First post, help please!

[CaroS]

Hi, this is my first post although I have been following your excellent advice for a year! I’m posting on behalf of my 27yr old daughter who has had an awful time since finishing uni at 22yrs, with “depression”. 2yrs ago she was diagnosed with b12 deficiency which explained a lot and at the time had TPO antibodies although her tsh was 1.35. 1yr ago her tsh had risen to 9 with a low t4, Hashimotos was diagnosed and she was started on levothyroxine by our GP, briefly 50mcg, then 100mcg. Her dose has been 125mcg since May. She self injects with methylcobalamin weekly, vit D in june 85nmol/l, supplements with b vits and methylfolate, minerals including magnesium, zinc and selenium [ she was supplementing selenium but stopped recently as level sl above range ] in range. Adrenals could be better and ferritin [ she takes liquid iron and is unable to tolerate even iron bisgycinate ] but problem high reverse T3 at 33 it was normal in January at 23 when she was on 100mcg levo. Will post results. She has not been feeling much better despite a T3 of 5, has recently been putting weight back on and still hasn’t got the energy to go out into the world despite psychological support. I’m not sure what to do for the best. Would reducing the levo clear the RT3, or excercise, or do I need to source T3? Sorry its a long post, I would really value your help!

Bloods 18/7/17, Cortisol and minerals 15/6/17 and bloods April 17 when on 100mcg levo

18/7/17Sample Type: Serum,

Test Patient Result Normal Range Units Comment

Biochemistry

Iron 23.8 6.6 - 26.0 umol/L

Ferritin 56.5 20 - 150 ug/L

Transferrin Saturation 39.55 20 - 50 %

TIBC 60.22 45 - 72 umol/L

Hormones

DHEA-Sulphate 3.2 0.26 - 11.0 umol/L

Thyroid Function

TSH L 0.01 0.27 - 4.20 mIU/L

Free T4 21.00 12 - 22 pmol/L

Free T3 5.00 3.1 - 6.8 pmol/L

Reverse T3* H 33.0 10 - 24 ng/dL

Reverse T3 ratio L 9.86 Normal >15 Ratio

Borderline 12-15

Low <12

Test Patient Result Normal Range Units Comment

Saliva

Cortisol (Saliva) Waking H 35.35 14.0 - 21.0 nmol/L

<11.0 Possible Addison's

Cortisol (Saliva) 12:00 8.28 4 - 9 nmol/L

Cortisol (Saliva) 14:00 6.70 3 - 8 nmol/L

Cortisol (Saliva) 16:00 H 9.76 2.5 - 7.0 nmol/L

Cortisol (Saliva) 18:00 H 9.91 2.5 - 7.0 nmol/L

Cortisol (Saliva) Before Bed H 6.60 0.8 - 4.5 nmol/L

>12.0 possible Cushing's

Result Reported : 14-Jun-17 4:38 PM

Sample Number:

Sample Type: Venous blood

Test Patient Result Normal Range Units Comment

Biochemistry

Ferritin 55.5 20 - 150 ug/L

Magnesium 0.93 0.6 - 1.0 mmol/L

Kidney Function

Sodium 142 137 - 145 mmol/L

Bone Screen

Calcium 2.38 2.12 - 2.52 mmol/L

Corrected Calcium 2.38 2.12 - 2.52 mmol/L

Thyroid Function

Free T3 4.69 3.1 - 6.8 pmol/L

Vitamins

Vitamin D (25 OH) 85 Deficient <25 nmol/L

Insufficient 25 - 50

Consider reducing dose >175

Vitamin B12 H >1476 Deficient <140 pmol/L

Insufficient 140 - 250

Consider reducing dose >725

Serum Folate >45.400 8.83 - 60.8 nmol/L

Minerals - Blood

Selenium* H 1.93 1.00 - 1.90 umol/L

Zinc (Plasma)* 14.00 11 - 18 umol/L

______________________________________________________________________________________________________________________________

Page 1 of 1 FINAL REPORT

Sample Received : 21-Apr-17 10:10 AM

Result Reported : 21-Apr-17 12:08 PM

Sample Number:

Sample Type: Venous blood

Test Patient Result Normal Range Units Comment

Biochemistry

CRP 0.10 <5.0 mg/L

Ferritin 43.2 20 - 150 ug/L

Thyroid Function

TSH L 0.05 0.27 - 4.20 mIU/L

T4 Total 90.9 64.5 - 142.0 nmol/L

Free T4 16.76 12 - 22 pmol/L

Free T3 4.01 3.1 - 6.8 pmol/L

Immunology

Anti-Thyroidperoxidase abs H 174.7 <34 kIU/L

Anti-Thyroglobulin Abs 28 <115 kU/L

Vitamins

Vitamin B12 H >1476 Deficient <140 pmol/L

Insufficient 140 - 250

Consider reducing dose >725

Serum Folate 45.40 8.83 - 60.8 nmol/L

______________________________________________________________________________________________________________________________

[Hidden]

As no one has replied yet I'll jump in:

With the high reverse T3 it likely indicates she is just not converting her dosage properly. This can happen if we don't get our nutrients absolutely optimal (deficient Vit D!! And ferritin should be minimum 70!) another big reason for high antibodies that effect conversion is gluten... and many here have adapted a gluten free diet for this reason. And I always like to suggest NDT (natural Dessicated thyroid) to anyone struggling with Levo as many people just do not tolerate it very well. But formost is the conversion issue! I would immediately do a week of gluten free and aggressively get both Vit D and ferritin levels addressed first. (I had bone crushing depression with low ferritin). Hope this is a help! X rusty

hypothyroidmom.com/gluten-w...

hypothyroidmom.com/92-of-ha...

stopthethyroidmadness.com/f...

[CaroS in reply to Hidden]

Thanks very much, she did try gluten free but only for 2 weeks and stopped because it upset her bowels - probably didn't give it enough of a chance. Her recent Vit D was 85 well in range and she supplements 1000iu for most of the year. Agree need to work on the ferritin.

[CaroS in reply to Hidden]

Oops put reply in wrong place! Thanks very much, she did try gluten free but only for 2 weeks and stopped because it upset her bowels - probably didn't give it enough of a chance. Her recent Vit D was 85 well in range and she supplements 1000iu for most of the year. Agree need to work on the ferritin.

[Hidden in reply to CaroS]

You might want to create a new post just to ask for PM on how to source T3. It is usually added by reducing Levo dose and adding 10 of T3, but again create a new post asking for protocol. But if her body is struggling with high antibodies and she continues with gluten in her diet... I can't provide an answer.

I would read more posts related to high antibodies with low TSH - here's just one:

healthunlocked.com/thyroidu...

thyroidboards.com/forums/to...

hypothyroidmom.com/hashimot...

endocrineweb.com/conditions...

Have you considered NDT yet - any struggling Thyroid patient would be well advised to weigh switching over:

stopthethyroidmadness.com/n...

hypothyroidmom.com/thyroid-...

[CaroS in reply to Hidden]

Thanks for your support, I have considered T3 or NDT although she's not keen on non NHS treatment but may change her mind. Will also try to persuade re a gluten free trial. Interestingly, I became hypothyroid in my 40's and have always been fine on levo [ although that doesn't influence me with her ], I never had my antibodies checked but as my tsh was 150 on diagnosis my thyroid may have completely died by then.