Hi I am posting results on behalf of my 31 year old girlfriend. She has under active diagnosed 2013 and she takes levothyroxine though was on T3 and felt well on it. She had 2 ultrasound scans, first one in 2012 showing an enlarged thyroid gland and second one in 2017 showing damage to the thyroid gland.
She has throat tenderness and she says when she feels the front of her neck where her thyroid is she can feel one lobe sticking out more than the other. She has difficult swallowing as well and she has gone from 47kg to 53.6kg within a month.
Her endo has dismissed her symptoms as generalised anxiety and this has upset her.
Advice would be appreciated.
TSH 3.80 (0.2 - 4.2)
Free T4 13.8 (12 - 22)
Free T3 3.0 (3.1 - 6.8)
Thyroid peroxidase antibodies 207.5 (<34)
Thyroglobulin antibodies 809.3 (<115)
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D3377
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She takes 100mcg levo now, this was reduced 2 weeks into 200mcg levo and then 200mcg levo and 20mcg T3 6 weeks before. Blood draw done early morning and fasting and she left off levo for 24 hours. The GP thinks she has coeliac because she is petite but having digestive problems of abdominal cramps and diarrhoea when eating gluten. I will post her vitamins and minerals below.
That was an absolutely enormous reduction in dose. She must be feeling truly awful.
Dose reductions should be 25mcg maximum at any one time and she probably didn't need dose reduction anyway
She will need to increase back up in 25mcg steps, waiting 6-8 weeks before retesting and if blood tests show ready, increase again in further 25mcg step.
At same time improving vitamins with supplements and going strictly gluten free
Only 5% with Hashimoto's are coeliac but over 80% find noticeable or significant improvement gluten free either due to just gluten intolerance (as serious as coeliac but no test currently) and also due to leaky gut and this enables gluten to incorrectly cross from gut into bloodstream causing high antibodies.
Ferritin 56.3 (30 - 400) down from 98.5 (30 - 400) in May 2017, confirmed iron deficient
For thyroid hormone to work ferritin needs to be at least 70, preferably half way through range. She can help raise her 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... or take an iron supplement but keep an eye on levels.
If she has confirmed iron deficiency anaemia, what are they doing about it? These are the guidelines for treating iron deficiency anaemia:
NICE Clinical Knowledge Summary for iron deficiency anaemia treatment (which will be very similar to your local area guidelines) cks.nice.org.uk/anaemia-iro...
How should I treat iron deficiency anaemia?
•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.
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.
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Folate 2.2 (2.5 - 19.5) down from >20 (2.5 - 19.5) in February 2017 Vitamin B12 198 (190 - 900) down from 538.6 (190 - 900) in February 2017
That's some serious decrease! Folate should be at least half way through it's range and B12 is best at the very top of the range. I would post on the Pernicious Anaemia Society Forum for further advice healthunlocked.com/pasoc and besides these results also mention ferritin level/iron deficiency and any signs of B12 deficiency she may be experiencing which you can check here b12deficiency.info/signs-an...
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Vitamin D 63.2 (50 - 75 suboptimal) taking 800iu D3 on prescription
She needs to get this up to the level recommended by the Vit D Council which is 100-150nmol/L. My suggestion would be to buy some Doctor's Best D3 softgels like these bodykind.com/productsearch/... and take 3000-4000iu daily for 3 months then retest. When the recommended level has been reached then she'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. She 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
Email Louise at Thyroid UK for list of recommended thyroid specialists
Louise.roberts@thyroiduk.org.uk
Keep reading as much as possible on here and elsewhere to learn all about Hashimoto's. It is as much a disease of the gut as it is the thyroid.
Most endocrinologists are male and virtually all Hashimoto's patients are female. Medicine is often misogynistic and Hashimoto's misunderstood or fobbed off as hysteria, stomatization disorder, hypochondria, anxiety disorder etc
Do they really think we all "imagine" these low vitamin levels.
As you have unfortunately discovered treatment for Hashimoto's here in UK is haphazard at best and barbaric at worst.
Hashimoto's severely affects the gut, something many endocrinologist seem to have little idea about.
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