Thyroid UK
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Help interpreting results - Hypothyroid

Hi,

My 3rd post here and I'm hoping for some advice please. I've been struggling with symptoms for nearly a year. I've been on thyroxine up to 200mcg/day and was overmedicated (t3 above range) and a host of horrible symptoms. I reduced to 175 and felt immediate relief but then after a few weeks began to feel overmedicated again - nausea, palpitations, feeling like I want to get out of myself (if that makes sense). Stuck with it for 8 weeks and now have the following results from blood tests. Left a gap of 24 hours between taking the thyroxine and the blood test. After the test I stopped thyroxine for a few days and felt instantly better. Not sure what to do next, any help would be much appreciated in interpreting the below:

Serum TSH level 0.12 mu/L [0.4 - 5.5]

Serum free T4 level 19.0 pmol/L [11.0 - 26.0]

Serum free triiodothyronine level 5.2 pmol/L [3.0 - 6.0]

Serum vitamin B12 level 550 ng/L [190.0 - 910.0]

Serum ferritin level 241 ug/L [22.0 - 322.0]

Serum folate level 10.2 ng/mL [3.9 - 26.8]

Restandardisation of serum folate assay.

THYROID PEROXIDASE ANTIBODY 443 iu/mL [< 50.0]

VITAMIN D 43.5 nmol/L (Total 25-OH Vitamin D, inc D2+D3):

I'm losing hope of ever feeling better. Thanks in advance for your assistance.

PS. I've tried 150 and felt undermedicated and I've tried 175 and felt hyper. Main symptoms are afternoon headaches, tiredness in the morning and a feeling of general malaise. Strangely when on 175 I felt near perfect at week 4 then felt bad from week 5 onwards.

16 Replies
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You haven't got an FT3 result? FT4 is within range but without FT3 its hard to say except it looks like you are not overmedicated. You have got elevated antibodies so have you tried supplementing 200mcg of selenium daily and taking a little magnesium at night? B12 could still be nearer the top of the range so if you're supplementing I'd carry on until next bloods and check again.

What levothyroxine are you taking? You could try swapping to another readily available formulation to see if it helps.

Perhaps it's just going to take a little longer than 8 weeks for everything to settle down on your current dose?

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Hi, had another look triiodothyronine is T3 which is 5.2. Ref the selenium and magnesium, I haven't tried that yet.

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Ok, you haven't given a reference range for FT3 but if it's the normal UK range it isn't too high. Can't be sure without the range though.

Give selenium and magnesium a go and have you also tried going gluten free? Many people with Hashimotos thyroiditis say it helps to prevent antibodies attacks and helps vitamin absorption.

naturalnews.com/046401_magn...

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This is roundthebends FT3 result:

Serum free triiodothyronine level 5.2 pmol/L [3.0 - 6.0]

2 likes
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Hi - the first thing that jumps out is that your vit d is too low and needs to be supplemented. Important to take vit k2-mk7 and magnesium.

The other thing is that you have active Hashimotos as shown by your high anti-bodies. I believe that particular being high shows an active attack. You aren't actuaactually over- medicated at all, in fact apart from those your numbers look fairly good. I wouldn't be inclined to change your dose again.

You didn't mention being gluten free - have you had a strict trial of that for at least 3 months to see if it makes a difference? It does for many of us and, combined with a suppressed tsh can, over time, help reduce the active attacks with associated hypo/hyper/hypo swings.

Gillian

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Thanks for the response. The fact that my numbers seem to look good overall is the bit that concerns me the most.....why then do I feel like poop :) I have an appointment with the nurse tomorrow and will speak about the low vit D.

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I'll also ask about going gluten free

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Your nurse is unlikely to know that going g/f can help with thyroid issues. Just saying it would be worth you trying it.

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No matter how good the results look, some people do not feel the benefit and it is how we feel which is the priority. Your FT4 could be little higher. Research has shown that T4/T3 benefits many hypothyroid patients. Now that they've withdrawn it is problematic. I think I'd source some T3 of my own and trial some with your T4. I shall add in SeasideSusie re your vitamins/minerals.

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Thanks. Just looking at my GP notes and he has written 'patient struggling to control symptoms, may benefit from T3'. However when I was on 200 my T3 was over range and T4 in range and the GP then said it didn't look like conversion issues

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Roundthebend As startagaingirl has mentioned, 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 imagine it is these fluctuations that are causing your problems and tweaking meds as necessary can help.

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.

Gluten/thyroid connection: chriskresser.com/the-gluten...

stopthethyroidmadness.com/h...

stopthethyroidmadness.com/h...

hypothyroidmom.com/hashimot...

thyroiduk.org.uk/tuk/about_...

**

As for vitamins and minerals, doctors generally don't know anything other than 'if it's in range then it must be fine'. They're not taught nutrition so unless you have a severe deficiency you don't get much, if any, help.

All vitamins and minerals need to be at optimal levels for thyroid hormone to work, regardless of what doctors say.

Serum vitamin B12 level 550 ng/L [190.0 - 910.0]

Serum folate level 10.2 ng/mL [3.9 - 26.8]

These work together. As for B12, 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."

That's good enough for me and I keep my level at around 1000. Sublingual methylcobalamin lozenges are what's needed if you wish to self supplement, along with a good quality B Complex to balance all the B vitamins.

Folate should be at least half way through it's range (15.35+ with that range) so a B Complex will help raise it.

**

Serum ferritin level 241 ug/L [22.0 - 322.0]

This is high. Are you supplementing? If not it should be mentioned to your GP for possible investigation.

**

VITAMIN D 43.5 nmol/L (Total 25-OH Vitamin D, inc D2+D3)

The recommended level, according to the Vit D Council, is 100-150nmol/L. Your level is far too low. My suggestion would be to buy some D3 softgels like these bodykind.com/product/2463-b... and take 5000iu daily for 2-3 months then retest. When you have reached the recommended level 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

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.

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Hi, great advice! Many thanks. Discussed with the doctor today and they gave me D3 but only 800iu so I'll see how I go and probably will order 5000iu myself. Aside from that the doctor didn't see anything of real concern and wants to approach 1 thing at a time to manage improvements. I sort of agree that it's easier to manage by sorting one thing at a time but I hope it won't take forever.

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Well, 800iu D3 wont raise your level, it's barely a maintenance dose for someone with a decent level to start with.

Just be aware that all vitamins and minerals - Vit D, B12, Folate and Ferritin - need to be optimal for thyroid hormone to work.

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Thought as much. Ordered the capsules you recommended as I can't be bothered messing around. Ref the Sublingual methylcobalamin lozenges and vitamin b complex. Can you recommend which ones? Looking at the internet it seems a bit of a minefield and I'd rather go with the tried and tested.

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For B Complex the one I use and recommend has just almost doubled in price, so I suggest Thorne Basic B.

As for B12, you only really need 1000mcg and this is the one I use cytoplan.co.uk/vitamin-b12-...

Don't forget the cofactors that are needed when supplementing with D3.

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Will do. Thanks for the time. Let's see what happens :)

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