Blood test results - please advise.

[lindajrst]

Hi there, I have just got my results back from Blue Horizon. I am not taking any medication at present but am looking to start taking something for my hypothyroidism. Tried taking T4 levothyroxine but it makes me feel awful so I came off it about 10 months ago. I'm hoping someone can advise me whether T3/T4, just T3 or NDT would be best and whether I need any supplements. Here are my results with ranges:-

CRP 0.60 <5.0 mg/L

Ferritin 106.0 20 - 150 ug/L

Thyroid Function

TSH H 10.57 0.27 - 4.20 mIU/L

T4 Total 69.2 64.5 - 142.0 nmol/L

Free T4 L 11.21 12 - 22 pmol/L

Free T3 4.42 3.1 - 6.8 pmol/L

Immunology

Anti-Thyroidperoxidase abs H 85.6 <34 kIU/L

Anti-Thyroglobulin Abs 33.7 <115 kU/L

Vitamins

Vitamin D (25 OH) 53 Deficient <25 nmol/L

Insufficient 25 - 50

Consider reducing dose >175

Vitamin B12 422 Deficient <140 pmol/L

Insufficient 140 - 250

Consider reducing dose >725

Serum Folate 21.22 8.83 - 60.8 nmol/L

Looks like TSH is high. Free T4 is low and Anti-Thyroidperoxidase abs (antibodies?) high but would also like to know if other readings are optimal or not.

Thank you so much,

Linda

[lindajrst]

Here they are again but with ranges in brackets - hopefully make it easier to read!

Thank you.

CRP 0.60 (<5.0 mg/L

)

Ferritin 106.0 (20 - 150 ug/L

)

Thyroid Function

TSH H 10.57 (0.27 - 4.20 mIU/L

)

T4 Total 69.2 (64.5 - 142.0 nmol/L

)

Free T4 L 11.21 (12 - 22 pmol/L)

Free T3 4.42 (3.1 - 6.8 pmol/L)

Immunology

Anti-Thyroidperoxidase abs H 85.6 (<34 kIU/L

)

Anti-Thyroglobulin Abs 33.7 (<115 kU/L)

Vitamins

Vitamin D (25 OH) 53 (Deficient <25 nmol/L

)

(Insufficient 25 - 50)

(Consider reducing dose >175

)

Vitamin B12 422 (Deficient <140 pmol/L

)

(Insufficient 140 - 250

)

(Consider reducing dose >725

)

Serum Folate 21.22 (8.83 - 60.8 nmol/L)

[Clutter]

Lindajrst,

TSH >10 with FT4 below range means you are overtly hypothyroid and need replacement thyroid.

I can't tolerate Levothyroxine on its own but I'm fine with T4+T3 combination so you might try that if you still have problems with Levothyroxine only. Your GP will prescribe Levothyroxine but may need to refer you to NHS endocrinology for a recommendation before s/he can prescribe T3. NDT isn't licensed for UK use so is rarely prescribed on the NHS and most members have private prescriptions or buy online and self medicate. You would have to try alternative methods of thyroid replacement to decide whether Levothyroxine, T4+T3, T3 only or NDT suits you best.

Thyroid peroxidase 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_...

VitD 53 is insufficient, around 100nmol/L is optimal. I would supplement 5,000iu D3 for a couple of months and then reduce to 5,000iu alternate days and retest vitD in May. Take vitD 4 hours away from thyroid replacement.

B12 <500 can be deficient so you may want to supplement to raise B12. I would supplement 1,000mcg methylcobalamin with a B Complex vitamin.

Folate is good.

[lindajrst in reply to Clutter]

Thanks very much for your reply. I'll get going with some Vitamin D whilst I decide what to try with the thyroid medication. My endocrinologist wants me back on T4 and doesn't seem to want to prescribe T3 so I'll need to get it myself if I decide to try that first.

I have been 100% gluten free for a few years and 99% grain free. I have so many food intolerances (wheat, dairy, eggs, nuts, coconut) and I am wondering if they will improve with correct thyroid replacement (I guess that's a question for another post though).

I had a test for antibodies last summer and the endo told me it was negative so it is strange that this one is positive. I'll have to see if I can get hold a copy of the previous test I had.

Is there somewhere I can find out what the different values mean? I don't really understand T4, Free T3 and Free T4. My Free T4 is low but I'm wondering why supplementing T3 can help? I'm trying to figure out which to try first (NDT, T3 only or T3/T4). Is it a case of just pick one and try it or can I get clues from my results?

Thanks again.

[Clutter in reply to lindajrst]

Lindajrst,

Your results determine you need thyroid replacement. The type of thyroid replacement is irrelevant in that sense, but if you can't tolerate Levothyroxine you will need T4+T3, T3 or NDT and will have to trial them to see how you do. An NHS endo will prefer to prescribe Levothyroxine but might also prescribe T3 if you are struggling on Levothyroxine.

TSH is a pituitary hormone which rises when thyroid hormones (T4 and T3) drop. T4 is a storage hormone which converts to T3 which is the active hormone. When T4 is low there won't be sufficient conversion to T3 and it is low T3 which causes hypothyroid symptoms. Currently, with high TSH flogging your thyroid gland, you may have quite good FT3 level but it isn't sustainable without some thyroid replacement. If you are taking T3 in addition to Levothyroxine, or T3 only, you don't have to worry about having decent FT4 levels as you will be boosting your FT3 by taking T3 direct rather than relying on conversion.

Thyroid antibodies fluctuate and are highest after a recent lymphocyte attack on the thyroid gland, then subside until the next attack, so they may have been low previously or have only just become positive ie recently gone over range.

[lindajrst in reply to Clutter]

That is really helpful. Thank you so much.

[silverfox7]

Hi! You say Levo made you feel awful, in what way? I'm just wondering if you might have had a reaction to the fillers or have started off on too high a dose

[lindajrst in reply to silverfox7]

Hi silverfox7 , I was on Levo for about 8 years (felt awful but didn't know why). I made some dietary changes (grain free etc) and weaned myself off T4. Felt so much better and my tsh was in the normal range for about 3 years (though close to being out). Then it started to go out of range and the doc advised me to go back onto levo. I started at 25mcg and then raised to 50, then to 75. Stayed on for about 6 months in total. I felt worse each time we raised the dosage. The list of my symptoms whilst on levo is as follows:- 1 stone weight gain in the 6 months I was on it, fatigue, insomnia, muscle twitches at night, heavy arms/legs (weakness), hot/cold, anxiety, mild depression, chest pain, increased heartbeat, brain fog. This disappeared when I came back off the meds. I still have general hypo symptoms tiredness, lethargy, dry skin, etc but don't feel dreadful as I did on the levo - thought I was dying at times!

[silverfox7]

Well you certainly need some medication now and I suspect you weren't on the right dose then. You need to listen to your doctor on this one but keep us in the loop. Could be the fine tuning you need help on as it sounds he's not so good with follow up. Get started again. He may try to start you on a high dose which might be better to step you up from a lower one but keep posting so you get plenty of advice along the way. Always stick to the same brand unless there is an allergy. The more things you keep the same the easier it is to find the cause if something goes wrong! Not saying it will but it's a good general rule to follow.

[lindajrst in reply to silverfox7]

Are you saying that maybe my symptoms were down to me not being on a high enough dose of T4? Do you think the symptoms would improve on a higher dose? (I felt worse as I raised the dose). I was thinking of trying T3 or NDT instead (by myself as endo isn't helpful on this).

Thanks for your help.

[silverfox7 in reply to lindajrst]

Yes your symptoms suggested you were under medicated. Some do have trouble raising, the worse case scenario is an adrenal problem but often its the brand of Levo not suiting you because of the fillers, raising too quickly and not giving your body chance to get used to it such as 25/50 on alternate days then stable 50 for a while then 50/75 and so on plus there are a few do and fonts do you may have been increasing it but at the same time doing something on some says that was effecting the dose. Have a read on the Thyroid Uk site as they have loads of things to read and learn from and doctors don't give any guidance on this. Often you have to listen to your own body and try to work out what it is saying and why.

May be keep a diary this time and jot down what you are eating as well as that might give you a clue. Missing a dose may not be a problem st first but it can catch up with you later. It can be difficult as re are all different and can react differently so it's often a case of trial and error to see what works and what doesn't.

Hope you get it sorted soon

[lindajrst in reply to silverfox7]

Thanks very much for your help.

[Hidden]

I felt terrible on levo and now take NDT which is better for me. I would try a combination of t4 and t3 though first, as suggested before you decide to switch to something other than levo.

[lindajrst in reply to Hidden]

Thanks. I'm quite scared of taking t4 again as it took me a while to regain my strength after stopping it but I'll probably give that a go. All other symptoms cleared up quickly.

[Hidden in reply to lindajrst]

It's worth a go and also ask your doctor to change the brand they prescribe as it could be the fillers. I only tried one type to be honest. Your t3 levels are not really really low but you may be someone who feels better when these are at the very top of the range. I am pretty much the same. I feel best when my t3 is over range slightly. Thing with doctors is that they freak if your levels go slightly over. My t4 never goes over though.

[lindajrst in reply to Hidden]

Really helpful, thanks