Medichecks results in today. Advice please?

[Hyburn]

THYROID STIMULATING HORMONE *0.007 mIU/L 0.27-4.20

FREE THYROXINE 14.6 pmol/L 12.00-22.00

TOTAL THYROXINE(T4) 89.8 nmol/L 59.00-154.00

FREE T3 4.91 pmol/L 3.10-6.80

THYROGLOBULIN ANTIBODY 19.300 IU/mL 0.00-115.00

THYROID PEROXIDASE ANTIBODIES 33.4 IU/mL 0.00-34.00

ACTIVE B12 159.0 pmol/L 25.10-165.00

FOLATE (SERUM) 5.1 ug/L 2.91 -50.0025 OH

VITAMIN D 58 nmol/L 50.00 -200.00 Interpretation of results: Deficient <25 Insufficient 25 -49 Normal Range 50 -200 Consider reducing dose >200

Inflammation Marker CRP -HIGH SENSITIVITY *6.6 mg/l 0.00-5.00

Iron Status FERRITIN 86.5 ug/L 13.00-150.00

MAGNESIUM *1.08mmol/L 0.60-1.00 (flagged as high but nothing to worry about - been supplementing so will cut back)

SELENIUM 1.10umol/L 1.00-1.90

RT3 was checked previously on 27 July 2017 and was 33*ng/dL 10.00-24.00 was flagged as too high.

Medichecks comments: "Your thyroid stimulating hormone is low whilst you have normal levels of thyroxine and T3. Given the normal levels of your thyroid hormones I suspect that this is simply due to your T3 suppressing your thyroid stimulating hormone more than would be expected when taking levothyroxine alone.

If you develop symptoms of an over-active thyroid (agitation, weight loss, anxiety, skin/hair changes) then you should discuss this result with your GP as you may need a dose decrease. I recommend rechecking your thyroid function in 3 to 6 months.

Your thyroglobulin antibodies are normal.

Your thyroid peroxidase antibodies are normal.

Your levels of vitamin B12 and folate are normal.

Your vitamin D levels are bordering on insufficient. This may progress to vitamin D insufficiency or deficiency if you don’t take steps to increase your vitamin D levels.

We recommend supplementing with 400 - 800 iu of vitamin D per day for twelve weeks. If you are already taking vitamin D then I recommend that you increase your dose.

Your CRP level is elevated, this is often caused by recent infection, injury or inflammation. If you are experiencing any symptoms such as unexplained fever, pain or inflammation then you should discuss this further with your GP.

The type of CRP test that you have had is one which can also indicate future risk of cardiovascular disease. I recommend repeating this test in 6-8 weeks to see whether it remains elevated. If it does then I recommend that you take a more aggressive approach to managing other cardiovascular risk factors such as blood pressure, cholesterol, diet, smoking and exercise levels.

Your ferritin level is normal indicating healthy iron stores."

On 200mcg Eltroxin and 20mcg NHS prescribed liothyronine when blood was taken.

Can't lose weight, fatigued, brain fog, heat intolerant, low libido, sleep apnoea, asthma, varicose eczema on legs, swollen legs and ankles, poor immune system, regular chest infections that floor me, flaky nails etc. Still feel hypo. NHS endo wants to increase T4 by 25mcg to try and get me into upper quartile of FT4 reference range but will not increase my T3. She does not test for FT3 or rT3 hence used Medichecks.

Was previously diagnosed by NHS as Vit D deficient and prescribed colecalciferol 1600IU for three months then 800IU. Have been taking this for six months already. No loading does given. Take it before bed and thyroid meds first thing on empty stomach. Don't have coffee don't eat for an hour. I am on Ibersartan for high blood pressure, Loratidine & Nasonex spray for hayfever/allergies, and use inhalers for asthma and montelukast tablets.

I have DIO2 gene from one parent which impairs conversion, had gallbladder removed in 1982, and since then have had IBS type symptoms which gastroenterologist subsequently decided was too much bile in my system. Questran he gave me bound me up so stopped using it. Been using apple cider vinegar in water before dinner.

Have been gluten free a while time now. First degree relative is severe coeliac. My blood tests were normal (I was eating gluten at the time) and GP has refused to refer for bowel biopsy (despite NICE guidelines). I feel better not having gluten and endo said I might be gluten intolerant.

Am desperate to feel better, lose weight and get my life back. Your help very much appreciated.

[Hyburn]

Forgot about cortisol saliva tests on 1 August 2017 in case these are relevant:

WAKING 8.13nmol/L (6-21)

12:00 4.16nmol/L (1.50-7.60)

16:00 2.050nmol/L (0.00-5.49)

BEDTIME <1.5nmol/L (0.00-1.99)

[Clutter]

Hyburn,

It's unlikely your FT4 will rise into the upper quartile while you are taking T3. High levels of FT4 aren't required when taking T3 direct. Raising Levothyroxine to 225mcg should raise FT4 but probably not that much and will also raise FT3. Unfortunately, increasing Levothyroxine dose may increase rT3 too.

Thyroid peroxidase antibodies are borderline for autoimmune thyroiditis (Hashimoto's) which could mean they were previously positive and have dropped, or may mean they are increasing and becoming positive. There is no cure for Hashimoto's which causes 90% of hypothyroidism. Levothyroxine treatment is for the low thyroid levels it causes. Many people have found that 100% gluten-free diet is helpful in reducing Hashi flares, symptoms and eventually antibodies.

chriskresser.com/the-gluten...

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

VitD is optimal around 100. It should be taken with the fattiest meal of the day to aid absorption. I would supplement 5,000iu D3 daily x 6 weeks and then reduce to 5,000iu alternate days and retest in 3-4 months.

[Hyburn in reply to Clutter]

Thanks Clutter for responding.

I don't want to increase my T4 but NHS endo does - she won't up my T3 which I think I need to do to get rid of the rT3. Do you think my T3 dose should be increased? I am already gluten free and have been for some time. Was on and off it for years and finally decided to be completely g/f. I believe I have had Hashimoto's for at least 30 years (but was only diagnosed hypo then) - so think levels probably dropping.

I will get Vit D optimised. Do you think my other vits are okay as lab says or should I try to get these up a bit too?

[Clutter in reply to Hyburn]

Hyburn,

I'd be inclined to raise T3 dose rather than Levothyroxine.

Folate is a bit low. It wouldn't hurt to supplement folic acid or methylfolate for 2-3 months to raise it and eating leafy green veg is good for raising folate.

[Hyburn in reply to Clutter]

Thanks again Clutter . I have increased my T3 by half a Tiromel (12.5 mcgs) and reduced Eltroxin by 50mcgs. Will sort out vits too & see how I go. Have endo appt in October.

[Clutter in reply to Hyburn]

Hyburn,

There was no need to reduce Levothyroxine because FT4 is low in range. Reducing Eltroxin by 50mcg and adding 12.5mcg T3 is equivalent to an overall 12.5mcg T4 dose reduction.

[Hyburn in reply to Clutter]

Thanks will add it back then. Thought because I had DIO2 gene & didn't convert well that T4 wasn't that important.

[Clutter in reply to Hyburn]

Hyburn,

The impairment just means that a little T3 added to T4 is helpful in improving conversion.

[Kell-E in reply to Hyburn]

If your rt3 is too high adding t3 will help some because at least there will be more competition for the t3 receptors. But I think you were correct in reducing t4 dose because a certain percentage is being converted to rt3, and you want to reduce rt3.

People in this forum do not seem to put much stock in the whole rt3 thing, but it certainly seems to have merit.

[Hyburn in reply to Kell-E]

Thanks for your reply. That is what I thought too but someone said not to reduce my T4.

[Kell-E in reply to Hyburn]

I saw that. It does not mean they are right.

[SeasideSusie Remembering]

Hyburn

THYROID STIMULATING HORMONE *0.007 mIU/L 0.27-4.20

FREE THYROXINE 14.6 pmol/L 12.00-22.00

TOTAL THYROXINE(T4) 89.8 nmol/L 59.00-154.00

FREE T3 4.91 pmol/L 3.10-6.80

On 200mcg Eltroxin and 20mcg NHS prescribed liothyronine when blood was taken.

"NHS endo wants to increase T4 by 25mcg to try and get me into upper quartile of FT4 reference range but will not increase my T3"

FT4 in the upper quartile really is only generally best when on Levo only. I wonder if your endo doesn't realise that taking T3 tends to lower FT4. I'm not sure increasing your Levo more will help, it's more T3 that you definitely need (and I know that you have added some self-sourced T3).

With everything that's going on, and the other medications you take, plus a couple of your nutrients not at optimal levels, then it could be affecting the absorption of your thyroid meds.

**

THYROGLOBULIN ANTIBODY 19.300 IU/mL 0.00-115.00

THYROID PEROXIDASE ANTIBODIES 33.4 IU/mL 0.00-34.00

I think your TPO antibodies are so close to the upper end of the range that you could very well be Hashi's. Being gluten free and taking selenium will help with reducing antibodies. It would be worth pushing for the bowel biopsy (print and quote the guidelines), if you have a diagnosis of coeliac it may well throw some light on why such a large dose of Levo is only producing a low FT4 (absorption problem?).

**

ACTIVE B12 159.0 pmol/L 25.10-165.00

FOLATE (SERUM) 5.1 ug/L 2.91 -50.0025 OH

I'm not good with Active B12 but it is sitting at the upper end of the range so that should be good. Folate is too low, that should be at least half way through range and if B12 is high then there's no problem with a high folate level. A good B Complex with 400mcg methylfolate will help raise your folate level - look at Thorne Basic B and Metabolics B Complex.

**

VITAMIN D 58 nmol/L 50.00 -200.00 Interpretation of results: Deficient <25 Insufficient 25 -49 Normal Range 50 -200 Consider reducing dose >200

The recommended level, according to the Vit D Council, is 100-150nmol/L. My suggestion would be for some D3 softgels like these bodykind.com/product/2463-b... and take 5000iu daily for 6-8 weeks then retest. Once you've 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.

**

FERRITIN 86.5 ug/L 13.00-150.00

This is over the level needed for thyroid hormone to work (which is 70) so that's good, although I've seen it said for females 100-130 is best. You don't really need to supplement but eating liver regularly (no more than 200g per week due to it's high Vit A content) and including lots of iron rich foods in your diet will maintain and could even raise your level apjcn.nhri.org.tw/server/in...

**

Do you do anything to support your immune system? Regular chest infections will obviously be debilitating. As I have a chronic, progressive lung disease, I need to do everything possible to prevent lung infections. I take Vit C daily (you can take that to bowel tolerance if you wish), I also take garlic liquid supplement daily (the liquid is more bioavailable than capsules), during the winter months I take a homoeopathic 'flu preventive' oscillococcinum (one a month November-April and I get mine made up at a homoeopathic pharmacy), plus at the first sign of any infection I take Oil of Oregano capsules which come from Greece.

**

This doesn't cover everything going on with you, I've only commented on what I have knowledge and experience of. Hopefully someone else will come along and offer some helpful suggestions.

[Hyburn]

Thank you sooo much SeasideSusie . This is VERY helpful. I will need to take time to go through it and make notes. I am hopeful of getting to the bottom of things with the help from this group.

[Hyburn]

Thanks again Clutter . I have been on 20mcg liothyronine for at least 8 years. I didn't realise it was so long but was prescribed by Dr Toft before he retired from the NHS & discovered on Spire website that was in 2009. At that time was on 175mcg of Eltroxin. Current endo increased this to 200mcg about 6 months ago but it only raised FT4 from 14.5pmol/L to 15.9pmol/L (9.0-21.0). TT3 stayed the same @ 1.6nmol/L (0.9-2.5). She does not test FT3 or antibodies. Was so fed up I ordered rT3 from Medichecks then went on from there.