Blood results Advice appreciated

[Kitti1]

Well finally after a lot of messing about I've finally got my results.

Quick recap - diagnosed at 18, now 48, was on 150mg for 25 years, still symptomatic. A clever doc reduced my dose 5 years ago to 125mg and Ive been a very dozey lardy ever since. Found out about t3 in Feb. ( trust me I'm a doctor) and thought I must need that and it started my journey of discovery.

A daft chemist changed my actavis for teva, which made me ill and during I had a gp blood test. Probably why TSH plummeted from last years gp test. Test last year on 125mg - TSH 5.9,( 0.35-5.5) ( dose kept the same ! ) recent gp test TSH 0.41. So clever gp dropped my dose to 100mg !

Ive been on that dose 6 weeks. I wanted to wait for the teva to be out of my system. But of course felt terrible on 100mg. Ive also been taking a vitamin B complex for 5 months and vit. B12 1000mcg for 4 weeks.

So I am over the moon with my results, but confused by some points.

Bloods taken 25/05/17

CRP 3.40 < 5.0

Ferritin 147.9 20 - 150

TSH 5.9 0.27 - 4.2 H

T4 total 75 64.5 - 142.0

Free T4 11.92 12 - 22 L

Free T3 2.68 3.1 - 6.8 L

Immunology

ATP 13.3 <34

AH 229 < 115 H

Vit. D ( 25 OH ) 32 L

Defficient < 25 Insufficient 25 - 50 Reduce > 175

Serum Folate 21.74 8.83 - 60.8

Vit B12 344

Defficient < 140 Insufficient 140 - 250 Reduce > 725

I'm a little concerned by my CRP being a little high but in the range.

What is the difference between total T4 and free T4 ? Why is one just in range and one not ?

T4 & T3 - So I can up my t4 and start on my t3 By how much please ?

I'm coeliac, but did not think I was hashis. Am I hashis ? Why is one of the anti bodies in range and one not ?

How much Vit D3 would you recommend please ?

Should I be adding folic acid ?

Should I double my vit. B12 ( currently taking 1000mcg ) or take more than that ?

Your time & advice is very much appreciated

[Clutter]

Hi Kitti1,

There was absolutely no need for your GP to reduce dose when TSH was 0.41 which is comfortably within range. Now your 125mcg dose needs reinstating and you will require another thyroid test in 6-8 weeks because you are so under medicated your FT4 and FT3 are below range.

If you don't intend increasing Levothyroxine dose you can add 1/4 tablet of T3 (6.25mcg) for a week to see how well you tolerate it. If okay add a second 6.25mcg dose 8-12 hours later. I think you will have scope to add another 6.25mcg to the first dose two weeks later if it feels necessary, then hold at 18.75mcg for 6-8 weeks and retest before increasing further.

Total T4 and T3 means the T4 and T3 is bound to proteins, ie not all of it is bioavailable. Free T4 and Free T3 are unbound and are available for use. Total T4 and Total T3 aren't much use which is why NHS uses FT4 and FT3.

AH range looks like thyroglobulin antibody range and it is positive for autoimmune thyroiditis (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 32 is insufficient. I would supplement 10,000iu D3 daily x 6 weeks and then reduce to 5,000iu daily and retest in 3-4 months. Most people are comfortable around 100nmol/L. Take vitD 4 hours away from Levothyroxine.

If you feel B12 deficient then increase dose. Otherwise 1,000mcg is sufficient.

There is no folate result so I can't advise about supplementing folic acid but there will be some folic acid or methylfolate in your B Complex vitamin.

Ferritin is high in range. If you are not supplementing iron this can indicate inflammation somewhere in the body. CRP is an inflammation marker too. Both are within range so I doubt your GP will be concerned.

[Kitti1 in reply to Clutter]

Thanks Clutter, no I'm not supplementing Iron, but I eat a lot of beans. Should I worry about the inflammation thing / do something about it ?

Ive been coeliac for nearly 20 years so am very strict with my gluten free. Why is one lot of anti bodies up and not the other ? I don't know much about hashis. Why are the anti bodies up if I'm gluten free ?

[Saggyuk in reply to Kitti1]

Antibodies can still be raised if gluten free but being gluten free might help lower these or prevent others for other reasons from starting.

They are different types of antibodies, the tpo ones are antibodies your body develops to attack your actual thyroid and attack the thyroid cells as for some strange reason, your body starts to see it as alien. The thyroglobulin is something not normally found in your blood but is leaked into your blood when other tissues are damaged/destroyed (maybe due to the above or other reasons) and because it's not a substance that's supposed to be in your blood, your body will develop antibodies to it. I think lol and if that makes sense. So you can have one or the other or both depending on what's going on in your body

[Clutter in reply to Kitti1]

Kitti1,

I wouldn't be worried about inflammation unless it is higher next time you test. It could be the Hashimoto's causing inflammation, particularly as your fool GP reduced your dose and made you under medicated.

Some people have positive thyroid peroxidase antibodies, some have positive thyroglobulin antibodies and some have both. Antibodies are a response to thyroid injury ie your autoimmune system attacking your own thyroid gland. Gluten-free helps some people reduce antibodies but it makes no difference for some people.

[greygoose]

Total T4 contains both Free T4 and bound T4 - that's why it's called Total - it's all the T4 in the blood. Free T4 is just the T4 available for use by the body.

[Saggyuk]

Hi Kitty

The CRP could just be because of the thyroid antibodies or other temporary issue but is still within range. Have you been having your annual coeliac antibody tests? How long have you been diagnosed coeliac for?

If you're trying to start the T3, I would just add 12.5 of this and retest in a couple of months. I normally add 10mcg and am okay with it but I suppose 12.5 is a little higher but you could do as clutter suggests and try a quarter and then another quarter if no issues

Clutter , there is a folate result up there - Serum Folate 21.74 8.83 - 60.8

[Clutter in reply to Saggyuk]

Thanks, SaggyUK, I so couldn't see it before

Kitti1, Folate is absolutely fine.

[Kitti1 in reply to Saggyuk]

Thanks for your replies and wisdom Saggy.

Ive been coeliac for 19 years. Annual coeliac antibody tests ? Nope never had one, never been offered one, never heard of them. I did have a top & bottom endoscopy amongst other tests to diagnose.

Yep I want to give T3 ago along with T4. I don't think I'm a very good converter. As when I was on 150mg I was still symptomatic. Do you think I should up my levo too ?

[Saggyuk in reply to Kitti1]

I would just do one at a time as otherwise you wont know which did what or what is causing problems if you have any. Plus upping them both might be too much which wont help you determine if the T3 is helping. 12.5 mcg might just be enough for you - it's hard to tell. I would up the T3 as usual until your bloods are optimal and then if you still want more T3, then you can start swapping instead of adding depending on how you feel.

Oh dear lol - yes, you're supposed to have annual coeliac reviews, the most important reason being the coeliac antibody test which can help identify if you're keeping it under control or whether CC is getting in your food intake and that your nutritional levels are all okay etc. Unlike other antibodies like thyroid, these are ones you can actually get to zero as you no longer have the item causing them in your body/system and the higher it is, the more that is sneaking into your diet. If it comes back zero, you are 100% gluten free lol

Read about it here:

coeliac.org.uk/coeliac-dise...