Thyroid UK
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I'm new and everyone suggested getting bloods. Here are the results. Can anyone help please.

Hi again,

I posted last week for the first time and got a lot of really helpful replies, everyone said get bloods done and post again, so here are my son's blood results and a reminder of his problems. He is 26 and was diagnosed hypothyroid 2 years ago. He had been treated for depression for a year before that and for the first year after diagnosis too. He takes Levothyroxine 62.5mcg and Liothyronine 10mcg. He is very fit and likes to run and cycle. He has energy for 2-3 weeks to work and exercise then he is exhausted and manages to work but nothing else (tree surgery- physical work). 2 weeks ago he ran a 6 mile hill race and played squash- extra physical activity, other than work he spent that week in bed, extremely tired and thoroughly fed up of feeling tired so often. This week he has managed work and some exercise but is exhausted again. This is all fairly typical of the last year.He had been off work for 18 months and started back in Jan 17

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I’m sorry this is so long. We really need some help please. It’s been a long and difficult 3 years. Neil has a GP appointment tomorrow so it would be great to get some advice. She is pretty helpful but admits to be at the limit of her knowledge, but she is open to ideas.

TSH 1.52 (0.27-4.20)

Free Thyroxine 15.1 (12-22)

T4 87.2 (59-154)

Free T3 5.06 (3.10-6.80)

Thyroglobulin antibodies <10 (0-115)

Thyroid Peroxidase <9 (0-34)

Active B12 99.9 (25.1-165)

Folate 11.13 (2.91-50)

Vitamin D (25OH) 58.3 (50-200)

Ferritin 260 (30-400)

CRP 2.3 (0-5)

Previous results

TSH 0.81Aug 16, 1.36in Dec 16, 1.56 June 17. NHs refused T4, T3 last time.

Antibodies 11 2015

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tired22

TSH 1.52 (0.27-4.20)

Free Thyroxine 15.1 (12-22)

T4 87.2 (59-154)

Free T3 5.06 (3.10-6.80)

I would say these suggest he is undermedicated. Most treated hypo patients feel best when TSH is 1 or below. As your son is taking T3, you'd expect to see a lower, even suppressed TSH, and a lowish FT4, and there is room for his FT3 to improve. His FT3 is 52% through range, it can easily be in the upper quarter so 5.9+

Hard exercise uses up T3, as he is not optimally medicated, and with the amount of exercise he is doing, then he is using up what T3 he has and it's not being replaced with such a tiny dose of T3 at 10mcg. I think the first thing I would do is increase his dose of T3 to 15mcg and see how he goes from there. It's possible to increase his Levo, and if his conversion is good enough then that would incease his FT3 as well as FT4, but as he's only on 10mcg T3 my thoughts are to increase that first. It would be an idea to ease off on the exercise until he is optimally medicated.

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Thyroglobulin antibodies <10 (0-115) Thyroid Peroxidase <9 (0-34)

These are fine, no sign of autoimmune thyroid disease with these results.

**

Active B12 99.9 (25.1-165)

Folate 11.13 (2.91-50)

I can't comment on Active B12, I only know about normal serum B12. However, folate should be at least half way through it's range. Taking a good quality B Complex containing 400mcg methylfolate can help raise folate level (eg Thorne Basic B), and eating lots of leafy greens can too.

**

Vitamin D (25OH) 58.3 (50-200)

The level recommended by the Vit D Council is 100-150nmol/L. He should supplement with D3 softgels like these bodykind.com/product/2463-b... and I'd suggest 5000iu daily for 8 weeks, then reduce to 5000iu alternate days. Retest 3 months after starting supplements. When he's reached the recommended level he needs to find a maintenance dose which may be 2000iu daily (or stay on 5000iu alternate days), may be less, and as he works outdoors he may need to supplement during the winter months only if he gets the sun on his bare skin (no sunscreen) for about 20-30 minutes daily during the summer. 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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Ferritin 260 (30-400)

This is good.

**

CRP 2.3 (0-5)

Within range so that's fine.

**

Bear in mind that GPs aren't trained in nutrition so his GP may not agree with the suggestions for supplements. When hypo we need optimal levels for all our vitamins and minerals, not just 'in range' which satisfies most GPs.

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Wow, thank you for the quick reply, I am really grateful,I had been feeling a bit of "where do we go from here". Brilliant info exactly what i was wondering about, should it be T3 dose that increases or Levo. What would the normal ratio of Levo to T3 be? i am just learning. Neil has a half marathon next weekend and he is a bit reluctant to increase anything before then. What would your view be on that? Can he get the D3 on the NHS? he is on a low income (though i am happy to buy). Sorry lots of questions.

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tired22 There isn't really a normal Levo to T3 ratio. We need what we need and we're all individual. I use 100mcg Levo to 25mcg T3 of one brand, and 31.25mcg T3 of different brand. You'll read that people need Levo:T3 at 3:1, 4:1, even 14:1. Some people find that 5mcg or 6.25mcg T3 makes a vast difference, others need much more. It really is a case of see what suits you.

If I reduce my Levo enough to make my FT4 plummet to bottom of range, I can't function. I need my FT4 at least half way, preferably the upper third, with FT3 close to the top. Other people function at different levels. You just have to find what is best. If your son is fine with FT4 that low, that's OK. Experiment, it can be a long road with lots of tweaks! Main thing is to get TSH down, and increasing either should do that. But personally, I feel that with all the exercise he does then he is using up his valuable T3 and he can't afford to do that.

If he is determined to do his half marathon, then increasing dose before then should probably help if it's T3 as it's quicker acting, if it's Levo there wont be much difference as it takes so much longer to notice any improvement. I can't think of any reason not to increase beforehand. But I do doubt the sense of doing all this exercise while he gets so exhausted.

He wont get D3 on the NHS with that level. If he was below 50 he might get 800iu prescribed but that's all. The softgels I linked to are actually very cheap and an excellent product. £13.95 for 360 softgels, that's a year's supply if you took one a day, and he will only need one a day for a few weeks then he'll reduce to alternate days, or even maybe 4 days a week, and maybe winter only. If you're in England and pay for prescriptions, that is an awful lot cheaper than having it on prescription.

The K2-MK7 and magnesium can't be prescribed so that will have to be purchased, as will the B Complex. Natural Calm Original Magnesium Citrate powder is cheap enough, mix with orange juice, start with a small amount, build up, one pot lasts a long time. Be careful though as it can have a laxative effect. If this is a problem, choose a different form of magnesium.

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Thank you Seaside Susie. He has been training and looking forward to this race for months, so it would be a huge disappointment not to do it, his exercise is the thing that is most important to him and his biggest priority after his his work. So its a catch 22 situation. I will try and convince him to take more T3 and hopefully the GP will encourage this tomorrow too. I have already looked at ordering some of the vitamins etc. Slow Dragon suggested a vitamin D spray, might try that rather than tabs?

We are in Scotland so don't pay for prescriptions, and we are lucky enough that he gets the T3 on prescription too. It comes from America i think.

Thank you again, you and this forum have given us new hope of getting our happy, energetic son back again :)

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I've not used a Vit D spray so can't really comment. It does say 'for better absorption' as it bypasses the stomach. So it's personal choice really. I used the Doctor's Best softgels and raised my Vit D from severely deficient at 15 to 202 in 2.5 months, so I was very happy with them, and they are so cheap and only contain the 2 ingredients - D3 and olive oil. I'm all for as few ingredients as possible, so many nasties in everything these days.

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That seems reasonable, we'll go with the gels.

Thank you so much again. I'm sure i will be on with more questions in the future.

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oops another quick question. You say T3 acts quicker. How quick would you estimate?

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He needs dose increase (25mcg) to bring TSH back lower. You might have to fight for that

Vitamin D needs supplementing. Aim for around 100nmol/L

Vitamin D mouth spray by Better You is easy to use and avoids gut

May be 3000iu daily to increase. Might need more but try this and retest after 2 months.

Test twice yearly to keep stable Maintenance dose may be 1-2000iu - may need more in winter than summer

Some people only need small dose to get rapid improvement so essential to test

Vitamindtest.org.uk - £28 postal kit

Adding Magnesium supplements recommended too when taking vitamin D.

Not sure about active B12 test- looks ok

Might try adding vitamin B complex a month or so after starting vitamin D/Magnesium

Only add one thing at a time and wait 2 weeks before adding another. Would perhaps add magnesium before vitamin D

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Thanks for your quick reply. You say change one thing at a time, so thyroid meds first then Vit D then magnesium, is that right_ i am just learning.

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I think SeasideSusie is correct- tweak T3 up first.

Then personally I would add magnesium first, followed by vitamin D, but either way is fine

No his vitamin D is not low enough for GP to prescribe and they only are allowed to prescribe 800iu (very rarely enough)

A half marathon is quite an ask. But yes probably don't increase T3 until after as adrenals have to catch up when dose changes

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Thank you Slow Dragon. I feel we have a way forward. I need to try to get this poor lad better, for all our sakes but especially his.

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hi again Slow Dragon

i don't understand about the T3 increase, marathon and Adrenals. Would you mind explaining? I feel he relies on me for best way forward and I'm not clear about that. Thanks

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One of the reasons we have to increase thyroxine dose slowly is the rest of the Endocrine system and metabolism generally has to catch up.

So we increase, wait 2-3 months for every thing to readjust, and then retest.

When we first increase, the others get out of balance and it can make you feel rough, until it all balances, especially if adrenals are exhausted.

Adrenal system is even more critical to health that thyroid.

The trouble is when we are under medicated and run out of energy, the adrenals have to kick in, to compensate so we start running on adrenaline.

Many hypos don't present as over weight, sluggish and exhausted.

Instead when very hypo we can be running almost all the time on adrenaline - may be thin, wired and with hyper type symptoms, unable to sleep but also exhausted

It becomes catch twenty two, if you are hypo, and undiagnosed a long time adrenals can be exhausted. But you need to increase thyroxine dose, which also requires more adrenaline.

Why GP's should always consider adrenals before starting a patient on thyroxine

If have been very hypo a long time before diagnosis people may need to creep Levothyroxine dose up incredibly slowly to avoid adrenal collapse.

Adrenal exhaustion is not the same as Addison's disease. Many hypos experience adrenal exhaustion to some extent.

With Addison's disease the adrenal system can not respond at all and its extremely serious and fatal if untreated. Treatment is with steroids.

With Adrenal exhaustion, the adrenal system can respond, but it's been working flat out for too long and is worn out.

NHS doesn't really acknowledge it exists.

This is good website to explain it

drlam.com

Vitamin D isn't actually a vitamin but a pre-steroid, so you can see why so many hypos run low on vitamin D

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Fabulous explanation, thank you. Neil has had some hyper symptoms periodically, especially after a race, so i am sure you have described his situation exactly! Since Neil has been treated for some time would you think that increasing by 5mcg of T3 would be a risk if running this half marathon in a week. He will definitely run but if he needs the T3 i think that sounds like a good way forward. What do you think?

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Hello tired22, i am writing you this before I go to bed it is 4 AM Eastern standard time where I live in the US but your post caught my attention. If you write me , Please do not be alarmed as I will be delayed due to the time difference.

I feel very deeply about the situation your son and yourself are living.

The vitamin D read caught my eye as I have been chronically low however your sons is high #.

please take a look at this as I remember reading sometime ago how it's not good to have high vitamin D either. I do not wish to alarm you but I do want to get this to you

Big hugs!!😊🌺🌈

en.m.wikipedia.org/wiki/Hyp...

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No vitamin D is not high

In USA you have very different units to measure vitamin D

endmemo.com/medical/unitcon...

58.3 nmol/L (UK) is only 23.35 ng/ml (USA)

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Thanks for that SlowDragon. I had a study of the Viamin D council last night, lots of info to absorb. I read lots about Adrenal exhaustion too. Last night i asked you "Since Neil has been treated for some time would you think that increasing by 5mcg of T3 would be a risk if running this half marathon in a week. He will definitely run but if he needs the T3 i think that sounds like a good way forward. What do you think?" I don't want to put the T3 up if he is at risk on his race. I understand its a lot to ask but just an opinion would be much appreciated.

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Your damned if you do and if you don't really

The obvious answer is not to race (but I know that's not really an option)

Probably put it up day after

I can't even manage 20 minute walk - the concept of running even up the road, is just a million miles away

But that's after 22 years of the wrong and totally inadequate treatment. I use to love walking holidays, can't even get round the park without 2 days exhaustion after. But without T3 it was so much worse and only been on it about 6 months. Improving but not fast enough.

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Thanks. Its a tough call, he will do it and probably flop 1/2 days later, but that's how its been for a long time. With Seaside susie's advice i had discussed with him and he took extra T3 as an extra dose in the evening. Thought we could try till say Thursday (does T3 act as quick as that?) and if no ill effects carry on. But now you have made me reconsider. He depends on me to advise him and it's hard to if i may be putting him at risk. Thanks for all your help, its so great to have some support.

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If you've started on higher dose definitely stick on it

Worse to reduce

Should be fine

He doesn't have Hashimotos

Yes it's very quick acting - almost instantly available

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Thanks. He only had more yesterday. I'm sorry to hear about your problems too, people suffer for such a long time . I hope the T3 will continue to help you.

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Thanks Slow Dragon. Fascinating link btw.

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Good morning Boohbette17

thanks for your reply. Please see SlowDragon's answer below with the link. My son's Vitamin D isn't high, the Range is 50-200 and his at 58.3 is on the low side. But thanks so much for thinking of us. Hope you slept well.

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Hi tired22! Thanks I did sleep well especially since I'm no longer struggling to write w a broken phone. I'm figuring out my new "baby" haha so , late but here I am. I saw what is the reason I thought it was high. Your post had (250H ) 58.3 (50-200) my eyes fixated on the first parenthesis as 250 H as reading 250 and HIGH- well, thank goodness not eh?!? Glad it's ok!!

😁

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Your son needs to be aware that exercise uses up a lot if T3. His FT4 is not very high and when he does intense periods of extra exercise his body has to convert this store of T4 to keep up and maintain his FT3 level. If he does not have enough T4 to convert his FT3 will drop during exercise as normal but be unsble to recover which is why he is crashing. He needs to even out his activity, this will allow his meds to be optimised in relation to regular high activity levels. A healthy person would just increase T4 production as and when needed but he cant and that is also why his TSH has started to increase, his body knows it needs more to do what he is asking of it.

If you go on my bio I have all my results showing, have a look at March and June I took up the Virgin global challenge on 25th May and was averaging 1200 steps a day, by the June test I had tanked my T4 and my T3 was just starting to drop I felt exhausted and had to give it up about 3 weeks later despite GP giving me a raise! My TSH had also started to rise even though the FT3 had only dropped very slightly.

I also posed some questions about exercise and he might find the answers helpful, they are earlier in the year in my post history.

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Thanks Phoenix605 that is really helpful and i will have a look at your bio too. The difficulty is he is slow to take ownership of his thyroid problem but i am working on that and progressing.

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If he is keenly competitive it might help if he understands that getting it right will maximise his chances, getting it wrong will destroy his enjoyment it might be the incentive he needs to take more control and responsibility, good luck!

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No he isnt that competitive, its more about achieving it. We had a good visit with GP and he has an increase so hope he'll improve towrad end of week. We also have a plan ahead and he is much more engaged since the appointment. I have read a lot of your previous posts and he has read some too. Little steps :) Thank you for your support.

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your son is pushing his hypothyroid body way too hard like it or not no pill can ever replace what a healthy thyroid does..no matter how welltreated hypothyroid patients have to learn to live within limits so as not to stress their bodies beyond limits

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