Advice please following recent thyroid panel

Hi everyone, I am new here and would really appreciate some advice on recent blood tests. I have been on 200mg levothyroxine for many years (I was diagnosed 20 years ago as hypothyroid and confirmed as Hashimoto's in 2015) and in September 2016 my GP reduced the dose to 175mg as my TSH was 0.01. In a repeat TSH blood test 4 weeks ago he reduced it again to 100mg, for review in 8 weeks, this is when I went to Blue Horizon and commissioned a full Thyroid panel (details below). I am now symptomatic again with rapid weight gain (up a dress size!), dry skin, asthma, constantly exhausted and in pain. I have requested on the last 2 visits to be referred to a private endocrinologist but my GP has refused. Any advice before I go back to the GP this month would be greatly appreciated. (Normal range in brackets)

CRP - 2.40 (<5.0) mg/L

Ferritin - 52.6 (20 - 150) ug/L

Magnesium - 0.89 (0.6 - 1.0) mmol/L

TSH - L 0.01 (0.27 - 4.20) mIU/L

T4 - 132.3 (64.5 - 142.0) nmol/L

Total Free T4 - H 24.46 (12 - 22) pmol/L

Free T3 - 5.27 (3.1 - 6.8) pmol/L

Anti-Thyroidperoxidase abs - H 46.6 (<34) kIU/L

Anti-Thyroglobulin Abs - H 929.3 (<115) kU/L

Vitamin D (25 OH) - 55 (Deficient <25 Insufficient 25 - 50 Consider reducing dose >175) nmol/L

Vitamin B12 - 554 (Deficient <140 Insufficient 140 - 250 Consider reducing dose >725) pmol/L

Serum Folate - 10.70 (8.83 - 60.8 New Range) nmol/L

[Clutter]

Drapkins,

TSH is suppressed and FT4 mildly over range which is why your GP has reduced your dose from 200mcg to 175mcg. I suspect your GP is attempting to raise your TSH and that's why he has slashed your dose to 100mcg. I think this is an over reaction and likely to make you quite unwell. Dose is usually adjusted in 25mcg increments every 6-8 weeks. I think it might be worth you seeing another GP at the practice for a second opinion and for a referral letter to a private endocrinologist.

Some patients need FT4 oveer range to deliver decent FT3 levels. Read Treatment Options in thyroiduk.org.uk/tuk/about_... Email [e-mail] if you would like a copy of the Pulse article to show your GP.

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_...

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

B12 is good but folate is a bit low. I would supplement a B Complex vitamin to raise folate.

Ferritin is optimal half way through range to 100. Supplementing iron with 1,000mcg vitamin C to aid absorption and minimise constipation will raise ferritin. Take iron 4 hours away from Levothyroxine.

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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.

[Saggyuk]

Yes, I agree, see another GP as that is a massive drop in meds so obviously doesn't know what he's doing as small decreases can make a massive difference to labs and bring you back in range so should have dropped by 25 and then rechecked six weeks later and dropped again if necessary!

[diogenes Remembering]

I'm not diagnosing, but I see you have been on T4 with suppressed TSH probably for 20 years. After this long time your body has changed. It will be almost impossible to return to a detectable TSH without getting gross hypothyroid symptoms. My wife has been on 150 mcg T4 for nearly 50 years and in all that time and as of today her TSH is suppressed whether FT4 is in normal range or not. Our doctor once tried to reduce her T4 dose to 100 to see if the TSH became detectable. It did, but only just and certainly still in the "hyper" part of the range, and the hypo symptoms struck in a week. So back to 150, and the GP accepts that. The whole balance between body, T4 dose and pituitary response gets shifted permanently over time. Its called epigenetic adjustment. The response of the body's genes to FT3 stimulation has altered for good and no amount of fiddling around will return it completely.

[shaws]

Do you have blood tests at the very earliest possible, and fasting. Although you can drink water. Also allow a 24 hour gap between levo and the test and take it afterwards although Diogenes has explained clearly why the doctor should not have reduced your dose.

[Hidden]

Thanks Shaws, the last test was mid day and I would have taken the test after Levo and did not fast. I will remember now to do this for my next test later this month. Debs