Morning. Just had my second blood test results, testing for antibodies and have a level of 540 with an optimal range of <35
Dr. Says tsh at 4.1 (range <4.2) therefore is healthy and so t4 etc. wasn't tested.
Just wondered if anyone could enlighten me about what these antibodies levels mean going forward?
TIA
Further info, I'm on levothyroxine of 100mcg but had bloods taken early morning before taking my tablet.
With high antibody levels you have an Autoimmune Thyroid Disease called Hashimoto's.
Your doctor knows little, like many. The aim of taking levothyroxine is to bring your TSH to 1 or lower. Not near the top of the range.
This is an excerpt from an article in Pulse Online (doctors' magazine) and is by Dr Toft who was President of the British Thyroid Association and his advice is. His recommendation is a "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. Part of article below and if you want the whole email louise.roberts@thyroiduk.org.uk who wont be back till the New Year.
2 I often see patients who have an elevated TSH but normal T4. How should I be managing them?
The combination of a normal serum T4 and raised serum TSH is known as subclinical hypothyroidism. If measured, serum T3 will also be normal. Repeat the thyroid function tests in two or three months in case the abnormality represents a resolving thyroiditis.2
But if it persists then antibodies to thyroid peroxidase should be measured. If these are positive – indicative of underlying autoimmune thyroid disease – the patient should be considered to have the mildest form of hypothyroidism.
In the absence of symptoms some would simply recommend annual thyroid function tests until serum TSH is over 10mU/l or symptoms such as tiredness and weight gain develop. But a more pragmatic approach is to recognise that the thyroid failure is likely to become worse and try to nip things in the bud rather than risk loss to follow-up.
Treatment should be started with levothyroxine in a dose sufficient to restore serum TSH to the lower part of its reference range. Levothyroxine in a dose of 75-100µg daily will usually be enough.
If there are no thyroid peroxidase antibodies, levothyroxine should not be started unless serum TSH is consistently greater than 10mU/l. A serum TSH of less than 10mU/l in the absence of antithyroid peroxidase antibodies may simply be that patient’s normal TSH concentration.
2.6 What is the correct dose of thyroxine and is there any rationale for adding in tri-iodothyronine?
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).
Even while taking the slightly higher dose of levothyroxine a handful of patients continue to complain that a sense of wellbeing has not been restored. A trial of levothyroxine and tri-iodothyronine is not unreasonable. The dose of levothyroxine should be reduced by 50µg daily and tri iodothyronine in a dose of 10µg (half a tablet) daily added.
While taking both hormones it is important serum TSH is normal and not suppressed. If the patient is still dissatisfied it should be made clear that the symptoms have nothing to do with thyroid disease or its treatment and perhaps issues at home and in the workplace should be addressed.
I disagree completely with his last paragraph above.
Why Shaws? Wouldn't taking enough T4 and T3 to suppress TSH risk raising FT3 above range?
This is the part I disagree with:-
"If the patient is still dissatisfied it should be made clear that the symptoms have nothing to do with thyroid disease or its treatment and perhaps issues at home and in the workplace should be addressed".
Due to the fact that if we are on optimum hormones we should be symptom-free. Rumours abound in the profession about T3 which is the best hormone I've taken. Many members find NDT bes. For some the addition of T3 to T4 works best. The blood tests were introduced for T4 only, so if we add in other hormones the results cannot correlate.
This is how I prefer a doctor to treat me. I take T3 only, so you'd reckon I will have a near zero T4 (not taking any) and a high T3.I am feeling well.
plokmijnuby Raised antibodies mean that you are positive for autoimmune thyroid disease aka Hashimoto's. This is where the antibodies gradually destroy the thyroid. Hashi's isn't treated, it's the resulting hypothyroidism that is treated.
Unfortunately doctors don't seem to attach much importance to Hashi's but you can help yourself by doing what you can to reduce the antibody attacks. Many members have found that adopting a strict gluten free diet helps enormously. Supplementing with selenium L-selenomethionine 200mcg daily and keeping TSH suppressed are also supposed to help.
Some reading about Hashi's:
stopthethyroidmadness.com/h...
stopthethyroidmadness.com/h...
thyroiduk.org.uk/tuk/about_...
Gluten/thyroid connection:
chriskresser.com/the-gluten...
With your TSH at 4.1 being just 0.1 within the top of the range, you doctor doesn't seem to know much about thyroid, it's certainly not healthy! You need an increase in your Levo. The aim of a treated hypo patient 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 respective reference ranges.
Dr Toft, leading endocrinologist and past president of the British Thyroid Association, states in Pulse Online Magazine,
"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)."
You can email louise.roberts@thuroiduk.org.uk for a copy of the article to discuss with your GP.
Thank you for these extracts. I will do some research and take a few to my doctor at our next discussion. She's kept me on 100mcg going forward with next test in 6 months.
I am keen to nip any symptoms or further automimmune issues in the bud in advance (despite having no obvious symptoms currently) so do you recommend trying an elimination diet or strictly cutting out gluten?
Also should I be seeking any further tests?
I would just go strictly gluten free. Gluten contains gliadin which is a protein thought to trigger antibody attacks so eliminating it completely is a good idea. The selenium supplement is always good for hypothyroidism, whatever the cause. Not only does it help reduce antibodies it also helps with conversion of T4 to T3.
Some people also find they need to be dairy free but I would see how you go with being gluten free first.
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