Lab Results for Hypothyroidism

Hi. Today I had my TSH, T4 and T3 checked and would like some advise on how to proceed. I'll note the more important lab tests but fair to say I definitely have had hypothyroid symptoms for a long time if not my whole life, though the situation worsened in late 2008 - early 2009 when I gained 70 pounds and had worse muscle weakness, digestion and other problems. I also have weak hands and boy it's hard to take quick notes in class. I should note that I was recently Vitamin D deficient and also had borderline low B12 which I have both supplemented to optimal levels in the past few months. With my calculations the T3 has gone from borderline bottom of range to low-normal, with T4 gone from bottom third to almost crossing below the range. But if this is the best it'll be with rest of numbers alright that too at this age of 26 then life will suck alright.

B12

June 2014 - 457 (156 - 698)

Aug 2016 - 166 (153 - 655) (self-supplemented from here)

Dec 2016 - 1476 (153-655) (decreased supplements since)

*will ask for blood tests for intrinsic factor, gastric parietal cells, homocysteine, and folate

Vitamin D

Aug 2016 < 20 (75 - 150)

Dec 2016 133 (75 - 150)

TSH

July 2013 5.30 (0.30 - 5.50)

March 2014 4.20 (0.30 - 5.50)

- started Erfa

Aug 2014 0.02 (0.30 - 5.50)

June 2016 < 0.01 (0.30 - 5.50)

* after paranoia of ineffectiveness or rather not being cured, I'm a perfectionist, I went off the meds prematurely though not as good results were likely due to vitamin deficiencies and dose

July 2016 2.40 (0.30 - 5.50)

Aug 2016 3.35 (0.32 - 5.04)

Sept 2016 2.37 (0.30 - 5.50)

Jan 2017 2.57 (0.32 - 5.04)

Free T4

April 2014 15 (11 - 22)

Aug 2014 17 (11 - 22)

June 2016 15 (11 - 22)

*went off meds

Aug 2016 15 (11 - 22)

Jan 2017 11.7 (10.6 - 19.7)

Free T3

April 2014 4.9 (4.0 - 7.8)

Aug 2014 6.2 (4.0 - 7.8)

June 2016 5.2 (4.0 - 7.8)

*went off meds

Aug 2016 3.9 (4.0 - 7.8)

Jan 2017 4.07 (3.0 - 5.9)

TPOab

Aug 2014 11 (< 35)

Aug 2016 16 (< 35)

AM Cortisol

Dec 2016 337 (125 - 536) *can't afford the more extensive saliva test

Ferritin

Aug 2016 120 (24 - 444) (according to STTM this is a good number)

Testosterone

Aug 2016 16.5 (8.4 - 28.8)

Still need to ask for a TGab but it may be the case I don't have Hashimotos. If I have subclinical hypothyroidism it must be genetic, gene mutation. Can't think of any other cause but it will be tough to convince my doctor to refer me to the endo. Rather that may be easy but last time the endo rejected the referral. I can't afford seeing naturopaths in the long-term. The doctor will tell me to exercise and eat healthy again and I will try that, though I don't see the correlation between obesity and low range of T4 and T3.

Anyways I would appreciate your guys' advise. So far I plan to compile scientific research that supports trying out low dose of thyroid hormones for subclinical hypothyroidism.

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  • From a South Korean scientific article:

    "Mild increases in serum TSH concentration in obese people are usually associated with serum T3 concentrations at the upper limit of the normal range. The latter may be due to increased de-iodinase activity, which acts as a compensatory mechanism during fat accumulation to increase energy expenditure. This altered thyroid hormone pattern can be reversed by weight loss."

    I've read the same in many other scientific articles. One problem dear doctor, despite being obese my T3 has not elevated but rather has decreased, making it even more difficult to lose weight! I have come across something called euthyroid sick syndrome, where T3 and T4 are low while TSH is normal and in my case could be slightly elevated from the obesity. It is all very confusing to me, the depression and anxiety has gone through the roof over the past 5 years though I am trying my best to not give up.

  • It's low T3 that causes obesity, not high. Low T3 causes all the hypo symptoms.

    Euthyroid sick syndrome is where the T3 is a good level (not low) in the blood, but isn't getting into the cells. If you have 'normal' TSH (around one) and low Frees, it is secondary or tertiary hypo, where there is a problem with the pituitary or the hypothalamus. But you don't have that, because your TSH went up as high as 5.30. You just have common or garden hypothyroidism, by the look of it. But, you can't really rule out Hashi's on just two negative TPOabs.

    So, are you still not taking any thyroid hormone replacement? Why so? Why did you stop it? Thyroid hormone replacement is for life, you don't just stop it when your TSH drops to somewhere in range. Last August, your FT3 went right down to below range, and it still isn't quite mid-range, so no wonder you have symptoms. Most people need it up near the top of the range to feel well. Your TSH is now 4.07, which is hypo, so you really do need to get back on the Erfa, fast. :(

  • What I was noting was that obesity that is not a cause of hypothyroidism results in elevated T3, so it was insulting when the doctor told me to exercise more when my T3 is instead low.

    Can you please elaborate what you mean by common or garden hypothyroidism? Is that like mild congenital thyroid deficiency? Also, as I was paranoid of not being cured after on 120 ERFA for 2 years, in the 2 years never saw a doctor just kept renewing my prescription lol I was very anxious/depressed to be serious about my health, I went off of it as the doctor instructed. Of course my B12/Vitamin D was low/deficient too in that time it seems though now they're fine.

    I don't think he will let me back on the ERFA now. I was thinking of gathering scientific evidence of subclinical hypothyroidism so he can make request to the endo again. In the long-term naturopaths and dessicated thyroid is expensive. Affordable but more expensive than an endo prescribing T4 and if needed add T3. I need to think about this for sure.

    Btw I had stopped the meds because after 2 years on it my my T4 was only 15 (11-22), same as before I went on them, dropping from the 17 when I first went on them. The T3 was 5.2 (4.0 - 7.8), slightly above the 4.9 before I was on it two years ago, and dropped from the 6.2 when I first went on it. So I was confused if there was even any progress. :(

    Right now my TSH is actually 2.57 (0.32 - 5.04), T3 is 4.07 (3.0 - 5.9), and T4 is 11.7 (10.6 - 19.7). Perhaps it's the perfectionism, I'm confused if the problem is the thyroid or something else. One hand I think it is, other hand I wouldn't want to go on it if it isn't. Would greatly appreciate your further advise though friend!

  • Sorry, I still don’t understand what you mean about obesity. Obesity never causes hypo, I don’t think. But, doctors never accept that our extra weight is due to being hypo, and almost always insult us with their talk of eating less and exercising more – when most of the time, that is the worst thing we could do!

    I suppose that, rather than ‘common or garden hypo’, I should have said ‘hypo of unknown causes’. You don’t have secondary or tertiary hypo, and you don’t have euthyroid sick syndrome, and there’s no proof of Hashi’s, so we just don’t know why you are hypo. It wasn’t meant to be derogatory. But, whatever the cause, it’s very doubtful that it can ever be cured. Thyroid hormone replacement is almost always for life. Erfa doesn’t treat the thyroid gland and cure it, it just replaces the hormone the gland can no-longer make. Paranoia, depression and anxiety are all symptoms of low T3.

    What sort of scientific evidence are you looking for? Doctors rarely read that sort of thing, anyway. Not many have open minds.

    It’s not surprising that your FT4 never got any higher – and, actually, that is quite high for someone taking T3. When you are taking any form of T3, your FT4 is usually low – sometimes below range – and TSH suppressed. That your TSH never got suppressed, or even very low, suggests that you never took enough Erfa. Also, your FT3 never got very high, so you really did need an increase in dose, rather than stopping the Erfa altogether. There won’t be any progress if you don’t take enough.

    So, right now, your TSH is suggesting that your gland is struggling to make enough hormone to satisfy your pituitary. Your FT4 is very low, and your FT3 is still under mid-range. And all this fluctuation in results dose rather point to Hashi’s. It would be a very good idea to get your TgAB tested, because that could be high. But, it is possible to have Hashi’s without ever having high antibodies. People like that are diagnosed by and ultra-sound scan. Have you had one of those?

    What ‘else’ do you think could be causing your elevated TSH, low Frees and symptoms? Are you on a draconian diet? Have you had a raging virus for the last few years? It’s very unlikely that there could be ‘anything else’, except a failing thyroid. Your nutrients are now optimal, But, even if they were low, they might account for bad conversion, and therefore low T3 and high TSH, but they wouldn’t cause low T4, as far as I know. So, I really think it has to be your thyroid gland itself that is at fault, don’t you?

  • Thank you for the response friend! What I meant firstly was that those who are obese without hypothyroidism have elevated T3, but can easily lose weight with right diet/exercise. Mine is definitely opposite, low T3, in fact two years for around 6 months I went on a paleo diet and did moderate exercise, and gained weight! Then I went on the meds and expected a miracle and became more pessimistic after.

    There is plenty of peer reviewed scientific evidence that subclinical hypothyroidism should be evaluated on an individual basis, taking account of history and symptoms, with trial dosages. But yes it's true most doctors won't spend that time with the patient. Because more patients they see more money they get! I guess even if I got lucky the doc would be very conservative in raising doses to optimal levels anyways.

    Tbh I was becoming paranoid reading about euthyroid sickness syndrome, it's reassuring I don't have it. I was always running out of breath quicker while running as a kid in my teens, even with healthier weight (slight skinny fat). Was always physically weaker than other kids though, despite getting a black belt in karate and exercise.

    No I've never had an ultrasound for the thyroid at all. I will ask for that, along with the TGab. I have had a bad diet for years, going for one or two meals a day, so I suspected my body went into starvation mode. I also had serious bout of tonsillitis 3 years ago, which is why I went to have my thyroid checked in first place. Have had flare ups here n there since and a disgusting pitted enlarged tonsil ever since. I've gotten paranoid of having lymphoma though ENT specialist said it was fine. Bouts of ulcers since a kid though, that lessened only for reoccuring tonsillitis to take its place lol. I guess I'm just afraid of having to take thyroid hormones my whole life man.

  • Another thing to add. I have tested positive with an allergy to dust mites and tree pollen. So my IGE is always through the roof when tested. But I've probably had that my whole life and things turn a big turn (worsening the slight low metabolism I had my whole life) when I was 18-19, gaining 70 pounds, digestive problems, and the rest.

  • Well, I don’t know where you get that information. I very much doubt that people who have obesity without hypothyroidism have elevated T3. I don’t know that studies have ever been done to verify their levels of T3. But, anyway, that is totally irrelevant. And you would have put on weight when exercising, because exercise uses up your T3, leaving you more hypo.

    You’re right about doctors! I don’t know where you live, but in the UK, they have been taught that you shouldn’t treat hypo until the TSH is 10, and anything else is subclinical. However, the true definition of subclinical, is ‘without symptoms’. You have symptoms, and are therefore not subclinical. You are overtly hypo when the TSH hits 3. But doctors just don’t know that/won’t accept it.

    As to the reluctance to raise doses, the problem is that they are terrified of a suppressed TSH, and it’s very difficult to get round that. That is why so many of us self-treat.

    Your body wouldn’t necessarily go into starvation mode, just because you were only eating two meals a day. Lots of people only eat two meals a day. But, it depends on the size of the meal.

    But, it does sound like you’ve been hypo for a long, long time. Hypothyroidism can also cause allergies. And symptoms precede blood test anomalies by quite a long time. You’ve probably been hypo your whole life – or at least a good part of it.

    Having to take thyroid hormone replacement for life, is nothing to be afraid of. What is it that scares you? I think you’re going to have to get used to the idea, though, because hypothyroidism doesn’t just go away.

  • I'm here in Canada where the range is usually 5 or 5.50 top depending on the lab. When I was 5.30 with range of 0.30 - 5.50 3 years ago the bastard should've treated me, instead said just lose weight. I've lost years of my life and lots of money too.

    Yeah I think it's probably best I use my GP for regular tests and ask either see a naturopath to get the meds again or ask GP to give me my old meds again. I don't even know if I should start low or start with 120ERFA again.

    Another thing I didn't mention. My liver tests have been fluctuating above range to top quarter quadrant range for years. And I never exactly drank as much as what you can consider an alcoholic; in fact the result changes did not correspond with me drinking more or less, it was quite random. Also, maybe it was a coincidence but worsening metabolism (70 pounds in less than half year) was when I started smoking cigarettes.

    Lastly, I know I have ADHD and always had it even as a kid though I had very sharp memory and very quick mind. My dad age 61 also has ADHD though doesn't seem like he's had hypo symptoms (last year his TSH was 0.65). Brother has ADHD too. I need to get on ADHD meds soon for school and life in general and am in waiting line for psychiatrist. I have noticed a sharp drop in my memory and reaction time though in class. Anywho what scares me is the perfectionism, the money for all these supplements, is it ADHD or only thyroid, etc. I should calm down and take it one step at a time eh.

  • I think that when you get back on thyroid hormone replacement, a lot of things are going to improve for you. I have read that ADHD isn't even a real thing, just another bid by psychiatrist to take complete control of human emotions and make them all into 'diseases', for which - of course - there is always a pill!

    Your dad could still be hypo, even with a decent TSH level, because the TSH is a very bad indicator of thyroid status.

    Yes, the best thing you could possibly do is calm down and take it one step at a time. :)

  • I think greygoose has a good point with this.

  • Since being diagnosed as Hypo I have made a number of changes to my eating habits, I now eat my main meal of the day at midday, in the evening I have a salad. It is my understanding that an underactive thyroid means a sluggish metabolism so my thinking is, eating my main meal gives my body more time to metabolise the food during the hours of activity .

    Perhaps just watching what I eat explains the improvement in the way I feel however, my weight is reducing, I don't feel hungry and I sleep very much better.

    My next bloods are at the end on the month lets see what the increase to 50 mcg has done to my numbers

    Before I retired I had a sedentary job, the weight just crept up on me. One thing I have noticed is, in the few years before I retired and before I started taking Levo I used to suffer from Gout in my the joints of my big toes, since taking Levo I haven't had a single attack again I suppose this is down to the sluggish metabolism and the Uric acid.

  • Hypo doesn't get on well with perfectionism. They are both too exhausting conditions. Ease up on yourself hard though it is, get back on meds and stabilise them and stay on them! When you are stabilised you will be in a better position mentally to cope with your perfectionism. I had quite extreme OCD but I have managed to "let go" and have a more manageable level now. My best wishes to you.

  • Thank you. Ever since 3 years ago that I had tonsillitis and then did tests and self-diagnosed with hypothyroidism only to give up and not follow up with the meds I've had hypochondria. In fact I've had either panic attacks or temporal lobe epilepsy events while on marijuana (which I've now quit but used to cope with my ADHD for years) where I thought I was dying and I only had few years to live. Even went to hospital around 8 months ago. Scary I know. Reminds me, I need to get the t-lobe checked too. I just get so anxious in the doctor's office, anxious of being called crazy.

  • Being optimally medicated could very well calm some of your anxiety issues. I hope so. Anxiety is a hypo symptom and those sufferers may not look typical hypothyrodic. Those who physically look typical may escape some of the extreme anxiety symptoms. Getting yourself medicated again will put you in a better position to see the woods from the trees! Many people suffer going to the GP, white coat syndrome comes to mind when blood pressure raises even in healthy people. Don't let anxiety put you off dealing with important issues. I always think "10 minutes from now this appointment will be over and I can go and have a cup of tea!"

  • You may be best on t3 only then if your t4 levels remained low for such a long time. You need to try and get t3 towards the top of the range. You will just get really ill stopping all meds altogether though.

  • I wonder if youve been tested for coeliac disease? You need to be eating a good bit of gluten for the antibodies to be present though. Please dont cut it out before getting tested as if you did have a problem with gluten having to reintroduce it to be tested will make you much more poorly than it did before. (Sadly my gp didnt know this so i cut gluten out and my test was negative, they later asked me to eat gluten again for 6 wks- no way im now ill for days with just a crumb!!)

    So the reason im saying this is a because you had low vit levels and despite tests may hve hashimotos. My hashi tests were negative too but i was already gf for years when they tested them so i dnt know if that wld affect results.

    I had a thyroidectomy 2 yrs ago so was plunged into hypo land. Strangely i recognised some of the symptoms from before i went gluten free. On first gojng gf i felt so much better and slowly lost 3 stone without dieting. Just prior to my tt i was feeling hypo again and putting on weight but as i always hve low tsh was never listened to by docs, now i hve no thyroid they hve to listen a bit more!

    Keep fighting the good fight, information is key, im sure you will find the answer for you eventually x

  • I tested negative for celiac disease, and I eat gluten regularly. I didn't see much improve in losing weight when I was gf for a few months a couple years ago, on a very strict diet. I have noticed my body can't digest lactose, eggs (not allergic but sensitive, diarrhea symptoms), and oats or something else in those cereals. But body can digest wheat and gluten products fine.

  • If you are intolerant to any food then don't eat it.

    If you do you are actually inhibiting your absorption of nutrients from the other food you are eating at the same time due to having diarrhoea.

    Doctors are rude about listening to people with intolerances even if some of their more specialised off-duty colleagues have noted it in an individual in multiple social situations.

    Also if you check ingredients for foods like cereals you will notice lots have lactose, milk or eggs in them. I'm aware your good labelling isn't as strict as in the EU where manufacturers have to write in bold common allergens in their products regardless of the chemical name used in the ingredients list.

  • I always avoid egg and oats, and most cereals. I drink lactose free milk and will enjoy other dairy products here n there but do notice when too much dairy affects the system so I try to limit that. I'm assuming the low digestive enzymes are at play here.

  • Many people get more lactose intolerant as they get older as we, as a human species, simply don't need to get our nutrients from dairy products once we are no longer children so the amount of lactase we have reduces. It's evolutionary* but modern diets don't help as they destroy the diverse range of healthy gut flora. So regardless of whether you sort out your gut flora or not, you will find you will never be able to consume the same amount of dairy products you consumed as before.

    Also be wary of lactose free milk, cream and cheese if it's the type where the lactose is removed or an enzyme is added to aid your absorption, I know personally a lot of people who have issues if they consume too much in a day. "Too much" varies by individual. Plant based milks, cream and cheese don't have the same issues.

    In regards to the oats you probably have an intolerance to avenin or another protein it. Again this won't go away and is confused with gluten intolerance simply due to the fact grains are frequently cross contamined with each other.

    *There are obvious exceptions but these groups of people diets is something like 80-95% meat, milk and blood/fish.

  • i would srart back at square one

    your ferritin is too low it like b12 ,vitd3 and folate should all always be at least halfway in their ranges to raise ferritin effectively eat liver at least once a week

    as suggested you may well be coeliac or gluten intolerant

    you may be taking rubbish like omerprazole

    you may be cooking with aluminium or non stick coated cookware or foil use only cast iron or stainless steel or glass

    what you think is a good diet very likely is not

    it takes at least a year on an adequate dose of NDT to heal damaged tissues and get t3 levels in the upper level of its range

    i wonder if you have thyroid hormone resistance

  • Ferritin

    Aug 2016 120 (24 - 444) (according to STTM this is a good number)

    ------------------------------------------

    The annoying thing about some of the pronouncements made on STTM is that they don't always mention reference ranges. And since reference ranges for ferritin differ from lab to lab you can't give a single number and say "That's what to aim for" or "That number is fine".

    There is a big difference between a ferritin level of 120 (24 - 444) and 120 (15 - 150).

    For the reference range you've been given your result is about 23% of the way through the range i.e. your result is in the lowest quarter of the range. You need to get it to mid-range or a little bit over (NOT the top of the range - that is not optimal for ferritin), so with a range of 24 - 444 you want to get yours up to about 250.

    To raise your iron levels there are lots of different kinds of supplements available.

    dl.dropboxusercontent.com/u...

    The above document was written by helvella, one of the admins on this forum.

    For any supplement you take the important thing is how much pure (elemental) iron it contains. A realistic maximum is approximately 200mg iron per day, in divided doses.

    For example, I used ferrous fumarate 210mg (FF) to raise my iron levels. Each pill contained 69mg of elemental iron, and I took one tablet, three times per day.

    Lots of people don't tolerate iron salts like FF very well. If that happens then buying ferritin or heme supplements might help (although they are far more expensive than iron salts). Another alternative is to buy a supplement with a lower dose of pure iron e.g. ferrous gluconate has about half the iron content of ferrous fumarate. Then there is ferrous bisglycinate (or "Gentle Iron") which has half again.

    If you eat meat then eating liver once or twice a week helps to raise iron levels more easily and with less gut irritation than iron supplements.

    To help the body absorb iron it is helpful to take vitamin C with each dose. Iron supplements cause constipation in many people. Vitamin C does the reverse. Take sufficient vitamin C to counteract the constipation caused by the iron, and also to help the body to absorb iron.

    Iron supplements and thyroid meds should always be taken at least 4 hours apart. Iron can reduce the absorption of thyroid meds a LOT which is why they must be taken separately.

  • Thanks. I will consider eating the liver meat but will get the ferritin tested again soon, any other iron tests to also do? I should note, I had stopped eating beef for two years when I took that test and started eating it again. The naturopath I saw two years ago had me do an expensive private blood test sent across the border from Canada to America which was a piece of shit. Testing positive IGE for milk and beef made me paranoid, but I retested this August and it was negative. And indeed I can handle both with ease (well I drink lactose free) but the beef may have increased my iron now. Will test it soon. Thanks though if it's low I will definitely follow your advise. Btw this is why I'm skeptical of naturopaths as I am for doctors they all want the money but yes NDT is easier to get with alternative doctors.

  • For more info on iron/ferritin and related subjects, this link is a good one :

    rt3-adrenals.org/iron.html

    For more meaty info on the subject this website is interesting :

    irondisorders.org/

    And I find this particular page from that site to be very handy :

    irondisorders.org/Websites/...

  • If you can get such a test where you live, this is the kind of thing to aim for when testing :

    medichecks.com/find-a-test/...

    although having a full/complete blood count with it would be helpful too.

  • Hi

    There is good sound advice above. Grey goose knows her stuff.

    I help clients with add/ADHD and new tests results are showing too much sugar early on in life is definitely unhealthy.

    Everyone is right go easier on yourself thyroid issues are for life and it takes ages to get them right. Please don't mess around with them and vitamin too much. It just gets overwhelming what's working and what is not.

    At the moment you need a hike up on everything especially t3. If someone feels great on 1400 b 12 so what? You can't die from those levels.

    No point testing coeliac my suggestion is go gluten an dairy free. Yes two meals a day are ok. Ideally breakfast like a emperor lunch like a king tea like a pauper is best.

    Concerned that the adrenals not fully sorted as they are more important than thyroid really.

    You do need a break down of cortisol and more important dhea through the day. These affect everything weight thyroid uptake. I know it's expensive but so worth it as usually it can be adjusted-there are only a few combinations you can have.

    Sleep needs to be b4 10pm as 10-12 you produce (or not) melatonin and this helps mood and weight hugely.

    Finally I think I saw your testosterone was low but I've been back and forth many times.

    Good luck take each day as it comes and please let unimportant things go. Meds for your ADHD aren't the answer.

  • Thanks I appreciate it. I should mention that I need to take ADHD mentions not only because it is possible to have both ADHD and hyoothyroidism, only time will tell if that's the case here or not, but because I'm back at school now taking two courses of university Math n Physics as I plan to go into the Physics program in the Fall with a full 4-5 course load.

  • One more thing to add. Having smoked marijuana for years when high I would realize that it would work like an ADD stimulant and slow me down, help me think and process better, and have effects different from non-ADD people which is common to those with an ADD mind. Symptoms similar to ADD can develop but it can be genetic, passed in families, as well. So since my brain would be sharper on it it can't just be the thyroid affecting those symptoms, though the thyroid definitely affects the severity of the symptoms I have noticed. And I have read in forums online of people with both ADD and low thyroid, where fixing the thyroid didn't fix everything until they also took the stimulants. My experience on the marijuana has been similar to people with ADD that aren't hypothyroid.

  • I'm seeing the doctor tomorrow morning and will request a bunch of tests. Anywho I thought I should mention this that I found in my blood test history. Thanks to the system in BC and Ontario provinces in Canada I can look up my results online.

    Platelet Count

    Aug 2013 276 (150 - 400)

    March 2014 199 (150 - 400)

    June 2016 204 (150 - 400)

    Aug 2016 223 (150 - 400)

    Neutrophils (type of white blood cell)

    March 2014 4.5

    June 2016 2.4 (2.0 - 7.5)

    Aug 2016 3.0 (2.0 - 7.5)

  • Andyb,

    Platelets and neutrophils are all within range (normal).

  • I think I would focus on mental health and specifically relaxation. Being anxious puts our bodies in a fight or flight state, and being in this state long term affects our physical health. Have you tried meditation, yoga, aromatherapy, massage, lavender baths, mindfulness, etc? Excercise such as walking in nature and swimming are good for circulation, physical and mental health. Eating well will also help, i.e. slowly and mindfully preparing and eating high quality meals with lots of nutritious fruit and veg. Do hobbies you enjoy and spend time with people who make you laugh.

    Good luck.

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