New results and pondering next step

[wellness1]

Hello, I'm new(ish) here and want to start by saying thank you. I have learnt so much

from this knowledgable and supportive community. I am posting recent results from the first test I did following guidelines I discovered here, i.e., early morning, fasting, 24 hours since last dose.

I know that I am undermedicated. Six days ago I increased from 75 to 100 mcg of Levo. It has taken me a while to get to this dosage, because sometimes I feel worse when I up my dose and that's the case now. Reading posts here made me realise

it can be a temporary reaction, so I shall persevere and see how I get on.

I am considering further testing (adrenals, sex hormes, genetic testing), further

lifestyle interventions, and additional vitamins. I have been GF for 3 months (no improvement yet). Perhaps I have not yet reached the correct dose of Levo. But maybe I need to explore T3 or NDT. Does anything in my results suggest a particular course of action? If I look into alternatives, do my labs point toward either T3 or NDT?

PATIENT RESULTS NORMAL RANGE UNITS

TSH 5.37 0.27 - 4.20 IU/L

T4 Total 83.7 64.5 - 142.0 nmol/L

Free T4 13.59 12 - 22 pmol/L

Free T3 3.32 3.1 - 6.8 pmol/L

Anti-thyroidperoxidase abs 170.6 <34 klU/L

Anti-thyroglobulin abs 438.4 <115 kU/L

CRP 4.9 <5.0 mg/L

Ferritin 140.5 20-150 ug/L

Serum Folate 17.19 8.83-60.8 nmol/L

Vitamin D (25 OH) 60 Deficient <25 nmol/L

Insufficient 25-50

Consider reducing dose >175

Vitamin B12 267 Deficient <140 pmol/L

Insufficient 140-250

Consider reducing dose >725

[wellness1]

Wow, not sure what happened with the spacing. Sorry about that. This may be easier to read:

TSH 5.37 (0.27-4.20)

T4 Total 83.7 (64.5-142.0)

Free T4 13.59 (12-22)

Free T3 3.32 (3.1-6.8)

Anti-Thyroidperoxidase abs 170.6 (<34)

Anti-Thyroglobulin abs 438.4 (<115)

CRP 4.9 (<5.0)

Ferritin 140.5 (20-150)

Serum Folate 17.19 (8.83-60.8)

Vitamin D (25 OH) 60 Deficient <25

Insufficient 25-50

Consider reducing dose >175

Vitamin B12 267 Deficient <140

Insufficient 140-250

Consider reducing dose >725

[Hidden in reply to wellness1]

As you say, undertreated. B12, take to 500, unless you have PA in the family, in which case get tests before supplementing. Ferritin quite high, you may have some inflammation going on. Until your thyroid medication is optimal you won't know if there is anything else going on.

You must be feeling v tired.

[wellness1 in reply to Hidden]

Thank you, Hidden . Very tired, indeed. It is definitely affecting my quality of life. I know many here are also experiencing this.

"Until your thyroid medication is optimal" Yes, this is my quandry, how long do I persevere with T4 monotherapy before trying another approach. I suppose this is something everyone must decide for themselves in consultation with their health care provider. But I simply wondered if there was anything in the labs that would suggest I should try T3 or NDT.

For example, if there was a sign that I wasn't converting properly, then I would consider changing my approach. But my FT3 and FT4 seem comparably low within their respective ranges. Perhaps someone like greygoose who has a lot of experience with this, could have a look?

I am pursuing the B12 issue. Thank you Clutter for the methylcobalamin recommendation.

[Hidden in reply to wellness1]

I'm no expert on uptake. But you are so undertreated on levo, I personally would wait till I got the TSH at or under 1 before I began to evaluate what symptoms remained, and what to explore next.

We are most of us trapped in the Minotaur's maze, going round in the dark with a monster we can't identify or describe. What makes it worse is our exhaustion, and weakness, and inability to think straight.

On B12, there is a big overlap between Hashis and Autoimmune Gastritis. Supplementing b12 destroys the ability to test for most indicators of AIG. Nevertheless, it is rational to supplement, so long as you don't have pins and needles, slow reflexes etc, until you get to an optimal levo dose. If you still have symptoms, you can then drop all b12, my guess is for about 3 months, and start the AIG tests.

We have to test ourselves, trial and observe our own reactions, because both AIT and AIG are chronic conditions on which little is spent on research, both are mysterious, amorphic conditions so far as science is concerned.

See you down there at a curve of the maze.

[wellness1 in reply to Hidden]

What a perfect metaphor for what seems to be a labyrinthine process! I am keen to understand the underlying cause of my Hashimoto's and have read a bit about H. pylori, but haven't really given much thought to AIG. Thanks also for the recommendation of persevering with Levo until my TSH is at or under 1. Very helpful reply. Cheers, Hidden

[Marz in reply to wellness1]

I expect you are aware of the on-line summit currently running - Betrayal - hosted by Dr Tom O'Bryan. Discussing auto-immunity running over 7 days.

Dr Izabella Wentz wrote the book - Hashimotos The Root Cause. Her website and Newsletters keep us up to speed .....

[wellness1 in reply to Marz]

Thanks, Marz . I have read The Root Cause -- invaluable! I also listened to her webinar. I have not had a chance to check out Betrayal. Thanks for mentioning it.

[Clutter]

Wellness1,

TSH is high and FT4 and FT3 are low in range. The 25mcg dose increase will help but you should retest in 6-8 weeks in case a further increase is required.

The goal of Levothyroxine is to restore the patient to euthyroid status. For most patients that will be when TSH is 1.0 or lower with FT4 in the upper range. FT4 needs to be in the upper range in order that sufficient T3 is converted. Read Treatment Options in thyroiduk.org.uk/tuk/about_...

Thyroid antibodies are positive for autoimmune thyroid disease (Hashimoto's). There is no cure for Hashimoto's which causes 90% of hypothyroidism. Treatment is for the low thyroid levels it causes. Many people have found that 100% gluten-free diet is helpful in reducing Hashi flares, symptoms and eventually antibodies.

chriskresser.com/the-gluten...

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

CRP is an inflammation marker. Yours is high which may be due to high antibodies and TSH.

Ferritin is high in range. If you are not supplementing this is also an indication of inflammation or infection.

Vitamin D is optimal around 100. I would supplement 5,000iu D3 for 2 months and then reduce to 5,000iu alternate days and retest in May. Take vitD 4 hours away from Levothyroxine.

B12 is low and there can be deficiency <500. I would supplement 1,000mcg methylcobalamin with a B Complex vitamin. Folate is good.

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