Thyroid UK
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This is my first post. I have been struggling for most of my adult life with brain fog, fatigue and weight issues. I have, through force of mind over matter, managed to remain functioning with considerable effort however am now 49 years old and perimenopausal and managing to be barely functioning is now exceptionally difficult. I don't drink alcohol or even coffee and have a reasonably clean diet, making my own meals and minimising processed foods. I do eat gluten and sugar.

Need help interpreting results and managing conversations with doctors who are heading towards a diagnosis of chronic fatigue which just feels wrong. I have a strong family history of thyroid/ Hashimotos and daughter with vitiligo.

I have recently been started on a trial of HRT to manage hormone levels and Levothyroxine 100 mcg (no diagnosis but thought worth a try to nip autoimmune development in the bud) but neither seem to be making much difference after a month. I've been unable to work for the last 3 months and now given an ultimatum by work to get back to full strength asap or consider resigning. Really need help.

Recent blood results with ranges in brackets:

TSH 2.4 (0.2-4.5)

Free T4 13 (9-21)

Vit B12 294 (180-2000)

GGT 75 (5-35)

Potassium 5.0 (3.6-5.0)

Calcium 2.4 (2.1-2.6)

ESR 28 (3-15)

TPO antibodies 46 (<6)

TG antibodies 11 (<4)

25-OH Vit D2-D3 8.9 (>30)

Thanks for any help,

3 Replies

Others will respond to the rest of your results but your TSH is too high yet, you should aim for 1 or below whichever makes you feel better. Your FT4 is quite low so I wonder what your FT3 is as it is T3 which is the active hormone needed in our receptor cells. Levo should convert to sufficient T3 when you're on the right dose. Sometimes people have difficulty converting levo so the addition of some T3 might be helpful.

Your B12 is too low and tell your doctor you are going to supplement with methylcobalamin sublingual B12 to bring it up to at least 1,000 but first of all can she check the intrinsic factor to disregard Pernicious Anaemia before you begin as supplementation can mask a problem.

Vitamin D is too low but others who know more will also respond. B12 is a hormone and Vit D a prohormone but both are very necessary for us to be healthy.

A deficiency in B12 and Vit D can also cause clinical symptoms.



Apart from the other things, your moderately raised ESR and antibody count indicate you are in an early stage of thyroiditis (whether Hashimoto's or other sorts isn't clear). If so there's bound to be unpleasant fluctuations as your thyroid gland is being attacked. See this site for some info on thyroiditis:


Welcome to the forum, Gailtay.

It takes 7-10 days to absorb Levothyroxine before it starts working and up to six weeks to feel the full impact of the dose but you should be feeling some improvement by then. Symptoms may lag behind good biochemistry by 6-8 weeks after you are optimally dosed.

Elevated thyroid peroxidase and thyroglobulin antibodies mean you have autoimmune thyroid disease (Hashimoto's). 100% gluten-free diet can help reduce Hashi flares and antibodies and slow progression of the disease.

TSH 2.41 means the thyroid has been damaged and is beginning to struggle to produce thyroid hormone, evidenced by FT4 13 which is low in range. Most people on Levothyroxine will be comfortable with FT4 in the upper range and TSH just above or below 1.0. 100mcg Levothyroxine will raise FT4 and is likely to suppress TSH <0.1. Suppressed TSH means there will be little/no thyroid activity and this can dampen Hashimoto's flares.

You should have a thyroid blood test 6-8 weeks after starting Levothyroxine. Arrange an early morning fasting (water only) blood draw as TSH is highest early and drops postprandially. Take Levothyroxne after the blood draw.

B12 is very low, 1,000 is optimal according to the PA Society. Supplement 5,000mcg methylcobalamin for 6-8 weeks and then reduce to 1,000mcg. Take a B Complex vitamin to keep the other B vitamins balanced.

VitD 8.9 is severely deficient. I was prescribed ProD3 40,000iu daily x 14, followed by 2,000iu daily x 8 weeks which lifted vitD from <10 to 107 in the replete range 75-200.

Elevated GGT can indicate liver problems.

ESR is an inflammation marker and may be elevated due to the elevated GGT or autoimmune disease.


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