New interpretation of results required please

[Zoellav]

Thyroid peroxidase antibodies 89.3 (<34 IU/mL)

Thyroglobulin antibodies 510.5 (<115 IU/mL)

TSH 54.8 (0.2 - 4.2 mIU/L)

Free T4 10.1 (12 - 22 pmol/L)

Free T3 3.0 (3.1 - 6.8 pmol/L)

Thanks

[SlowDragon Administrator]

Are you in UK? Has your GP seen these results? If so what dose of Levothyroxine has been prescribed

Or are you already on Levothyroxine and diagnosed as having Hashimoto's. (Autoimmune Thyroid disease)

As your antibodies are high this is definitely Hashimoto's, (also known as autoimmune thyroid disease). About 90% of hypothyroidism in UK is due to Hashimoto's.

Hashimoto's very often affects the gut, leading to low stomach acid, low vitamin levels and leaky gut.

Low vitamins that affect thyroid are vitamin D, folate, ferritin and B12. Important to test these. If they are too low they stop Thyroid hormones working. Have these been tested? if not ask that they are. Always get actual results and ranges.

As you have Hashimoto's then hidden food intolerances may be causing issues, most common by far is gluten. Changing to a strictly gluten free diet may help reduce symptoms and eventually start to lower antibodies. Very very many of us here find it really helps and can slowly lower antibodies, improving symptoms

thyroidpharmacist.com/artic...

thyroidpharmacist.com/artic...

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

chriskresser.com/the-gluten...

[Zoellav in reply to SlowDragon]

I'm in UK and GP hasn't seen results, they are NHS ones and I am not on thyroid meds and I am undiagnosed

[Zoellav]

Ferritin 15 (30 - 400 ng/L)

Folate 2.3 (4.6 - 18.7 ng/L)

Vitamin B12 157 (180 - 900 pg/L)

Vitamin D 24.4 (<25 nmol/L severe deficiency)

[SlowDragon Administrator]

So you need to take all these results, including vitamins to GP.

You are hypothyroid and need starting on Levothyroxine (replacement thyroid hormone) - 50mcg is typical starting dose.

Always take Levo on empty stomach and then nothing apart from water for at least an hour after. Many take on waking, but it may be more convenient and possibly more effective taken at bedtime

verywell.com/should-i-take-...

Many people find Levothyroxine brands are not interchangeable. Once you find a brand that suits you, best to make sure to only get that one at each prescription.

You will need retesting after 6-8 weeks and most likely dose increased in 25mcg step. Retesting etc until TSH is around one.

All thyroid tests should be done as early as possible in morning and fasting and if taking Levo don't take it in the 24 hours prior to test, delay and take straight after.

You will also need supplements to improve ferritin and vitamin D.

Full testing for Pernicious Anaemia, and intrinsic factor before also supplementing B12 and folate

SeasideSusie is the supplements expert. She will no doubt reply too

[SeasideSusie Remembering]

Zoellav

Ferritin 15 (30 - 400 ng/L)

You need to ask for an iron panel and full blood count to see if you have iron deficiency anaemia.

Ferritin needs to be at least 70 for any thyroid hormone to work (our own or replacement), and recommended is half way through range.

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.

If you are diagnosed with iron deficiency anaemia then the treatment is 1 x ferrous fumarate two or times a day, with your ferritin level it ought to be the maximum.

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...

**

Folate 2.3 (4.6 - 18.7 ng/L) Vitamin B12 157 (180 - 900 pg/L)

You are both folate and B12 deficient. Please post on the Pernicious Anaemia Society forum for further advice healthunlocked.com/pasoc/posts

Check to see if you have any signs of B12 deficiency (I'd be surprised if you don't), if so quote them in your post, along with your folate, B12 and ferritin/iron results. You will probably be advised to have testing for Pernicious Anaemia and may well need B12 injections. Whatever they advise, discuss with your GP.

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."

**

Vitamin D 24.4 (<25 nmol/L severe deficiency)

You have severe Vit D deficiency. Point this out to your GP and ask him to follow the guidelines.

NICE treatment summary for Vit D deficiency:

cks.nice.org.uk/vitamin-d-d...

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. Go and see your GP and ask that he treats you according to the guidelines and prescribes the loading doses. Do not accept 800iu D3, that is their prescribed maintenance dose once loading doses are finished, and it isn't even enough then. Once the loading doses have been completed you will need a reduced amount (more than the 800iu you will be prescribed) 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/