Advice appreciated on Thyroid 24 hr urine results... low normal but under range for ratio

[hw7342]

My results are as follows:

24 hr Urine Genova Feb 2016

T4 2030 pmol (1030 - 8240)

T3 890 pmol (610 - 3380)

T3 : T4 ratio 0.44 (0.50 - 2.00)

Bloods via NHS Jan 2016

TPO Ab 63.8 KU/L (< 5.6 normal)

TSH 3.85 mU/L (0.35-5.00)

FT4 13.3 pmol/L (9-22)

FT3 4.4 pmol/L (2.6-5.7)

I am symptomatic of Hypo/Hashis with feeling fatigued, cold, brain fog, forgetful, joint pain and stiffness, nerve pain, nails break at slightest touch, infertility, mood swings for the last 6 years since my son was born. I have Oral Lichen planus, painful bladder and Dry Eye syndrome which all started within a year of each other 4 years ago. I also had preeclampsia with my first pregnancy which i have heard can be hypothyroid related. TPO antibodies were detected as high after my second miscarriage 3 years ago.

I was put on 25mcg of Levothyroxine in January 2016 for infertility and TSH above 2.5 (anything above 2.5 they consider bad for conception). However i decided to come off of this after only 2 weeks as i just felt so horrendous on it and all my symptoms got 100 times worse. I had planned to decide what to do (seeing someone privately?) after getting my above Genova urine results back but now they are largely in-range i am stumped. The only thing flagged up is the T3:T4 ratio being low. Taking everything into consideration i do feel that i have a T3 issue but don't want to waste money seeing someone privately if they are going to take one look at the results and not want to help. I am currently gluten free and supplementing with Selenium, Zinc, Magnesium, Iron, and liquid Vit D. Any advice greatly appreciated.... Do you think a reverse T3 test could shed any more light? Thank you.

[Clutter]

Hw7342, I haven't seen anyone able to interpret urine results on the forum and the articles I've read indicate urine thyroid testing is not a good indicator for hypothyroidism.

Jan results confirm antibodies are positive for autoimmune thyroid disease (Hashimoto's) which causes 90% of hypothyroidism. 100% gluten-free diet can help reduce Hashi symptoms and antibodies.

chriskresser.com/the-gluten...

thyroiduk.org.uk/tuk/about_...

hypothyroidmom.com is a good resource for Hashi/hypothyroid women planning pregnancy.

NICE recommend the TSH of women planning conception and newly pregnant should be in the low-normal range 0.4-2.0 with FT4 in the upper range.

cks.nice.org.uk/hypothyroid...

The only way to reduce TSH and raise FT4 and FT3 is to take replacement. Perhaps you could halve your 25mcg dose and take 12.5mcg for a week or two before increasing to 25mcg as introducing Levothyroxine a little slower and gentler may be more tolerable. If you can't tolerate Levothyroxine you could try Liothyronine (T3) or NDT but you will probably need private prescriptions or have to buy online without prescription as it's unlikely they'll be prescribed on NHS.

I think it is unlikely you will have high rT3 as you only took 25mcg Levothyroxine for two weeks and are unlikely to have built up unconverted levels of T4.

_______________________________________________________________________________

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.

[hw7342 in reply to Clutter]

Thanks for the reply Clutter. I'll do a bit more research into who might prescribe privately. And also online sourcing...

[Clutter in reply to hw7342]

Hw7342, what is it you want to source privately or online?

[hw7342 in reply to Clutter]

Hi Clutter thanks for replying to me above a month ago. Since then i have found out i am very low ferritin and anaemic so that is perhaps why i felt worse on the Levothyroxine? What do you think? At the beginning of this month (unmedicated) my TSH has gone back down to 2.19. But FT4 has dropped to 11pmol/L  and FT3 to 4 pmol/L.  My miscarriage gynae prescribing 25mcg of Levo (which i am not currently taking) won't up this dose so i don't feel comfortable giving it another go (once i get my ferritin up) until i can be sure that i can get hold of more Levothyroxine in case it being a low dose would make me worse. All they are concerned about is bringing TSH below 2.5. My TPO Ab are 63 so clearly my FT4 and FT3 lowering over the years might be an indication that my thyroid is getting less able to cope with things. I did want to have a reverse T3 test done at some point just to make sure that previous stress and dieting has not lead to RT3 being an additional problem although my cortisol testing was all fine. Should i wait until my iron is better in order to test RT3? Do you know any reliable online sources for T4 that you can pm me with when you have the time? I would also be willing to give T3 a go to relieve my symptoms but thought i need to get the iron up first?... Many thanks. I see you are very busy replying to lots of  people.

[Clutter in reply to hw7342]

Hw7342,

It's could be low iron made it difficult to tolerate the Levothyroxine but it may be that you needed to adjust to it..  It can take months to raise iron levels so you should start taking Levothyroxine which must be taken 4 hours away from iron.  You could start with 12.5mcg for a week or two before raising to 25mcg and this will raise your FT4 and reduce TSH and start improving your symptoms.  It's premature to consider increasing your dose until you see how your thyroid levels respond to 25mcg.

Positive TPOab (Hashimoto's) is why your thyroid is underperforming and reducing TSH and adopting gluten-free will slow progression.

High rT3 is usually caused when people are taking high-ish doses of Levothyroxine which isn't converting to T3.  It's not often someone not taking replacement will have a problem with rT3.  You can order rT3 tests from Genova and Blue Horizon via thyroiduk.org.uk/tuk/testin...

________________________________________________________

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.

[hw7342 in reply to Clutter]

Thank you for such a fast response Clutter. Would needing to adjust slower cause the extreme fatigue, cold and depression that i felt in the second week of taking the 25mcg? It was not anything like the hyper symptoms that some people report with adjustment problems. That's why i jumped to the conclusion it was too low a dose. I have a history of severe depression and i am just very nervous of the way it made me feel and would feel safer to have a back up plan. Maybe i have just got to bite the bullet though...

[Clutter in reply to hw7342]

Hw7342,

I doubt it, it's more likely your hypothyroid symptoms were worsening before the 25mcg started working.  People do sometimes feel worse when they first start taking Levothyroxine as their body begins to metabolise the hormone.  I only suggested starting lower for a week or two to see whether it felt more tolerable than when you were taking 25mcg.  It would be better to start 25mcg as soon as you can.  I'm afraid it is trial and error to see what suits but if you aren't taking 25mcg there's no point in considering buying higher doses.

_______________________________________________

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.

[hw7342 in reply to Clutter]

Okay. I know they generally say 6 is weeks to make a difference and my gp thinks at least 3 months before you should test again. How long do you think it takes? Kind regards 

[Clutter in reply to hw7342]

hw7342,

Up to six weeks to feel the full impact of a dose and some improvement in symtoms.

6-8 weeks after starting Levothyroxine or a dose adjustment to check levels and make further dose adjustments if required.

8-12 weeks for most bothersome symptoms to improve after optimally medicated but it can take a lot longer for some symptoms to resolve.

I'd been optimally medicated for more than 15 months before I stopped feeling cold to the core and then it was difficult to tolerate heat because I didn't sweat.  Started to perspire mildly when hot a year later.

[hw7342 in reply to Clutter]

Crikey okay well that is helpful thanks

[hw7342 in reply to Clutter]

Hi Clutter. These are my latest results after an increase 6.5 weeks ago to 75mcg levo. Do you think i am over medicated? My symptoms are still all the same at the moment but from your reply above i realise i need to be patient.

TSH 0.03 (0.27 - 4.20)

FT4 22.24 (12-22)

FT3 6.05 (3.1 - 6.8)

FERRITIN 28.2 (20-150)

Thank you

[Clutter in reply to hw7342]

Hw7342,

TSH is suppressed and FT4 mildly over range and FT3 is within range but I don't think you are biochemically over medicated.

Ferritin is very low, optimal would be 75-100. Supplement iron and take each tablet with 1,000mg vitamin C to aid absorption and minimise constipation. Take iron 4 hours away from Levothyroxine. Retest Ferritin in 4-6 months.

_______________________________________________

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.

[hw7342 in reply to Clutter]

thank you