Hypothyroid?

[Sam_H87]

Hi I feel very cold since the weather has cooled down and my eyes have gotten cholesterol deposits under them. Are these hypothyroid symptoms? Thank you

Serum TSH 22 (0.2 - 4.2)

Serum Free T4 10.3 (12 - 22)

Thyroid peroxidase antibodies 91 (<34)

[ITYFIALMCTT]

High cholesterol can be a symptom of hypothyroidism tho' those deposits are also associated with familial hypercholesteraemia or other conditions. See, e.g., bhf.org.uk/heart-matters-ma...

There's a list of symptoms of hypothyroidism here: thyroiduk.org.uk/tuk/about_...

Do you have the results of any blood tests (like a thyroid work-up) that you can share here so that people can comment on them and make suggestions?

[Sam_H87 in reply to ITYFIALMCTT]

Hi I have hypothyroidism and I am taking medication I will post these

[Sam_H87 in reply to ITYFIALMCTT]

Results now added taking 25mcg levothyroxine

[ITYFIALMCTT in reply to Sam_H87]

Woah - were you only recently diagnosed and just started on the medication?

That's genuinely a TSH of 22 (0.2-4.2)? And your T4 is below the range?

Some people will be along to comment soon and I'll imagine there'll be quite some advice for you.

Were you tested for vitamin and mineral levels? If so, can you post the results as it rounds out the picture because it's difficult to correct thyroid hormone levels when vitamins and minerals aren't in the appropriate range.

[Sam_H87 in reply to ITYFIALMCTT]

Hi I have been on the 25mcg since diagnosis 2012 and I will post vitamin and mineral results now thanks

[SeasideSusie Remembering in reply to Sam_H87]

I have been on the 25mcg since diagnosis 2012

Excuse me, I just have to do this, no offence intended

Oh FFS!

Will be back when I've picked myself up off the floor and read everything.

[ITYFIALMCTT in reply to Sam_H87]

OK, I've just seen in your other post that you've been diagnosed since 2012 and on this dose since then? (Could you delete that other post if no-one has answered there yet?)

shaws SeasideSusie greygoose and others may well have some guidance for you.

[Sam_H87 in reply to ITYFIALMCTT]

Yes been on this dose since 2012. I am sure I need it increased

[shaws Administrator in reply to Sam_H87]

Dump your doctor - he/she is hopeless and knows nothing at ALL about how to treat people who are hypothyroid.

Five years on 25mcg - I wonder if you can sue him/her

[shaws Administrator in reply to Sam_H87]

You are on an inadequate dose of thyroid hormones. Pity doctors are so poorly trained.

A starting dose is 50mcg of levo with a blood test and 25mcg increment every six weeks till we feel much better. Not when the TSH is 'somewhere' in the range. It should be 1 or below.

[Sam_H87]

Parents have told me I can't possibly be hypothyroid and they want me to get second opinion

[SeasideSusie Remembering in reply to Sam_H87]

Ermmmmmmmmm - sorry but do they know more than the doctor who diagnosed you?

How old are you Sam_H87 ?

Why are your parents doubting your diagnosis?

[Sam_H87 in reply to SeasideSusie]

I am 30 years old and they think I am hyperthyroid because of weight loss and tremor and protruding eyes

[SeasideSusie Remembering in reply to Sam_H87]

Sam

they think I am hyperthyroid because of weight loss and tremor and protruding eyes

If these symptoms are intermittent, then this could very well be due to the Hashi's. The fluctuations in antibodies can cause hypo to hyper to hypo swings.

If, however, they are there all the time, further investigation is needed and you should seek a referral to an endocrinologist who is a thyroid specialist, not a diabetes specialist (most endos are diabetes specialists). You can obtain a copy of the thyroid friendly endo list from [e-mail] then ask on the forum for feedback on any you could be referred to.

Protruding eyes can be indicative of hyperthyroidism so it might be an idea to find out if you are hyper or just having Hashi's hyper swings.

Tremor could actually be low B12. Have you posted your vitamin and mineral results -

Vit D

B12

Folate

Ferritin

[Sam_H87 in reply to SeasideSusie]

Thanks the only thing that is there all the time is the tremor so I will post vitamin and mineral results. I am under an endo at the moment.

[SeasideSusie Remembering in reply to Sam_H87]

I am under an endo at the moment.

Then shame on your endo. He/she knows diddly squat about treating hypothyroidism/Hashimoto's. Undoubtedly a diabetes specialist pretending to know what they're doing with thyroid disease.

Sam_H87 I think you should seriously consider finding a new GP and a new endocrinologist. I think you might have realised by now that neither of your present ones know what they're doing and they have kept you unwell. I would also look into whether you have a case for complaint against them both for negligence.

[Angel_of_the_North in reply to Sam_H87]

Don't see how you can be hyper with a TSH of 22 and underrange FT4!!! Tremors can be adrenal/cortisol problems, as can weight loss.

[SeasideSusie Remembering]

Sam_H87 OK, I'm back now, just had to get over that although I shouldn't be surprised at anything any more.

Serum TSH 22 (0.2 - 4.2)

Serum Free T4 10.3 (12 - 22)

Thyroid peroxidase antibodies 91 (<34)

25mcg Levo since diagnosis in 2012

So you have an idiot doctor who knows nothing about treating hypothyroidism.

You are grossly undermedicated with a vastly over range TSH and an under range FTe. You need an immediate increase of 25mcg followed by a retest in 6 weeks time. Then you need a further retest followed by another 25mcg increase after another 6 weeks. Repeat and repeat until your symptoms abate and you feel well. This is the protocol your GP should have followed way back in 2012.

If your GP doesn't agree, find another one. In fact, you'd be better off with another one anyway!

When having thyroid tests, always book the first appointment of the morning, fast overnight (water allowed) and leave off Levo for 24 hours. This gives the highest possible TSH which is needed when looking for an increase in dose or to avoid a reduction. It also means that continuity of conditions allow for accurate comparison of results.

**

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.

From thyroiduk.org.uk/tuk/about_... > Treatment Options

According to the BMA's booklet, "Understanding Thyroid Disorders", many people do not feel well unless their levels are at the bottom of the TSH range or below and at the top of the FT4 range or a little above.

Booklet is written by Dr Anthony Toft, past president of the Briish Thyroid Association and leading endocrinologist. Available from pharmacies and Amazon for about £4.95.

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)."

You can obtain a copy of the article by emailing [e-mail] print it and highlight question 6 to show your GP. Then ask for your increase in dose.

**

Your high, over range, TPO antibodies confirm 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.

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...

**

[Sam_H87]

Ferritin 37 (30 - 400)

Folate 2.2 (2.5 - 19.5)

Vitamin B12 241 (190 - 900)

Total vitamin D 56.3 (50 - 75 vitamin D may be suboptimal and long term may lead to clinical effects. Advise on safe sun exposure and diet. Supplementation may be indicated)

Taking 800iu D3 and 5mg folic acid.

[SeasideSusie Remembering in reply to Sam_H87]

Sam

Ferritin 37 (30 - 400)

Ferritin should be half way through it's range. As yours is so very close to the bottom of it's range I would ask your GP to do an iron panel and full blood count to see if you have iron deficiency anaemia.

You need supplementation and that will probably be in the form of iron tablets unless your GP will agree to an iron infusion to raise your ferritin in 24-48 hours, whereas tablets will take months.

If you are prescribed iron tablets then take each one 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.

Usual treatment is 1 x ferrous fumarate once or twice daily and for iron deficiency then it's 1 x ferrous fumarate 2 or 3 times daily. With your low level of ferritin I imagine that the maximum is required.

Also, eating liver regularly, maximum 200g per week due to it's high Vit A content, will help, as will eating lots of iron rich foods apjcn.nhri.org.tw/server/in...

**

Folate 2.2 (2.5 - 19.5) - 5mg folic acid

Vitamin B12 241 (190 - 900)

Well the folate deficiency is being addressed but you should have been checked for signs of B12 deficiency before starting it because it can mask these signs. Think back and see if you have any signs b12deficiency.info/signs-an... If so then please post on the Pernicious Anaemia Society for further advice, quoting Folate, B12, Ferritin/iron information and any signs of deficiency you may have healthunlocked.com/pasoc

I have read (but not researched so don't have links) 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?" by Sally M. Pacholok:

"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."

So you can see that your B12 needs to increase considerably and your folate should be at least half way through it's range.

**

Total vitamin D 56.3 (50 - 75 vitamin D may be suboptimal and long term may lead to clinical effects. Advise on safe sun exposure and diet. Supplementation may be indicated) - 800iu D3 daily

Well, 800iu D3 isn't going to raise your level. It is hardly a maintenance dose for someone with a reasonable level. What you need is a decent dose of D3 and my suggestion is softgels like these bodykind.com/product/2463-b... and I would take 5000iu daily for 6-8 weeks then retest. Once you've reached the level recommended by the Vit D Council - which is 100-150nmol/L - 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/

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.

[SlowDragon Administrator]

So your high antibodies means you have Hashimoto's, also known as autoimmune thyroid disease. 90% of hypothyroidism is UK is due to autoimmune Hashimoto's

When you have Hashimoto's then hidden food intolerances very likely be causing issues, most common by far is gluten

Very, very many of us with Hashimoto's find changing to strictly gluten free diet helps reduce symptoms significantly and eventually can lower antibodies

thyroidpharmacist.com/artic...

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

chriskresser.com/the-gluten...

Low stomach acid is very common and a cause of low vitamins especially when under medicated, as you are.

Lots of posts on here about how to improve with Apple cider vinegar or Betaine HCL

thyroidpharmacist.com/artic...

Other things to help heal gut lining

Bone broth

thyroidpharmacist.com/artic...

Probiotics

carolinasthyroidinstitute.c...