Hi everyone, looking for advice regarding symptoms. I was diagnosed with primary hypothyroidism in 2012. Currently taking 100mcg Levo but felt better on higher doses. Symptoms are mainly things like
depression
heavy periods
fatigue during the day
muscle cramps
dry skin
constipation
feeling cold
low pulse
palpitations
loss of appetite
weight gain
puffy eyes and feet
pins and needles
Am I likely undermedicated? I'm sure that I am. Thank you
Written by
blueamber
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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. The antibody attacks cause fluctuations in symptoms and test results and you can swing from hypo to hyper and back again.
The hyper swings are temporary, and eventually things go back to normal. Test results settle back down and hypo symptoms may return. Thyroid meds should then be adjusted again, increased until you are stable again.
If you've got old results from when dose changes were made, you might see suppressed TSH along with very high/over range free Ts which would be a hyper swing and your dose would probably have been reduced. When you swing back to hypo type symptoms you'd probably have a higher TSH and lower Free Ts and dose should then be increased.
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.
Unfortunately many GPs and endos either don't know anything about Hashi's or attach no importance to it.
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TSH 1.79 (0.2 - 4.2)
Free T4 15.9 (12 - 22)
Free T3 3.6 (3.1 - 6.8)
You are currently undermedicated. 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 when on Levo only. You need an increase in your Levo.
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Some of your symptoms will likely be due to low nutrient levels:
Ferritin 16 (15 - 150)
Ferritin should be half way through it's range. As you are just 1 point within range it would be a good idea for your GP to carry out an iron panel, full blood count and haemoglobin test to see if you have iron deficiency anaemia.
In any event your ferritin must be increased so ask your GP to prescribe iron tablets. The usual amount for low ferritin is one Ferrous Fumarate once or twice daily, and for iron deficiency anaemia it's one Ferrous Fumarate two or three times daily.
Take each iron tablet with 1000mg Vitamin C to aid absorption and help prevent constipaton. Always take iron 4 hours away from thyroid meds and two hours away from other medication and supplements as it will affect absorption.
Eating liver regularly, maximum 200g a week due to it's high Vit A content, and eating lots of iron rich foods will help too apjcn.nhri.org.tw/server/in...
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Folate 2.37 (2.50 - 19.50)
Vitamin B12 239 (190 - 900)
You are folate deficient with low B12. Do you have any signs of B12 deficiency b12deficiency.info/signs-an... If so then post on the Pernicious Anaemia Society forum here on Health Unlocked for further advice, quoting these results, any signs of B12 deficiency, and your ferritin (and iron if done) results then discuss with your GP healthunlocked.com/pasoc
If no signs of B12 deficiency you will need your GP to address the folate deficiency and that is usually with 5mg folic acid daily.
You should also address your low B12 as anything under 500 can cause neurological problems.
I have read (but not researched) that BCSH, UKNEQAS and NICE guidelines recommend:
"In the presence of discordance between test results and strong clinical features of deficiency, treatment should not be delayed to avoid neurological impairment."
And an extract from the book, "Could it be B12?":
"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".
"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml.
That's good enough for me and I keep mine around 1000. Sublingual methylcobalamin lozenges are what's needed to supplement B12 yourself (5000mcg daily to start then when the bottle is finished use 1000mcg daily as a maintenance dose) along with a good B Complex to balance all the B vitamins.
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Vitamin D 30.3 (25 - 50 deficient)
You are just 0.3 above the NICE Clinical Knowledge Summary level for Vit D Deficiency. Ask your GP if he will treat you for this with loading doses as per the Summary, your local area guidelines which he may refer to should be similar
Treat for vitamin D deficiency if serum 25-hydroxyvitamin D (25[OH]D) levels are less than 30 nmol/L.
For the treatment of vitamin D deficiency, the recommended treatment is based on fixed loading doses of vitamin D (up to a total of about 300,000 international units [IU]) given either as weekly or daily split doses, followed by lifelong maintenance treatment of about 800 IU a day. Higher doses of up to 2000 IU a day, occasionally up to 4000 IU a day, may be used for certain groups of people, for example those with malabsorption disorders. Several treatment regimens are available, including 50,000 IU once a week for 6 weeks (300,000 IU in total), 20,000 IU twice a week for 7 weeks (280,000 IU in total), or 4000 IU daily for 10 weeks (280,000 IU in total)."
When the loading doses are finished you will need to achieve the level recommended by the Vit D Council which is 100-150nmol/L. If your GP prescribes 800iu daily this wont be enough, so you can ask on the forum for guidance at that time. Once you've reached the recommended level a maintenance dose will be needed which may be 2000iu daily, it's trial and error which is why it's recommended to retest once or twice a year to stay within the recommended range. You can get a private fingerprick blood spot test from City Assays vitamindtest.org.uk/index.html
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Please come back and tell us what your GP is going to do and prescribe.
•Address underlying causes as necessary (for example treat menorrhagia or stop nonsteroidal anti-inflammatory drugs, if possible).
•Treat with oral ferrous sulphate 200 mg tablets two or three times a day. ◦If ferrous sulphate is not tolerated, consider oral ferrous fumarate tablets or ferrous gluconate tablets.
◦Do not wait for investigations to be carried out before prescribing iron supplements.
•If dietary deficiency of iron is thought to be a contributory cause of iron deficiency anaemia, advise the person to maintain an adequate balanced intake of iron-rich foods (for example dark green vegetables, iron-fortified bread, meat, apricots, prunes, and raisins) and consider referral to a dietitian.
• Monitor the person to ensure that there is an adequate response to iron treatment.
You need to insist your GP follows the guidelines and treats you appropriately.
You could tell him you've taken advice from ThyroidUK which is NHS Choices recommended source of information for thyroid disorders.
I truly despair at how some GPs are just leaving patients to become more and more unwell It's beyond believe that he gives you a diagnosis of iron deficiency anaemia then does absolutely nothing. You might want to consider reporting him for negligence.
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It's beyond believe that he gives you a diagnosis of iron deficiency anaemia then does absolutely nothing. You might want to consider reporting him for negligence.
Results
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Test Results - Underactive Thyroid
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