dreadful. The fact that you were on steroids may have knocked out your cortisol feed back loop (HPA axis) also take your thyroxine everyday not sure what you mean by b/t but you take it throughout ivf and at all times. Your t3 looks low, I would expect it to be higher indicating some issue with converting, I had this when my cortisol was low and I felt awful.

[helen642]

Cortisol is needed to convert thyroxine

[Maron007 in reply to helen642]

Thanks Helen642 saw endo dr today, she wants to check cortisol followed by synacthen test, also checking magnesium and for celiacs disease and b12. If all ok as suggest a supplement if t3.

All promising, however manufacturing shortage of synacthen so have to wait til middle of august.

Scan showed 2cm cyst and bloods confirmed not down regulated enough, so had a pragynl injection and on day 4of 5 day courser of prevara tablets. Fingers crossed next week sometime I will be ready for stimulation drugs.

Thanks for all your advice x