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[Bethanj]

Hi I have been losing weight with hypothyroid? Taking 25mcg levothyroxine. Also anaemic.

TSH 10.2 (0.2 - 4.2)

Free T4 12.7 (12 - 22)

Free T3 3.6 (3.1 - 6.8)

Thank you for reading

[SeasideSusie Remembering]

Bethanj You are undermedicated.

How long since diagnosis?

Have you been on a higher dose? If so why only 25mcg now?

Have you had thyroid antibodies tested - were they positive for Hashimoto's?

What vitamins and minerals have been tested? Please post results and say what you are supplementing and the dose.

[Bethanj in reply to SeasideSusie]

Diagnosed 2013

Was on a higher dose of 175mcg levothyroxine

Reduced in 25mcg increments due to low TSH down to 25mcg

Antibodies were positive

TPO antibodies 84 (<34)

TG antibodies 257.3 (<115)

Ferritin 21 (30 - 400) taking ferrous fumarate 210mg

Folate 2.3 (2.5 - 19.5) taking folic acid 5mg

Vitamin D 33.2 (25 - 50 deficiency. Supplementation is indicated) vitamin D 800iu stopped in 2015

Vitamin B12 201 (190 - 900)

Thanks

[SeasideSusie Remembering in reply to Bethanj]

Bethan - oh dear, you appear to have a doctor who doesn't really know very much about hypothyroidism and even less about nutrients (no surprise there, doctors aren't taught nutriion).

***

Reduced in 25mcg increments due to low TSH down to 25mcg

TSH is of no significance once we have been diagnosed. TSH is a pituitary hormone, the pituitary checks to see if there is enough thyroid hormone, if not it sends a message to the thyroid to produce some. That message is TSH (Thyroid Stimulating Hormone). In this case TSH will be high. If there is enough hormone - and this happens if you take any replacement hormone - then there's no need for the pituitary to send the message to the thyroid so TSH remains low.

Unfortunately, doctors seem not to understand this and become TSH obsessed then when it goes low they reduce our dose by ridiculous amounts, or even stop it altogether.

*

TSH 10.2 (0.2 - 4.2)

Free T4 12.7 (12 - 22)

Free T3 3.6 (3.1 - 6.8)

The aim of a treated hypo patient generally is for TSH to be 1 or below or wherever it needs to be for FT4 and FT3 to be in the upper part of their respective reference ranges when on Levo. You desperately need an immediate increase of 25mcg, retesting in 6-8 weeks time then another increase, and retesting/inceasing needs to be carried out every 6-8 weeks until you feel well.

Ask for an increase and use the following information to support your request - from thyroiduk.org.uk/tuk/about_... > Treatment Options (and mention that you have contacted NHS Choices recommended source of information for thyroid disorders, which is ThyroidUK, better not to mention the internet)

According to the BMA's booklet, "Understanding Thyroid Disorders", many people do not feel well unless their levels are at the bottom of the TSH range or below and at the top of the FT4 range or a little above.

The booklet is written by Dr Anthony Toft, past president of the British Thyroid Association and leading endocrinologist. It's published by the British Medical Association for patients. Avalable on Amazon and from pharmacies for £4.95 and might be worth buying to highlight the appropriate part and show your doctor.

Also -

Dr Toft states in Pulse Magazine, "The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance.

But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."

You can obtain a copy of the article by emailing [e-mail] print it and highlight question 6 to show your doctor.

Always book your thyroid tests for the very first appointment of the morning, fast overnight (water allowed) and leave off Levo for 24 hours. This gives the highest possible TSH which is needed when looking for an increase in dose or to avoid a reduction. Doing it every time means you can compare results accurately. This is a patient to patient tip which we don't discuss with doctors or phlebotomists.

***

TPO antibodies 84 (<34)

TG antibodies 257.3 (<115)

Has anyone bothered to tell you that you have autoimmune thyroid disease aka Hashimoto's as confirmed by your high antibodies? This is where antibodies attack the thyroid and gradually destroy it. The antibody attacks cause fluctuations in symptoms and test results.

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.

Read and learn about Hashi's, you'll need to help yourself as most doctors dismiss antibodies as being of no importance and don't understand the nature of Hashi's.

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

stopthethyroidmadness.com/h...

stopthethyroidmadness.com/h...

hypothyroidmom.com/hashimot...

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

Hashi's and gut/absorption problems go hand in hand, and frequently low nutrient levels are the result. SlowDragon has information and links to help there.

***

Ferritin 21 (30 - 400) taking ferrous fumarate 210mg

For thyroid hormone to work ferritin needs to be at least 70, preferably half way through range. You really need an iron infusion so ask for one, because tablets will take months to raise your level (particularly at the dose prescribed for you) whereas an infusion will raise your level within 24-48 hours.

Also, 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...

*

As your ferritin is below range, you should ask for an iron panel and full blood count to see if you have anaemia. If you are diagnosed with iron deficiency anaemia the treatment is 2 or 3 x ferrous fumarate daily. 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.

***

Folate 2.3 (2.5 - 19.5) taking folic acid 5mg Vitamin B12 201 (190 - 900)

Please check for signs of B12 deficiency here b12deficiency.info/signs-an... then post these results on the Pernicious Anaemia Society forum for further advice healthunlocked.com/pasoc

Bear in mind that taking folic acid can mask signs of B12 deficiency so think back to before you started taking it.

Also, when posting on the PA forum, quote your ferritin result, any anaemia information if this has already been checked, plus any signs of B12 defciency from the list linked to.

You may need testing for Pernicious Anaemia and you may need B12 injections. If further investigations are carried out, you should not be taking folic acid. They will advise further on the PA forum.

**

Vitamin D 33.2 (25 - 50 deficiency. Supplementation is indicated) vitamin D 800iu stopped in 2015

Why was your D3 supplement stopped? What level did you reach? Did your GP not advise to continue with a self sourced supplement to maintain the level reached?

To be honest, you would be better off getting your own, 800iu is probably all you'll be prescribed now and it wont be enough. I would normally suggest D3 softgels but as you have Hashi's and a possible absorption problem, SlowDragon advises a D3 spray, eg Better You. A lot of sprays come in 3000iu dose so you could get that and for now take 6000iu daily then when you've reached the level recommended by the Vit D Council - which is 100-150nmol/L - 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 helps D3 to work and 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.

You can get D3/K2 sprays so you may want to check those out as well.

[Bethanj in reply to SeasideSusie]

Hi thanks I reached 70.2 on vitamin D 3000iu when I was told to stop, it was an oral spray. I was originally prescribed 800iu but this was stopped as well. I thought I have anaemia due to complete blood count showing below range MCV and above range MCHC and low iron? If so why don't doctors know this sort of stuff? It is frustrating.

[SeasideSusie Remembering in reply to Bethanj]

Bethan - this just goes to show that when something is in range, that's good enough for doctors. They have no concept of the fact that there is a point in the range that is best. You should not have been told to stop when you reached 70.2, you should have been told at the very least to maintain that level. So restart your D3 supplement and aim for 100-150nmol/L then when you have reached that find your maintenance dose. I like to keep mine as close to the top of that range as possible and I need to take 2000iu daily all year round as I don't tolerate the sun at all well so I don't get make natural Vit D from that.

Below range MCV and over range MCHC suggests iron deficiency anaemia. If you have those results and your doctor has done nothing about them, then point out the following: 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.