Changed TSH level prior to NDT

[lopushanya]

Could anyone help me understand my results please.

I have posted my results here before. ..

in September blood tests showed TSH 6.08 (0.34 - 5.60), T4 9.3 (7.9 - 20.0), T3 5.4 (3.8 -6.0).

I have had a lot of hypo symptoms for years, although bloods were borderline.

My ferritin is low - 9 and I have been taking iron supplements for 2 weeks now.

endocrinologist wanted to start me on 50 mg of Levo, but I managed to get a private prescription for half a grain of NDT - and have been taking that for a week.

Prior to starting NDT I was unwell with sore throat and severe depression and was signed off by GP for 2 weeks. During my appointment I asked for blood test to check for Vit B and other minerals - which came back as normal. I didn't realise GP asked for thyroid check as well.

As results came normal GP asked me not to start thyroxine, but I already started on it and not sure what to do. The blood test was done a day before I took my first NDT.

TSH 3.64

T4 11.5

T3 4.6

I can not understand the reason for results to become normal. Could it be down to taking iron?

Should I keep taking NDT and get blood test in 6 weeks?

Many thanks,

Helen.

[humanbean]

There are lots of reasons for TSH to fluctuate, but the two most likely to change your results are :

1) There is a circadian rhythm to the production of TSH. It is at its lowest in the afternoon and at its highest during the night. If your blood tests were done at different times of day then this could be one explanation.

2) If you have Hashimoto's : en.wikipedia.org/wiki/Hashi...

then you have antibodies that are attacking your thyroid. The levels of antibodies fluctuate over time and can cause big swings in thyroid hormone levels.

Can you remember what time of day your blood tests were done? Had you eaten before the tests?

People on this forum are recommended to always, always, always get thyroid tests done under the following conditions :

a) Arrange the blood draw as early in the morning as possible - by 9am at the very latest, the earlier the better.

b) Fast overnight and before the blood draw. Don't eat or drink anything except water. Drink a reasonable amount of water - dehydration and over-hydration should be avoided.

c) Don't take your thyroid medication for 24 hours before the blood draw. Instead, take it immediately after the blood is taken.

[lopushanya in reply to humanbean]

Hi humanbean

Thank you for your reply.

I don't know if I have Hashimoto's - how can this be tested for?

I had a blood test late morning, I would have had breakfast but didn't take thyroid medication, as NDT arrived next day. I have never been on thyroid medication before.

I will find out the ranges for Vit B.

Thanks,

Helen.

[humanbean in reply to lopushanya]

To test for Hashimoto's you would need to be tested for thyroid antibodies. There are three different kinds, and for someone who is hypothyroid (or tending that way), the NHS would usually test just one - TPOAb.

See the table on this page for an explanation of the different types :

labtestsonline.org.uk/under...

NHS testing is often inadequate though. People who have Hashimoto's could get a positive result on TPOAb, TgAb, or both. If only TPOAb is tested then some cases of Hshimoto's are missed.

The NHS is also often reluctant to test for antibodies at all. Hashi's is the cause of 90% of cases of hypothyroidism in the UK, and the treatment is the same whether or not antibodies are positive.

The difference for sufferers is that antibodies attack the thyroid. As the cells of the thyroid are killed off by the attack they release any thyroid hormone they contain into the body/bloodstream. As the thyroid hormone levels rise, TSH drops. This could mean that you drop out of being hypothyroid and back into the normal range (at least as far as the doctor and the blood tests are concerned). In fact, Hashi's can make results bounce around a lot as levels of antibodies fluctuate. All the time this is going on the patient feels dreadful.

Destruction of the thyroid by antibody attack can take years, even decades. It doesn't happen overnight. Eventually there is too little thyroid left to produce thyroid hormone at normal levels and the person becomes permanently hypothyroid. In the meantime the patient has been told for years that they are fine, and perhaps they might benefit from some anti-depressants, or to be treated for anxiety.

Many people with thyroid problems find that a 100% gluten-free diet helps to damp down antibody attacks, and helps them to feel better. It gives more stability in thyroid function tests as well, which is better for the patient. Bear in mind that doctors are not interested in Hashi's and don't treat it. They only care about the hypothyroidism it induces years down the line - and the longer they can fob you off the happier they are.

[humanbean]

Don't take a GP's word for it that your blood tests are "normal". Ask for copies of the results, including the numbers and reference ranges.

The kind of thing that happens is :

Vitamin B12 result = 201, reference range is 200 - 1000. Many doctors would say such a result was normal because it is within the reference range. But most people feel at their best when B12 is right at the top of the reference range.

Similar things happen with other nutrient blood tests. If the result is within the reference range it is declared "normal". Different nutrients have different optimal levels - don't assume that top of the range is best for everything, it just happens to be the case for vitamin B12.

[greygoose]

Actually, 3.64 for TSH is not normal. Even though it is in range, the ranges are unrealistic. A lot of people would have symptoms at 3.64.

At 2.0, it's obvious that your thyroid is struggling. At 3.0, you are openly hypothyroid, and in a lot of countries you would be treated at 3.0. It's only the sadists in the NSH that insists you keep on suffering until your TSH reaches 10.

And it's not just the TSH that has gone down, it's also the FT4 and the FT3. That smells very much like Hashi's to me. The thing with knowing you have Hashi's, even though the treatment is the same, is that you know what to expect. You know that it's going to get worse unless you find a way to lower the antibodies - and you can't count on doctors for that! You know to keep your TSH suppressed. And you know to try gluten-free/dairy-free/sugar-free diets and selenium to see if they help. Your doctor won't tell you that.

You also know that you might have difficulty converting, and that NDT might possibly not work for you. None of these things might be true, but you're aware that they can be, so you're prepared for them. Whereas your doctor will be totally at sea!

If I were you, I would continue with the NDT, because you are still hypo, despite the change in labs. And then get tested in 6 weeks, as you said, to see where you are. But, also be aware that your doctor knows nothing about thyroid!

Take care.

[lopushanya in reply to greygoose]

Hi greygoose

You have given me so much to think about !

I will carry in with NDT, at least my low mood has lifted, I couldn't carry on the same way.

Best wishes and Happy New Year x

[greygoose in reply to lopushanya]

You're welcome. And a very Happy New Year to you, too.

[shaws]

Personally I would take the NDT. A TSH of 3.4 is not 'normal' when you have clinical symptoms. A trial of NDT will not do any harm but you must go gradually. That's how they used to treat people before the blood tests were introduced along with clinical symptoms. What they mean is that your TSH is within 'the range' which is classed as 'normal' if you've never been diagnosed whilstt ignoring clinical symptoms.

Maybe this will help you understand a little as it takes a lot of reading to try to help ourselves.

thyroiduk.org.uk/tuk/testin...

You don't wait too long on a dose, 1/2 grain is around 50mcg of levo so you should increase by another 1/2 in two weeks time and so on until you feel much better. Always take pulse/temp several times a day as a guide.

"I am not a medical professional and this information is not intended to be a substitute for medical guidance from your own doctor. Please check with your personal physician before applying any of these suggestions"

[lopushanya in reply to shaws]

Thank you shaws

It's difficult to know if i need to increase the dose, as I have never taken any thyroid medication before. Symptoms are improving slowly.

Thank you.

Happy New Year to you.

Helen.

[shaws in reply to lopushanya]

The usual, if taking NDT is to begin a low dose for 2 weeks and then increase every 2 week with either 1/4 or 1/2 grain until you feel your health is back to normal.

If we stay on a low dose a bit too long we can have a rebound effect in which we might feel worse.