advice please

[ellej]

hi my name is elle and I am 27 years old I would like to ask my doctor for thyroid medication for symptoms of low thyroid of puffy eyes and feet constipation dry skin heavy periods tiredness cramps muscle pain hair loss pale skin weight gain how do I go about doing this please thank you

[SeasideSusie Remembering]

ellej You need to ask him to carry out thyroid function tests and if you are diagnosedl hypothyroid he should prescribe levothyroxine.

Here is a checklist of signs and symptoms of hypothyroidism thyroiduk.org.uk/tuk/about_... Print it and tick all those that apply and show your GP then ask to be tested.

Ideally you should have

TSH

FT4

FT3

Thyroid Antibodies - TPO and TG

and because some of your symptoms might be indicative of low nutrient levels, also ask for

Vit D

B12

Folate

Ferritin

Iron panel/full blood count would be good too.

If you get all these done to start with it gives the best possible picture.

[ellej in reply to SeasideSusie]

sorry I am not good at explaining myself. I have under active thyroid I think

tsh 48 (0.2 - 4.2)

free t4 10.1 (12 - 22)

free t3 3.4 (3.1 - 6.8)

I take thyroid medication

[SeasideSusie Remembering in reply to ellej]

How much thyroid meds? You are very undermedicated.

[ellej in reply to SeasideSusie]

25mcg levothyroxine

[SeasideSusie Remembering in reply to ellej]

And have you been on a higher dose before? If so why was it lowered?

[ellej in reply to SeasideSusie]

thanks yes I was on a higher dose before of 125mcg levothyroxine and it was stopped altogether because gp wanted to investigate symptoms which she said might be related to adrenal insufficiency

[SeasideSusie Remembering in reply to ellej]

And has she investigated adrenal insufficiency?

[ellej in reply to SeasideSusie]

no not yet I really want her to chase it up

[SeasideSusie Remembering in reply to ellej]

Well, you definitely need your dose of Levo increased. The aim of a hypo patient generally is for TSH to be 1 or below or wherever it is needed for Free T4 and Free T3 to be in the upper part of their respective reference ranges.

Ask your GP to increase your dose immediately and to support this - from thyroiduk.org.uk/tuk/about_... > Treatment Options

Dr Toft states in Pulse Magazine, "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)."

Dr Toft is past president of the British Thyroid Association and leading endocrinologist. You can obtain a copy of the Pulse article by emailing [e-mail] print it and highlight quesion 6 to show your GP.

[ellej in reply to SeasideSusie]

ok will do this thank you

[Marz in reply to ellej]

ellej Your adrenals will become stressed if your thyroid remains UNDERTREATED. Also are you taking VitC with the iron to aid absorption ? It would also help your adrenals .....

[ellej in reply to ellej]

diagnosed 2015

[ellej]

thyroid peroxiase antibodies 304.5 (<34)

thyroglobin antibodies 289.3 (<115)

[SeasideSusie Remembering in reply to ellej]

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. I'm guessing you've maybe had your thyroid meds reduced because of TSH being suppressed and maybe FT4/FT3 being over range?

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...

[ellej]

taking iron and vitamin d and folic acid thank you

[SeasideSusie Remembering in reply to ellej]

How much?

[ellej in reply to SeasideSusie]

sorry 800iu vitamin d 5mg folic acid and 210mg ferrous fumarate 3 times a day

[SeasideSusie Remembering in reply to ellej]

ferritin 15 (30 - 400) 210mg ferrous fumarate 3 times a day

I take it you have been diagnosed with iron deficiency anaemia to be prescribed ferrous fumarate 3 times a day. That is the correct treatment.

Also, eating liver regularly can help, maximum 200g per week due to it's high vit A content, and include lots of iron rich foods in your diet apjcn.nhri.org.tw/server/in...

**

folate 2.1 (2.5 - 19.5) 5mg folic acid

vitamin b12 138 (180 - 900)

Has your GP done anything about your below range B12? Do you have any signs of B12 deficiency b12deficiency.info/signs-an... If so please go to the Pernicious Anaemia Society forum here on Health Unlocked for further advice healthunlocked.com/pasoc

You will probably need testing for Pernicious Anaemia, you may need B12 injections. I do believe you shouldn't be supplementing lfolic acid until these tests have been carried out - they will advice on the PA forum. Quote these results, any signs of B12 deficiency, and your ferritin/iron information.

Also ask your GP why she's done nothing about your below range B12.

**

Total 25 oh vitamin d 20.6 800iu vitamin d

Well, 800iu D3 isn't going to ever raise your level. It is hardly a maintenance dose for someone with a reasonable level.

Your GP is treating you for Insufficiency when in fact you are severely Deficient.

NICE treatment summary for Vit D deficiency:

cks.nice.org.uk/vitamin-d-d...

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)."

Each Health Authority has their own guidelines but they will be very similar. Go and see your GP and ask that he treats you according to the guidelines and prescribes the loading doses. Once these have been completed you will need a reduced amount to bring your level up to what's recommended by the Vit D Council which is 100-150nmol/L, and then you'll need a sensible maintenance dose which may be 2000iu daily, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. You can do this with a private fingerprick blood spot test with City Assays vitamindtest.org.uk/

[ellej in reply to SeasideSusie]

thanks yes I have been diagnosed iron deficient and the results were taken after supplementing I don't know why my levels are not rising after being on iron for 3 years the folate since end of 2016 and the vitamin d since 2013

[SeasideSusie Remembering in reply to ellej]

Well, it's up to your GP to find out why your levels aren't rising. Bring this up with him/her and ask for investigations.

You could very well have an absorption problem, gut problems are common with Hashi's. When SlowDragon is around hopefully she will chip in with information about that.

[Nanaedake in reply to ellej]

Were your vitamin blood test results above taken after you'd been supplementing and how long had you been supplementing for leading up to the blood tests?

I see that SeasideSusie has responded with vitamins advice, great because she's the vitamins guru on here!!

[ellej in reply to Nanaedake]

thanks for reply yes the bloods were done after supplementing I don't know why they are still so low and I have been taking the iron since 2014 the folate since end of 2016 and the vitamin d since 2013

[Nanaedake in reply to ellej]

If you follow SeasideSusies vitamins advice it should help to bring them up but do check out your B12 levels on the Pernicious Anaemia forum on Healthunlocked as she suggested.

What has your doctor said about the fact that the supplements have not sufficiently raised your levels and why haven't they done anything about it or looked into it?

Is there another doctor in the practice you could see?

[ellej in reply to Nanaedake]

the gp hasn't said anything just keeps prescribing me the same things over and over again. I get frustrated that they prescribe me them but don't look into why my levels are not improving when I have been on them for so long. I can try to see another doctor

[Nanaedake in reply to ellej]

Yes do try a different doc and take the information SeasideSusie has supplied with you to your appointment. Ask your doctor why they think your levels have not improved and insist they look into it. I think its extremely remiss of your doctor to do nothing about it.

[shaws Administrator in reply to ellej]

Unfortunately, if we want to get well we have to read, learn and inform ourselves as to what will bring back good health.

It is not forthcoming from the doctors as they appear to be very poorly trained except to take notice of the TSH alone. I doubt they know one clinical symptom.

We can find a way back to good health. First when you have a blood test for your thyroid hormones, it has to be at the very earliest possible, fasting (you can drink water) and allow a gap of 24 hours between your last dose of levo and the test and take afterwards. This keeps our TSH at its highest as it drops throughout the day. Also levo has to be taken on an empty stomach with a full glass of water and wait an hour before eating. Food interferes with the uptake as does coffee.

[swtjamie in reply to shaws]

Is it important to wait a hour? I take my other meds half hr after my levo. I drink lil bit of water maybe 4 oz as i hate water. Should I drink more?

[shaws Administrator in reply to swtjamie]

Yes, we have to wait for an hour. Food interferes with the uptake.

Sometimes levo can stick in our throat, so a full glass of water makes sure it gets to our stomach.

Other medications could interfere with the uptake of levothyroxine, especially iron so it is best if you could take all your supplements at lunchtime

.

The other option is you take levothyroxine at bedtime, but you must have last eaten about 2.5 to 3 hours previously, especially protein as it takes longer to digest.

If having a blood test next a.m. you miss the bedtime dose and take next morning and bedtime as usual.

[swtjamie in reply to shaws]

Thank you so much i am so glad i found this group. Everyone is amazing

[ellej]

ferritin 15 (30 - 400)

folate 2.1 (2.5 - 19.5)

vitamin b12 138 (180 - 900)

total 25 oh vitamin d 20.6

[swtjamie in reply to ellej]

Ive been thinking about taking B12 so i can have some energy. I have zero

[SindeeRae]

If you think you have a thyroid issue, you need to see an endocrinologist. You can either look one IP yourself, or you'll probably need to talk to your general practitioner so that Dr is able to set you up.

Heavy periods, I had an issue with and for me, I was anemic, needed more iron and then I had to seea gynecologist and they put me on an IUD since I had already had a tubalectomy done.

Rest of the stuff, I have no clue about

[ellej in reply to SindeeRae]

I don't have a thyroid issue by the looks of things thank you

tsh 48 (0.2 - 4.2)

free t4 10.1 (12 - 22)

free t3 3.4 (3.1 - 6.8)

I take thyroid medication

[greygoose in reply to ellej]

You DO have a thyroid issue by the looks of things. You may take thyroid 'medication' - thyroid hormone replacement - but you're not taking enough. When you are taking thyroid hormone replacement (levo) your TSH should be one or under. You have a long, long way to go to get there!

[SlowDragon Administrator]

Your high antibodies mean you have Hashimoto's also called autoimmune thyroid disease.

Hashimoto's can really affect how our digestive system works. It causes lower stomach acid and leaky gut. You may possibly have coeliac disease, but it's much more likely that it's gluten intolerance

These websites are very good - links about gluten, but lots more info too

thyroidpharmacist.com/artic...

amymyersmd.com/2017/02/3-im...

Also about low stomach acid

thyroidpharmacist.com/artic...

Make an urgent appointment with another GP at the practice, (if there is one) this one should not leave you without thyroid medication. Your TSH indicates you need thyroxine.

Might be a good idea to take friend or family member along for moral support if you can.

You need to follow SeasideSusie advice on supplements, and get back on thyroxine asap.

But also really suggest you change to strictly gluten free diet for at least 3-6 months. If it helps, and many of us find it does then stick on it.

Email Louise at Thyroid Uk for list of recommended thyroid specialists.

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