Hi I am posting on behalf of my adult daughter, she is 30 and has hypothyroidism but am I right in thinking she has Hashimotos?
TSH 10.4 (0.27 - 4.20)
Free T4 13.9 (12 - 22)
Free T3 3.2 (3.1 - 6.8)
Thyroid peroxidase antibody 277.5 (<34)
Thyroglobulin antibody >1300 (<115)
Advice appreciated.
JG2511 Yes, the high antibodies confirm Hashi's.
A strict gluten free diet and selenium L-selenomethionine 200mcg daily can help reduce antibodies, as can keeping TSH suppressed.
Hashi's and gut/absorption problems tend to go hand in hand and nutrient levels are likely to be low. Has she had vitamins and minerals tested:
Vit D
B12
Folate
Ferritin
Iron panel
Full blood count
If so, please post results for comment and say if supplementing, with what and the dose.
Hashi's information:
hypothyroidmom.com/hashimot...
stopthethyroidmadness.com/h...
stopthethyroidmadness.com/h...
chriskresser.com/the-gluten...
And she currently needs an increase in dose to bring TSH down to the lower part of it's range, 1 or lower, and free Ts to the upper part of their ranges, if that is where she feels well
Thanks Susie, she is taking 50mcg Levothyroxine and was diagnosed 2013. She is taking 50mcg Levothyroxine because her endo says he is trying to stabilise her and get her levels back on track after a massive fluctuation 2 months ago.
The massive fluctuation will be due to the Hashi's, that's the nature of the beast. When the antibodies attack they dump a load of thyroid hormone into the blood stream and produce a 'Hashi's flare' which can cause a hyper-type swing. Adjustment to dose can be made during these flares and readjustment when things settle down.
Thanks I don't think she knows this and I am surprised her endo didn't tell her either. She went from what he called "thyrotoxic" to those results within 2 months. She felt no different during the swing, then felt OK-ish and now feels absolutely awful.
Unfortunately, most doctors know very little, if anything, about Hashi's and dismiss antibodies as of no importance. Of course, a Hashi's patient knows better which is why a Hashi's patient has to read, learn and help herself.
A doctor will say that there is no treatment for autoimmune thyroiditis (their name for Hashi's), and they are correct, the treatment is for the hypothyroidism it causes. But they seem very ignorant of the fact that Hashi's causes these flares where symptoms can go from hypo to hyper-type, then swing back to hypo again, and they don't seem capable of knowing what to do when these swings happen.
They also dismiss the connection between Hashi's and the gut and the gluten connection. Gluten contains gliadin which is a protein thought to trigger antibody attacks, and you don't have to be coeliac for a gluten free diet to help reduce antibodies. There are many members here who will tell you how much better they are after going gluten free.
Ok thanks. She tried going gluten free before but this was back when she had a goitre and couldn't swallow anything. She did recognise she had Hashimotos and she needed to be gluten free at the time, she just didn't know what to eat because the goitre etc. She went to the GP for advice on not only the goitre but diet and the GP asked her why she was thinking about excluding bread and pastas because that was what she needed to gain weight. She said because of the Hashimotos/antibodies. The GP got angry with her saying she did not need a change in diet and she was making things very difficult for herself. She then refused to help her and ended the appointment at that.
She does not cook and though her goitre has come back it is not affecting her swallowing. She mainly relies on microwave meals and takeaways. If she is at work she will get a sandwich because that's all that there is that is enough for her to carry on until she goes home.
She did not feel completely well on higher doses or with T3 added either.
If her nutrients are low then they bring their own symptoms, plus thyroid hormone can't work unless levels are optimal. If not already tested, ask for them to be done.
She is iron deficient and takes 1 iron tablet a day, she is taking vitamin D 6000iu and 5mg folic acid. Also B12 injections once every 3 months for symptomatic relief of B12 deficiency symptoms despite in range but fluctuating B12 levels. Her GP has arranged for her to be tested for pernicious anaemia but she has already taken her B12 shot.
Ferritin 41 (15 - 150)
MCV 77.2 (80 - 100)
MCHC 374 (310 - 350)
MCH 28.2 (28 - 32)
Haemoglobin estimation 123 (115 - 150)
Haematocrit 0.41 (0.37 - 0.47)
RBC count 4.42 (3.80 - 5.80)
WBC count 6.14 (4.00 - 11.00)
Platelets 256 (150 - 500)
Iron 9.3 (6.0 - 26.0)
Transferrin saturation 16 (12 - 45)
Vitamin B12 443 (190 - 900)
Folate 2.2 (2.5 - 19.5)
Vitamin D total 48.8
(<25 severe vitamin D deficiency
25 - 50 vitamin D deficiency
50 - 75 vitamin D may be suboptimal
>75 adequate vitamin D)
Iron deficiency is treated with Ferrous Fumarate 2 or three times daily. See 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."
She should ask her GP to check local guidelines, which should be the same, and ask for appropriate treatment.
She should take each iron tablet with 1000mcg Vit C to aid absorption and help prevent constipation, and take iron 4 hours away from thyroid meds and 2 hours away from any other medication and supplements as it affects their absorption.
**
Ferritin needs to be at least 70 for thyroid hormone to work, so besides the iron tablets she can help raise ferritin by eating liver regularly, maximum 200g per week due to it's high Vit A content, and include lots of other iron rich foods in her diet apjcn.nhri.org.tw/server/in...
**
She should stop taking folic acid until she has been tested for Pernicious Anaemia Mon fact ask on the Pernicious Anaemia Society forum for further advice, explaining about the folic acid, B12 injections, give results for folate, B12 ferritin, the iron deficiency information, etc. They will advise what's best healthunlocked.com/pasoc
For us Hypos/Hashi's we recommend B12 to be at the very top of the range and folate atmleast half way through it's range.
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Vit D is recommended to be 100-150nmol/L by the Vit D Council, so she has a long way to go. She can continue with her 6000iu daily but also take the 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, 4 hours away from thyroid meds.
As she has Hashi's, SlowDragon recommends a spray form of D3 for better absorption, eg Better You.
Magnesium helps D3 to work and comes in different forms, check to see which would suit and as it's calming it's best taken in the evening, 4 hours away from thyroid meds naturalnews.com/046401_magn...
**
SlowDragon has links and information which can help with absorption and gut problems.
Thanks yes she does take the 3000iu Better You spray only that she has been doubling it to 6000iu. When she took it just the once it wasn't raising the vitamin D that much. Might the reason why she was achy taking the increased dose of vitamin D be because she wasn't taking the K2? She was taking magnesium to help her with sleep, that is a spray as well and by Better You. She finds it a bit oily if she goes mad.
There are other ways of taking magnesium - Epsom salt baths, magnesium oil/cream.
I don't know if the lack of K2 would cause her to be achy. It could be that she's not absorbing the D3 well enough due to absorption problems caused by the Hashi's.
She was recommended to take 1 ferrous fumarate for what her haematologist calls "recurring iron deficiency anaemia" - I don't understand why he didn't give her 2 or 3 iron tablets because that was what she was taking before.
As antibodies are high this is 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. About 5% are coeliac, but over 80% of us find gluten free diet helps significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)
Changing to a strictly gluten free diet may help reduce symptoms. It can slowly lower antibodies too
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...
Infections - e.g. Glandular fever (EBV) or H Pylori or many others can also be a cause
hypothyroidmom.com/hashimot...
Great film definitely shows why just testing TSH is inadequate and how complex a disease
drbradshook.com/understandi...
Avoiding all soya including soya lecithin if possible can also help. Soya is not good for Thyroid
Do you have results from when she was on higher dose AND T3. It might be helpful to see. Often we are not over medicated at all, they just freak out at low TSH
She tried going gluten free before but this was back when she had a goitre and couldn't swallow anything. She did recognise she had Hashimotos and she needed to be gluten free at the time, she just didn't know what to eat because the goitre etc. She went to the GP for advice on not only the goitre but diet and the GP asked her why she was thinking about excluding bread and pastas because that was what she needed to gain weight. She said because of the Hashimotos/antibodies. The GP got angry with her saying she did not need a change in diet and she was making things very difficult for herself. She then refused to help her and ended the appointment at that.
She does not cook and though her goitre has come back it is not affecting her swallowing. She mainly relies on microwave meals and takeaways. If she is at work she will get a sandwich because that's all that there is that is enough for her to carry on until she goes home.
Well to get better she probably needs to be gluten free. Medics here are currently very behind on recent research
Gluten free just requires a little planning. There are plenty of good gluten free breads these days. Making her own sandwiches might even save money
Lots of ready meals are gluten free
M&S is especially good. But they are all catching up. You just have to read the ingredients lists
Yes results from when she was on higher dose with T3 (100mcg Levothyroxine and 12.5mcg T3)
TSH <0.02 (0.2 - 4.2)
Free T4 20.5 (12 - 22)
Free T3 5.4 (3.1 - 6.8)
Her vitamin and mineral results looked better as well.
Ferritin 187 (15 - 150) iron infusion done a month after, level has dropped since then
Folate 11.2 (4.6 - 18.7)
Vitamin B12 545 (190 - 900)
Vitamin D total 72 (50 - 75 suboptimal)
These thyroid results pretty much perfect, I expect endo freaked at low TSH, but FT4 within range and FT3 well within range
Vitamin D was still too low
All thyroid tests should be done as early as possible in morning and fasting and don't take Levo in the 24 hours prior to test, no T3 in 12 hours before, delay and take straight after. This gives highest TSH and most consistent results
Was this how tests were done?
But we still can't take T3 and not be gluten free. The constant variation is no good
Yes that was how tests were done.
Daughter's other results
First test results 
Wife's results
blood test results
Test results
