I'm new here - am posting on behalf of my wife who was diagnosed as hypothyroid around 20 years ago. She appeared to be medicated correctly on levo up until around 4 years ago, when started to notice hypo symptoms returning - primarily hair thinning and loss but also has low heart rate, feeling cold, dizziness, motion sickness, dry skin, low energy, brain fog and more. We now think this "attack" on her thyroid was triggered by pregnancy/giving birth.
Very upsetting experiences with her doctor/endo who on top of this reduced her dose to 150mg levo - has now led us to get a private tests with the following results.
TSH - 15.10 mlU/L (0.27-4.2)
T4 Total - 62.3nmol/L (64.5-142)
Free T4 - 11.80 pmol/L (12- 22)
Free T3 - 2.78 pmol/L (3.1 - 6.8)
Anti-Thyriodperoxidase abs - 9.0 (<34)
Anti-Thyroglobulin abs - 155 (<115)
Vitamin D (25 OH) - 57 (51-174)
Vitamin B12- 327 (251-724)
Serum Folate - 34.6 (8.83 - 60.8)
She didn't take any levo for 2 days before the tests were done.
So my wife looks like she is is undermedicated and needs an increased dose of levo, which would hopefully raise her Free T4 (and maybe her T3..?). Before these results we discussed switching to NDT though to get T4 & T3. Also not sure exactly what the high anti-thyroglobin abs means and her vitamins also seem not ideal?
Any advice on these results would be gratefully received!
Thanks
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mackadoo
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It looks like she is undermedicated, especially with signs and symptoms such as low heart rate, feeling cold and dry skin. The blood test results indicate this but skipping two days levothyroxine makes them inaccurate. If we try to compensate for this maybe her 'real fT4' is around 14.0 which is still low for someone on levothyroxine. When having a blood test you should avoid having the blood drawn within about three hours of you last levothyroxine dose but not let it go over 24 hours.
Usually patients on levothyroxine do well when their fT4 is around 18 – 20 and their TSH is around 0.5 – 2.0. This usually brings fT3 towards the middle of its interval. However, it is more important to go by signs and symptoms than blood tests. I would get the doctor to increase her levothyroxine dose and see how she goes. If this doesn’t work then it makes sense to introduce some liothyronine (L-T3) rather than pushing fT4 too high.
I would always go along with your wife when she is seeing the doctor about her thyroid, otherwise they tend to bully patients and be unhelpful. It's important to be polite but assertive and make sure they address her hormone status.
Hi jimh111, thanks for your reply and comments/advice. Yes I agree going for more than 24hrs without levo before testing was not ideal. Very bad experiences with her GP and when she does go back I will definitely go with her.
Hello macadoo, your wife's thyroid antibodies are raised as shown by the thyroglobulin result. It is more unusual but entirely possible to have raised thyroglobulin and low thyroid peroxidase although I've seen it before on this forum. There are other conditions that might raise thyroglobulin antibodies too so discuss with GP. Thyroid antibodies are raised in Hashimotos thyroiditis. You can read about it on Thyroid UK website.
Your wife needs to increase thyroid meds. She is undermedicated. Most people don't feel well until their TSH is around 1.0 or slightly lower and FT3&FT4 are near top of range.
Vitamin deficiencies need addressing for Levothyroxine to work well. Results show vitamin D deficiency and there is no iron or ferritin result listed. VITAMIN B12 needs to be top of range for optimal health.
The high antibodies mean that your wife is 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.
As Nanaedake says, it's more common for TPO to be raised, but it is possible for TPO to be normal and TG antibodies raised.
She 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.
Your wife needs an immediate increase in her Levo to bring her TSH down and increase her free Ts. 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.
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Vitamin D (25 OH) - 57 (51-174)
Th recommended level, according to the Vit D Council, is 100-150nmol/L.
Your wife could supplement with D3 softgels like these bodykind.com/product/2463-b... and I suggest taking 5000iu daily for 3 months then retest. When she's reached the recommended level she'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
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
If none present then her B12 could do with improving. 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."
Sublingual methylcobalamin lozenges are what's needed to supplement B12 yourself along with a good B Complex to balance all the B vitamins.
Folate should be at least half way through it's range so that result is pretty good.
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Was ferritin tested? That should be half way through it's range with a minimum of 70 for thyroid hormone to work, and I've read that for females it should be 100-130. Low ferritin can be one cause of hair loss, but it's a hypo symptom as well.
Yes, some supplementation is needed, but she could also raise her level by eating liver regularly, maximum 200g per week due to it's high Vit A content, and including lots of iron rich foods in your diet apjcn.nhri.org.tw/server/in... I raised mine from 35 to 91 just by eating liver (still do now), much easier than trying to fit iron supplements around everything else. Iron tablets need to be taken 4 hours away from thyroid meds and two hours away from other medication and supplements as it will affect absorption and with 1000mg Vit C with each tablet to aid absorption.
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