I have managed to secure a meeting with an endocronologist and just need some advice on what questions to ask. I'm doing ok (ish) on levo 75g a day. Still have some fatigue, night sweats and muscle aches. I want to know what to ask about my conversation rate and my antibodies. My last test results - July 2016 are as follows. Many thanks for your help.
T4 total 99.3 (range 64.5-142)
Free T4 18.87 (range 12-22)
Free T3 4.72 (range 3.1 - 6.8
TSH 1.61 (range 0.27-4.2)
Anti-Thyroidperoxidase abs 291.3 (<34)
Anti-Thyroglobulin abs 381.4 (<115)
My GP has said not to worry about the antibodies as 'we all have them' and I should 'just get out and exercise' if I am worried about energy and weight (I just smiled..)
I just want to be sure that I am doing all I can to be in the best of (my) health. Many thanks
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Mantras131
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Oh good grief Mantras131 , another GP that knows diddly squat about Hashimoto's!
You were given information by Radd about Hashi's and what to do in a previous post so follow that advice. Your endo may or may not know anything about gluten free and selenium helping.
In a treated hypo patient the aim is for TSH to be 1 or below or wherever it is needed for FT4 and FT3 to be in the upper part of their ranges and the patient to feel well and symptoms alleviated.
Generally it's thought that FT4 should be in the upper third and FT3 in the upper quarter. Your FT4 is 68.7% through it's range so just about in the upper third. Your FT3 is 43.7% through it's range so a fair way off the upper quarter. Considering you still have some symptoms then an increase in meds could be given, especially as your TSH is 1.61.
Dr Toft, past president of the British Thyroid Association and leading endocrinologist, wrote in a Pulse Online magazine article:
"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.
In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance.
But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.
This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."
If you email louise.roberts@thyroiduk.org.uk she will let you have a copy of the article which you can print out and discuss with your endo.
Be prepared for the endo to not agree with this thinking and to tell you that all your results are fine, in which case you'll need to fight your corner and you should concentrate on emphasising your symptoms and for the need for them to improve rather than treat a set of numbers.
If all your vitamins and minerals are at their optimal levels - and you were advised about this in a previous post - then that gives the best chance of thyroid hormone working properly and good conversion taking place. If they're not yet at their optimal levels then supplement and get them there. Once they're optimal if your FT3 remains lower than your FT4 and you're still symptomatic then there's reason to add some T3 to your Levo.
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