Thyroid UK
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Advice on Test results and what to do next

Hi All

I have just had some test results back and they are as follows: TSH 2.93 (0.27-4.20); Free T4 16.8 (12.00-22.00); Total T4 100.0 (59 - 154); T3 3.73 (3.10 - 6.80) Antibodies Throglobulin 905.0 (0 - 115); Peroxidase 600 (0 - 34).

My prescription for Levo is 125 per day but I take slightly less than this - 37.50 less over a 7 day period. I did this 18 mths ago as i felt I may have been having too much. I know my T3 is low so my questions are:

Do i take more Levo and how slowly should I build up to taking the full dose - will this higher the T3?

Back in April this year my TSH was suppressed at 1.1 (sorry cannot remember perimiters) with a T4 of 19.9 (12 -22) - this one done at the surgery where they do not do T3 and only do T4 because my TSH was suppressed. I haven't changed meds dose so why the change in my new tests?

I take supplements of Magnesium, Selenium (about 3 months now), Vit D ( 72 at last test a couple of months ago) B Complex, B1 and have just started to take B12 again.

B12 18 months ago was 719 and I was advised by BH to lower slightly; Serum Folate was 20.09 (10.4 - 42.4) Ferritin 119.0 (20 - 150) - this was all 18 months ago.

I also have to take a PPI daily as I have Barretts and I need to protect this and stop it progressing to anything worse so have no choice. From what I have read I understand that this can slow up the T3 conversion too.

I am hoping more Levo will higher the T3 too - i want to start off as simply as possible to redress this before worrying whether I need to take T3 etc . Which direction would be the best one?

Many thanks

Hannah

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Hannah13

TSH 2.93 (0.27-4.20)

Free T4 16.8 (12.00-22.00)

Total T4 100.0 (59 - 154)

T3 3.73 (3.10 - 6.80)

These results show undermedication. The aim of a treated hypo patient generally is 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.

F4 is 48% through it's range, FT3 is 17% through it's range. They should be fairly in balance with FT4 in the upper third and FT3 in the upper quarter, which is what suits most people.

They also show that your conversion isn't very good. Good conversion takes place when the FT4:FT3 ratio is 4:1 or below (some say 3:1). Your ratio is 4.5 : 1

Increasing Levo will increase FT4 and will increase FT3 to a certain exent but wih poor conversion probably not enough. With those results the addition of T3 would be beneficial either by adding synthetic T3 or changing over to NDT.

**

Antibodies Throglobulin 905.0 (0 - 115)

Peroxidase 600 (0 - 34)

Your high antibodies mean that you are positive for autoimmune thyroid disease aka Hashimoto's which is where antibodies attack the thyroid and gradually destroy it.

Antibodies wax and wane and can cause fluctuations in symptoms and test results.

You said

"Back in April this year my TSH was suppressed at 1.1 (sorry cannot remember perimiters) with a T4 of 19.9 (12 -22) - this one done at the surgery where they do not do T3 and only do T4 because my TSH was suppressed. I haven't changed meds dose so why the change in my new tests?"

This is most likely due to the Hashi's as it causes swings from hypo to hyper and back again as and when the antibodies attack. During an attack, the dying cells dump a load of thyroid hormone into the blood stream which can cause hyper type symptoms and results. Then things settle down and swing back to hypo. It's the nature of Hashi's.

You can help 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...

**

Optimal levels for vitamins and minerals for us Hypos are below, regardless of the generic comments on private blood test results.

Vit D - 100-150nmol/L

B12 - very top of range, even 900-1000

Folate - at least half way through it's range

Ferritin - half way through it's range with a minimum of 70 for thyroid hormone to work

When optimal levels are reached, supplementing at a maintenance dose should continue.

**

Your PPI's are obviously a problem, so taking them as far away from your thyroid meds and supplements is a good idea.

**

Please be aware I'm not medically qualified, my reply is based on personal experience, research and reading and just my opinion.

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Thank you so much SeasideSusie for the comprehensive and helpful reply - I really appreciate the effort you have put in.

I want to start with increasing the Levo and then have another test in 3 months and see where I am then. Would I increase the Levo by all 37.50 (3 days x 12.50 per day) in one week or would I be better doing it over 3 weeks - 12.50 per week?

I have started to go GF too - if the antibodies are lowered would that also help T3 conversion?

I will keep going with the B12 and Vit D (I usually stop D over the summer months) and selenium etc.

If this doesn't do the trick then I will have to think again. Strangely I don't feel that ill and have more energy then I have had for a long time. But I guess the B1 and B12 and mag. could be helping with that. I do have blips of feeling over/under but have put that down to having Hashi's.

I am not sure i am brave enough to go it alone with T3 or NDT . I just don't know enough about any of it and who would you go to if things were not right? If I went to the GP with this problem of not converting to T3 what would happen? Would they ignore it or would I be sent to an Endo? What do Endo's do about this problem - do they prescribe NDT or T3?

Thanks again - you are so knowledgeable .

Hannah

Reply

Hannah

Is there a reason you want to increase Levo so slowly? If a GP was increasing your Levo, the normal amount would be 25mcg daily. If you want to be cautious then 12.5mcg daily. There is plenty of room with your latest results to increase by 12.5mcg daily. If you don't want to cut your tablets, then if you have some 25s then take an extra 25mcg alternate days. I think 37.5mcg a week increase wont make a lot of difference.

With Hashi's, be aware that doses can need adjusting from time to time when a hyper swing happens, then readjusting when that's over and you go hypo again.

**

You say you've started GF - is that cutting down or cutting out completely? I'm not GF but everything I've read says it has to be strictly GF. I don't know if that will help conversion I'm afraid.

**

Optimal levels of all vits and mins will help thyroid hormone to work, and that includes conversion of T4 to T3. Also the selenium helps with conversion (which I think you might know :) ).

Is there a reason you're taking a separate B1 (just curious)?

**

Adding T3 or starting NDT is a big, scary step for most of us. But with help of forum members who are experienced with this it's not so bad. I remember being wary of adding T3, and took it very slowly and increased very gradually. But you learn and become less anxious about it.

Some people tell their GPs they've done it and found them to be quite supportive. Some have found their GPs quite hostile about it. I haven't told my GP, I'm just getting my Levo off the, adding T3 and doing my own tests. They're so uninterested I've not been called for a thyroid test since March 2014.

Some GPs and endos would prescribe T3 if they could, they understand about conversion and know that T3 is helpful when conversion is poor. Unfortunately they are few and far between and their hands are tied now as T3 appears on the list of medication now not to be prescribed. NDT would need a very open minded endo/GP who would need to take personal responsibility for prescribing it as it is unlicensed so it's rarely prescribed.

If you wanted to try and see if you can get T3 prescribed, email louise.roberts@thyroiduk.org.uk for the list of thyroid friendly endos, then ask on the forum for any feedback/is this endo T3 friendly and members can respond by PM.

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Thanks SeasideSusie

I will take the extra 37.50 in one week straight away.

I am going as GF as I can but i don't want it to rule my life as such . I am going to give it a go and then test privately in 3 months. I have read too that you need to be a 100 per cent free of gluten.

I am surprised that you haven't been contacted by your GP for a test since 2014 - that is awful. I do get tested once a year from the GP and feel pretty sure that if i wanted a test in between for some reason they would give it to me.

I take B1 (Thiamine) because it is very good for giving you extra energy. I learnt this from Dr Isobelle - she has recommended it a lot to people as it really does work. I noticed the energy increase within a couple of days.

Of course, adrenals are another thing to consider - I am not sure what state mine are in as I have had a lot of stress with a very close bereavement etc.

Thanks again for the info - no doubt i will be back again with further questions.

Hannah

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The trouble with being "almost gluten free" is that your missing out on stuff and making some changes & sacrifices but with little or no effect, as it won't work unless absolutely 100%

Each time we eat even a small amount of something with gluten in it can take weeks to reduce antibodies again. It really is all or nothing

There are lots of gluten free alternatives these days, plenty of flours for baking, even some pretty good breads. (M&S brown seedy is excellent)

Gluten free beer is indistinguishable from normal

Cakes and biscuits tend to be too sweet, so a good excuse to try some home baking!

By sticking absolutely to 100% gluten free you should start to see antibodies fall as well as improving conversion and less symptoms

Suggest you give it a really serious go for 3-6 months

Personally my antibodies have fallen slowly at every test since going GF & much faster now also on T3 (my endo delighted and astonished & now a gluten free convert ) In 20 years on Levo before gluten free my antibodies never ever went down

I never thought I had any gut symptoms at all. Always thought "gluten intolerance" was some airy fairy made up thing!

It was joining here and reading about gluten, low vitamins and magnesium that made me try it (medics never suggested it)

Antibodies are now a quarter of level before I started GF just eighteen months ago

I now have small amount T3 added via endo/NHS in part due to recognition of significant improvement since gluten free

Vitamin D - with Hashimoto's you may need to supplement all year, just reduce dose in summer.

We tend to need of use more

Vitamindtest.org.uk for £28 postal kit - best to test twice yearly

My previous GP practice also didn't test Thyroid levels for over 4 years.

I now just get my own tests as want/need to track FT3 and both antibodies, which NHS don't test

Remember to stop vitamin B complex or any supplements with biotin in 3-4 days prior to any further blood tests

As Biotin can falsely affect blood test results

endocrinenews.endocrine.org...

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Reply

Thankyou Slowdragon - I really will try and cut it all out - I didn't realise that you had to be so exact about it. I will PM you later re some more GF ideas and advice if you don't mind.

Great news too that your NHS Endo is playing ball with you - there must be doctors out there who have an UT - I cannot imagine that they are all sitting there with low T3 and feeling unwell and doing nothing about it.

Very helpful reply and appreciated

Hannah

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