Help with results...please!

My daughter was diagnosed with Hashis three years ago and put on Levothyroxine. I have been challenging her doctor for the last three years to help her as her results were 'normal' but that is certainly not how she felt. Here are her hard fought for results!

TSH level 2.71 mu/L 0.35-3.5mu/L

T4 level 14 pmol/L 8.00-21 pmol/L

Vit D level 60 nmol/L 50-120nmol/L

Free T3 3.4 pmol/L 3.8-6.0

ferritin 13ug/L 23-300

Vit B12 401 ng/L 130-1100

Also have a full blood count that showed

Lymphocyte count 3.54 10*9/L 1.00-3.00

We have an appointment with our GP tomorrow who admits he knows little of Hashimotos. How on earth do I approach this?

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julijkb - the fact that he knows little of Hashimoto's isn't a surprise, very few doctors attach any importance to it. Just deal with it yourself (or your daughter) and help to reduce the antibodies by adopting a strict gluten free diet which has helped many members here. Gluten contains gliadin (a protein) which is thought to trigger autoimmune attacks so eliminating gluten can help reduce these attacks.You don't need to be gluten sensitive or have Coeliac disease for a gluten free diet to help.

Supplementing with selenium l-selenomethionine 200mcg daily can also help reduce the antibodies, as can keeping TSH suppressed.

stopthethyroidmadness.com/h...

stopthethyroidmadness.com/h...

hypothyroidmom.com/hashimot...

thyroiduk.org.uk/tuk/about_...

Gluten/thyroid connection:

chriskresser.com/the-gluten...

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TSH level 2.71 mu/L 0.35-3.5mu/L

T4 level 14 pmol/L 8.00-21 pmol/L

Free T3 3.4 pmol/L 3.8-6.0

You're being told they're normal purely because they're in range. The aim of a treated hypo patient generally is for TSH to be 1 or below or wherever it is needed 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 if that is where you feel best, when on Levo only.

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, wrote this in a Pulse Online magazine article:

"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)."

If you email louise.roberts@thyroiduk.org.uk she will let you have a copy of the article which you can print out and show your GP.

Highlight question 6 then ask for an increase in Levo.

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ferritin 13ug/L 23-300

You must ask her doctor how can this result be normal. It's under range FGS! Ask why there are ranges if they are going to be ignored. Ask for an iron panel, full blood count that shows MCV, MCH, MCHC (if you've not already got these results), and a haemoglobin test, to see if she has anaemia.

Ideally she needs an iron infusion, at worst she needs iron tablets. That will be Ferrous Fumarate one tablet once or twice daily for low ferritin, and one tablet two or three times daily for iron deficiency anaemia. Take each iron tablets with 1000mg Vit C to aid absorption and help prevent constipation and take iron four hours away from Levo and at least two hours away from any other medication and supplements as it affects their absorption.

Ferritin needs to be at least 70 for thyroid hormone to work.

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Vit B12 401 ng/L 130-1100

Where is the folate test result? B12 and folate work together, both are needed.

B12 below 500 can cause neurological problems. Are there any signs of B12 deficiency b12deficiency.info/signs-an... - if so you need to pop over to the Pernicious Anaemia Society forum with B12/Folate/Ferritin/iron information for further advice healthunlocked.com/pasoc If not then supplementing with sublingual methylcobalamin lozenges 1000mcg daily plus a good B Complex to balance all the B vitamins should help.

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You would have to ask her GP about the high lymphocytes.

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PS - sorry, missed this

Vit D level 60 nmol/L 50-120nmol/L

The recommended level is 100-150nmol/L according to the Vit D Council.

She should supplement with D3 softgels like these bodykind.com/product/1478-b... (they do a 360 tub which is better value) and take one daily then retest in 3 months, privately if necessary with a blood spot fingerprick test from City Assays vitamindtest.org.uk/index.html

When she's reached the recommended level, reduce to one every other day and see if that keeps her within the recommended range. It's trial and error finding a maintenance dose so it's recommended to retest once or twice a year to keep within the recommended range.

There are important cofactors needed when taking D3 vitamindcouncil.org/about-v...

D3 aids absorption of calcium from food and K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems.

D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds.

Magnesium comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds naturalnews.com/046401_magn...

Check out the other cofactors too.

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Thanks for the reply. She has been gluten-free for two years. Is increasing her levo the only option here? What about the fact she doesn't seem to be converting T4 to T3. Would a combination treatment be an option?

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I'm not sure at the moment that she has much of a conversion problem, at the moment it could be that it's more a case of she isn't on enough Levo. She needs to get that TSH down to 1 or below, which should increase both Free Ts before we can see what conversion is actually happening

TSH level 2.71 mu/L 0.35-3.5mu/L

T4 level 14 pmol/L 8.00-21 pmol/L

Free T3 3.4 pmol/L 3.8-6.0

If the FT3 doesn't move much into the range, stays low, and the FT4 increases then you'll know that conversion is a problem. BUT conversion can't take place until all vitamins and minerals are at optimal levels, and ferritin is particularly important here. No conversion can take place until it is at least 70. So that's another reason not to jump to the conclusion that conversion is poor.

Optimal levels for us hypos are

B12 - very top of range, even 900-1000

Folate - at least half way through range

Ferritin - at least 70

Vit D - 100-150nmol/L

So these levels need to be worked on first, if the building blocks aren't in place then thyroid hormone can't work.

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That makes complete sense. Should we work on the levels of vits and minerals before we increase the levels of levo?

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There's no reason not to do them at the same time. An increase in Levo takes 6 weeks to be fully effective. Starting to improve nutrient levels now can only help. Don't start all the supplements at the same time though, introduce one, wait a week or two then introduce the second one, wait a week or two, and so on. By doing that if there are any adverse reactions you'll know what caused it.

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She is already on 75mg of levo......

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But it's not enough is it, her results show that.

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Thanks for such a detailed answer - really helpful.

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This was amazingly helpful and gave me the confidence to challenge the gp once again. Collecting results today after increasing my daughters levothyroxine. Will let you know!

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This was amazingly helpful and gave me the confidence to challenge the gp once again. Collecting results today after increasing my daughters levothyroxine. Will let you know!

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Sorry, folate 9.8ug/L 2.7-15

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Folate is good :)

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Hi Juli, it looks as if she is not converting plus the fact that her ferritin is so extremely low. We had a series of interviews by doctors and researchers who explained the importance of iron and a certain part of the stomach lining necessary to absorb it and even supplementing is difficult for the same reason. Some people try liquid iron but more acid is needed to break down minerals. I've been touting the use of unfiltered vinegar which has enzymes as well. Using it with meals has been very beneficial in many ways. There is also betaine or HCL or Pepsin you could try.

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Thanks, I shall see what the doctor has to say today.

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Apart from what everyone else has said, how can the results be "normal" when Ft3 is under range? And so is ferritin? Has she been tested for iron deficiency anaemia? D and B12 are also too low, so folate probably is too.

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