Endo Appointment

So went to see the endo - my results have improved slightly - TSH now 66.29. He thinks I may have a problem with absorption - mainly because my diabetes meds are making me sick... So he's changed my diabetes meds and is not ruling out changing my thyroid meds but wants to get my diabetes under control first.

So lots of tests ordered and a review appointment booked, we'll see how we get on!

6 Replies

  • I hope everything goes smoothly for you.

  • Linkypie, how much Levothyroxine is prescribed? I imagine tissue transglutaminase (tTg) has been ordered to rule out coeliac disease which is a common cause of malabsorption?

  • I've already had coeliac disease ruled out (gp did it) am on 300mcg thyroxine

  • Linkypie, the serum test can give false negatives and positives. Hopefully they'll drill down with other tests. 300mcg is a hefty dose and you don't seem to be absorbing, so if not coeliac, and if other malabsorption is ruled out your endo needs to consider resistance to thyroid hormone.

  • re Clutter, yes, but there's a lot of drilling to do besides celiac - you are in the position of the North Sea.

    H pylori ruled out?

    "It is now firmly established that H pylori infections cause iron deficiency in both adults and children. The 2012 Maastricht Consensus clearly states:

    “The association of H pylori with unexplained iron-deficiency anaemia has been conclusively proved in adult and paediatric populations. Two separate meta-analyses in recent years have supported this association, with one illustrating a clear link between H pylori infection and iron-deficiency anaemia1 and the other showing that H pylori eradication increases haemoglobin levels in these patients.”

  • And then there's the problem that hypoT causes achlorydia, low stomach acid, and that causes iron def in itself.

    The following is fascinating if you are an iron deficiency geek. Which you will be soon. (!) Obviously, they are talking about anemia here, but iron depletion short of anemia would be caused in the same way.

    © 2015 American Society for Nutrition

    Is achlorhydria a cause of iron deficiency anemia?1

    Andrea L Betesh, Carol A Santa Ana, Jason A Cole, and John S Fordtran*

    Department of Internal Medicine, Baylor University Medical Center, Dallas, TX


    We re-evaluated the old hypothesis that gastritis-induced achlorhydria is a cause of iron deficiency anemia (IDA) in humans. First, we analyzed the currently available research on the association between achlorhydria and IDA. When gastric acid secretion was measured after maximal stimulation, the frequency of achlorhydria (or severe hypochlorhydria) was 44% in patients with idiopathic IDA and 1.8% in healthy controls. In some patients with pernicious anemia, presumed achlorhydria preceded the development of IDA in time. However, we found no credible evidence that IDA caused gastritis or that IDA preceded the development of achlorhydria. Thus, correlational results favor achlorhydria as the causal factor in the association between achlorhydria and IDA. (OK, I THINK WE WOULD ALL HAVE WORKED THAT OUT.)

    Second, we sought to determine whether gastritis and achlorhydria cause negative iron balance. When biosynthetic methods were used to isotopically label iron in food, (THIS IS THE GOOD BIT) achlorhydric patients were found to have severe malabsorption of nonheme iron, (THAT IS IRON FROM VEG, NOT MEAT) which persisted after the development of IDA. In 1 study, achlorhydria reduced the normal increase in heme-iron absorption from hemoglobin in response to iron deficiency. (SO BASICALLY VEGGIES WHO ARE HYPOT ARE AT HUGE RISK OF IRON DEF - BUT IT LOOKS LIKE ALL 35 per cent of HYPOTs WITH GASTRITIS ARE AT GREATER RISK, THEY DISCOVERED WHEN THEY GOT DOWN TO ANALYSING THE POO.) After an injection of isotopic iron into normal men, the physiologic loss of iron from the body was found to be 1 mg/d. Patients with chronic gastritis had excess fecal loss of isotopically tagged plasma iron. Calculations based on these results indicate that the absorption of iron from a typical Western diet by achlorhydric patients would be less than physiologic iron losses, creating a negative iron balance that could not be overcome by the adaptive increase in duodenal iron absorptive capacity that occurs in response to iron deficiency. The combination of results from these correlational and pathophysiologic studies supports the hypothesis that gastritis-induced achlorhydria can be an independent cause of IDA.

    OK, so have they tested you for antibodies to intrinsic factor, parietal cells and serum gastrin - as a starter?

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