Hi I am new and I am confused by results and symptoms. I had an ultrasound which showed I have a bulky thyroid gland in 2012. I had a second ultrasound in 2015 which showed the thyroid was hypoechoic. Since this time I have a goitre that has been growing down into my chest and I was diagnosed hypothyroid/Hashimotos in 2013. I have been on 50mcg Levo for all this time. Due to symptoms of feeling cold, headaches, constipation, joint pain, hair loss, tiredness, sweats, is it possible I am Hashitoxic? Endo and GP say I am over replaced. I am so confused right now. Thank you!
TPA 685.3 (<34)
TGA >1300 (<115)
TSH 0.03 (0.2 - 4.2)
FREE T4 22.6 (12 - 22)
FREE T3 4.3 (3.1 - 6.8)
VITAMIN B12 144 (180 - 900)
FERRITIN 21 (30 - 400)
FOLATE 1.8 (2.5 - 19.5)
VITAMIN D TOTAL 25.5 (25 - 50 DEFICIENT)
Written by
Kitsun
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Kitsun - post the thyroid test results (with reference ranges) which, according to your endo and GP, show that you're overmedicated.
TPA 685.3 (<34)
TGA >1300 (<115)
Your antibodies are very high.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.
Some of your symptoms are indicative of low nutrient levels. Have you had the following tested, if so please post results for comment, if not then ask for them to be done
TSH is irrelevant when taking replacement thyroid hormone. TSH is a pituitary hormone, the pituitary checks to see if there is enough thyroid hormone, if not it sends a message to the thyroid to produce some. That message is TSH (Thyroid Stimulating Hormone). In this case TSH will be high. If there is enough hormone - and this happens if you take any replacement hormone - then there's no need for the pituitary to send the message to the thyroid so TSH remains low.
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)."
If you would like a copy of the article, email louise.roberts@thyroiduk.org and you can print it off, highlight question 6 to show your endo and GP.
Dr Toft is past president of the British Thyroid Association and leading endocrinologist. He also wrote a booklet "Understanding Thyroid Disorders", where he states "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." The booklet is published by the British Medical Association for patients and it is available from pharmacies and Amazon for about £4.95.
You can only be overmedicated if FT3 goes over range.
Do you have any signs of B12 deficiency b12deficiency.info/signs-an... (I'd be surprised if you don't) .If so then post on the Pernicious Anaemia Society forum for further advice. Include your B12, folate and ferritin results, iron deficiency information if you've been tested, and mention any signs of B12 deficiency you 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."
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FERRITIN 21 (30 - 400)
Did you have a full blood count and iron panel done to see if you have iron deficiency anaemia?
Ferritin must be at least 70 for thyroid hormone to work (our own or replacement hormone).
If you are found to have iron deficiency anaemia then the treatment is as follows
NICE Clinical Knowledge Summary for iron deficiency anaemia treatment (which will be very similar to your local area guidelines)
•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.
If no iron deficiency anaemia then treatment for low ferritin would be 1 x ferrous fumarate once or twice daily. With below range ferritin I think you should have the maximum amount.
Ideally you need an iron infusion so ask for one, but you may only be prescribed tablets which will take months to raise your level whereas an infusion will raise your level within 24-48 hours.
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.
You can help raise your 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...
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VITAMIN D TOTAL 25.5 (25 - 50 DEFICIENT)
You are 0.5 away from severe Vit D Deficiency. Point this out to your GP and ask to be treated with loading doses of D3 not the 800iu daily he will probably want to prescribe.
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.
Once the loading doses 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 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
Don't start all supplements at the same time. Start with one, give it a week or two and if no adverse reaction then add in the second one, give them a week or two, if no reaction add in the next one, etc. This ensures that if you do have any reaction you will know what caused it.
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Your GP has been extremely negligent in ignoring these results, you have severe deficiencies in all of them and they can make you very ill.
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Please come back and tell us what your GP says - although you may wish to see a different one - and tell us what he is going to do.
I have below range MCV 77.5 (80 - 98) and above range MCHC 369 (310 - 350), they were the only things out of range. Iron panel was normal with iron 8.2 (6.0 - 26.0) and transferrin saturation 14 (10 - 30)
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