Hypothyroid or hyperthyroid?

Hi new member here, I can't work out whether I am hypothyroid or hyperthyroid?

Symptoms suggesting hyper - sweats, weight loss, tremor, increased appetite

Symptoms suggesting hypo - feeling cold, constipation, fatigue, breathlessness, depression.

Diagnosed 2011 with hypothyroid and have raised antibodies.

Graves disease maybe?

Thank you

TPO antibodies 289.3 (<34 IU/mL)

TG antibodies 353.1 (<115 IU/mL)

24 Replies

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  • Please post your latest thyroid blood test results along with lab ranges and people can help you make sense of them. You have autoimmune thyroid disease otherwise known as Hashimotos.

    Without knowing if you've had TSI antibodies tested and viewing the results I wouldn't know if you had Graves disease as well. It's more likely you are experiencing fluctuations in thyroid levels due to Hashimotos.

    If you are not optimally dosed and even if you are, you may have co-existing vitamin deficiencies which are very common and these may be causing some of your symptoms.

    If you've had vitamins tested then post results along with laboratory ranges for all blood tests and people here can help you make sense of them.

  • Thanks negative for TSI

  • TSH 9.3 (0.2 - 4.2)

    Free T4 12.6 (12 - 22)

    Free T3 3.3 (3.1 - 6.8)

  • In that case you have Hashimotos and you're undermedicated. Most people don't feel well until their TSH is near to 1.0 or slightly lower. The aim of thyroid hormone replacement is to feel well and be symptom free. You can see your FT4 is at the bottom of the range as is your FT3 which is the most important measure. You want FT3 in the top third of the range. If you're taking thyroid hormone you need an increase. If you're not on Levothyroxine then you need to visit the doctor with these results and get a prescription for 50mcg of Levothyroxine.

    Also get B12, ferritin, folate and vitamin D tested as likely to be deficient.

  • Thanks I take 25mcg diagnosed 2011

  • Ferritin 15 (30 - 400)

    Folate 2.2 (4.6 - 18.7)

    Vitamin B12 157 (180 - 900)

    Vitamin D 18.3

    (<25 severe

    25 - 50 deficient

    50 - 75 suboptimal

    >adequate)

  • As you can see, all your vitamin results are dire. What has your GP said about these, what have you been prescribed and what date did you get these test results? If your GP has not contacted you then make an urgent appointment on Monday. You may need more tests to rule out pernicious anaemia.

    Your symptoms are likely a combination of low thyroid levels and vitamin deficiency. You are not taking enough thyroid medication which is partly why your vitamin levels are so low but there could be other contributing factors such as other autoimmunity or low stomach acid causing insufficient absorption.

    You need a blood test every 6 weeks and a thyroid medication dose increase until your TSH is nearer to 1.0 and you feel better. However, your levothyroxine will not work well until you address your vitamin deficiencies.

    Make sure you take levothyroxine on an empty stomach with a full glass of water and no food or drink (except water) for an hour afterwards. Take supplements or other meds at least 4 hours or more after taking levothyroxine.

    Hopefully tomorrow or soon SeasideSusie will respond with her excellent vitamins advice so you can go informed to discuss with GP.

  • Thanks test results taken a month ago and I haven't been contacted about them so will do this Monday

  • Well, I'm afraid that is very negligent of your GP. In fact if there is another GP you can see then visit someone else in the practice and point out the GP has not contacted you although results were available one month ago. Get your deficiencies sorted and then make a complaint.

    You are severely vitamin D deficient and your ferritin is very low so you need a full iron panel but your treatment for iron deficiency should commence even before you get more blood test results.

    You should be tested for intrinsic factor antibodies before supplementing with B12 or folate to rule out pernicious anaemia. You will probably need B12 injections. You should take a good B complex in addition to whatever treatment your doctor initiates to keep all the B's in balance.

    Good luck on Monday and tell us what happens and what treatment the doctor gives you. Check out SeasideSusie's posts to other people before you visit GP.

  • Yes will do this. Thanks :)

  • My GP only tested me for low thyroid. I researched my symptoms and found that it was likely due to Hashimoto's. I lied to my GP; so that, he would test me for Hashimoto's. He tested me and the results were positive for Hashimoto's and one other autoimmune disease. My GP recommended me to see a Rheumatologist. I hate to lie, but sometimes it is necessary. I now have 7 specialists taking care of me for different illnesses (polyneuropathies, Hashimoto's, Celiac, Sjogrens, severe neuromuscular disease (lungs), the beginnings of Alzheimers. If I hadn't taken responsibility for my disease state, I could've died.

  • Firefly3

    You're not going mad!! It is possible to have fluctuating symptoms that can go between hypo and hyper. I have experienced this confusion myself..the blood results are important and as others have said, you have to sometimes push to get tests, results and have follow ups, then keep pushing until you feel better! I know this can be hard when you're feeling so under par anyway, but get support. I have had a battle for 18 months but finally had a full thyroidectomy four days ago! It's a long story but I would urge you to nip it in the bud, change doctor, get second opinions, demand to see an endocrinologist if your symptoms are persistently fluctuating. As everyone who's suffering from thyroid issues will say, it can take over your life and you can lose many months or even years of precious living. I have another part of my journey to go in getting my levels sorted but I am determined to get my life back and be the best version yet of myself! Good luck and ask for help. All the best!

  • To be left on just 25mcg of levothyrocine since 2011 is gross negligence

    25mcg will barely treat a fly ...all uour sympyoms are resukt of poor treatment and direly low vitamin levels which in turn prevent your body utilising levothyroxine so they must be sorted very urgently

  • May I suggest you join the pernicious anaemia forum on health unlocked where you will find a wealth of information concerning the B12 deficiency and also folate.

    I agree that you need an urgent appointment with a gp, preferably not the same one that you've been seeing.

  • Thanks will do this

  • Symptoms suggesting hyper - sweats, weight loss, tremor, increased appetite

    When the body has insufficient thyroid hormone it has to use alternatives that aren't designed for the job. And those alternatives are cortisol and adrenaline (epinephrine in US terminology). The hyper symptoms people get when under-medicated for hypothyroidism are usually caused by the high levels of cortisol and adrenaline.

    However, some people can't keep producing high levels of cortisol for years, and their levels eventually begin to drop. There is a lot of symptom overlap between high and low cortisol, and many people interpret those symptoms as "being hyper", when in fact they are definitely hypothyroid.

    In the case of high cortisol, with luck, getting nutrient levels and thyroid hormone levels up to optimum will cause the cortisol and adrenaline to reduce by itself. However some people have to take supplements to persuade the cortisol to reduce before they can tolerate sufficient thyroid hormone for their needs.

    In the case of low cortisol people will have to take supplements to support their adrenals, or they may have to take adrenal supplements. In the worst case scenario they may have to take meds to raise cortisol directly, but that should only be done when there is a proven need for it.

  • Thanks I have low cortisol, no idea what to do about it. Genova offered me no recommendations on what to take

  • Genova won't offer any recommendations. They don't deal with the public, all their tests are done through a 'practitioner' and ThyroidUK acted as your practioner as a service for members. Genova provide the results and expect the practioner to discuss results with the patient.

    You can check your results with Dr Myhill's article about interpreting adrenal results drmyhill.co.uk/wiki/Adrenal...

    You could also make a new post asking if anyone has any suggestions how to deal with your particular result.

  • Firefly3 Are these the results that your GP hasn't contacted you about? If so ask why there has been such a delay and if they were going to ignore the results then make a formal complaint.

    Ferritin 15 (30 - 400)

    You can see your ferritin is below range, for thyroid hormone to work it needs to be at least 70, preferably half way through range.

    You need an iron supplement and because it's so far below range you should ask for an iron infusion, that will bring your level up in 24-48 hours whereas tablets will take many months.

    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...

    You also need to ask for an iron panel and full blood count to see if you have any form of anaemia. It's quite likely you may have iron deficiency anaemia and if this is diagnosed then the treatment will be 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 2.2 (4.6 - 18.7) Vitamin B12 157 (180 - 900)

    These results are dreadful. You are both folate and B12 deficiency. Check for signs of B12 deficiency here b12deficiency.info/signs-an... then you need to post on the Pernicious Anaemia Society forum for further advice healthunlocked.com/pasoc You will no doubt need to be tested for Pernicious Anaemia and likely to need B12 injections. Quote your folate, B12 and ferritin results, iron deficiency information if you've already been tested, and any signs of B12 deficiency you are experiencing.

    If your GP prescribes folic acid for your folate deficiency, do not start taking it until further investigations have taken place.

    **

    Vitamin D 18.3

    You have severe Vit D deficiency and you need loading doses, do not accept anything less, your GP may just want to give you 800iu, it must be the loading doses - see 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 maintenace treatment of about 800 IU a day. Higher doses of up to 2000IU 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 regims 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. Once these have been completed you will need a reduced amount (not a paltry 800iu) 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/

    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.

    **

    Come back and tell us what your GP is going to do and what he prescribes.

    **

    The fact that you have Hashi's is quite likely to be the cause of your dire nutrient levels, along with such a low dose of Levo.

    Hashi's and gut/absorption problems go hand in hand, and poor nutrient levels are often the result. SlowDragon has information and links to do with that.

    Here is some information about Hashi's, read and learn so you can help yourself but you're unlikely to get any help from your doctor, most dismiss antibodies as of no importance and don't understand the nature of Hashi's.

    Hashimoto's 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.

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

    stopthethyroidmadness.com/h...

    stopthethyroidmadness.com/h...

    hypothyroidmom.com/hashimot...

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

  • Yes GP has never contacted me. Thanks

  • So you were diagnosed in 2011 and put on 25mcgs

    Have you ever had larger dose?

    You should have been retested after 6-8 weeks and dose increased by 25mcg , wait an retest .....,,repeatedly, increasing dose in 25mgc steps until TSH around one

    Presumably you had tests been then and now, at least annually

    What were past blood tests

    If you put them up here we can see how long your GP has been ignoring obvious results

    Changing to a strictly gluten free diet may help reduce symptoms. Very many of us find it essential. Some also or instead need to look at dairy, or just casein in cows milk

    Starting with just cutting out gluten is best way to proceed

    thyroidpharmacist.com/artic...

    thyroidpharmacist.com/artic...

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

    chriskresser.com/the-gluten...

    scdlifestyle.com/2014/08/th...

    Low stomach acid can be an issue

    Lots of posts on here about how to improve with Apple cider vinegar or Betaine HCL

    thyroidpharmacist.com/artic...

    Other things to help heal gut lining

    Bone broth

    thyroidpharmacist.com/artic...

    Probiotics

    carolinasthyroidinstitute.c...

  • Yes I was on 175mcg before

    TSH 1.50 (0.2 - 4.2)

    Free T4 19.3 (12 - 22)

    Free T3 4.0 (3.1 - 6.8)

  • Well this is very different, extremely relevant information.

    Would have been helpful to say this right from the start

    This result from when on 175mcg is fine, in fact FT3 is LOW.

    Why was dose reduced? TSH is not too low

    when dose was reduced was it reduced from 175mcg to 25mcg in single reduction?

    Who did this GP or endo?

    I am tagging SeasideSusie humanbean and reallyfedup123 in to this

    How long have you been on 25mcg.

    You need immediate increase of 25mcg, massive amount of supplements due to such crass management

    Gluten free diet likely to also help significantly

    Hopefully you are seeing a different GP tomorrow

  • As SlowDragon has said there was nothing wrong with your results when on 175mcg other than the low FT3 so you didn't need a reduction in dose. And here we have another doctor, GP or endo, who hasn't got a clue about how Hashi's affects the patient or how to deal with the fluctuations it brings.

    You have been mismanaged with your treatment, your nutrient levels appear to have been neglected for a month, you really need to see a different GP and get your nutrients sorted as a first step, along with an immediate increase in your Levo.

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