Results advice please

New here diagnosed 2013 taking 150mcg levothyroxine thanks

TSH 5.3 (0.2 - 4.2)

Free T4 13.7 (12 - 22)

Free T3 2.6 (3.1 - 6.8)

Thyroid peroxidase antibodies 804 (<34)

Thyroglobulin antibodies 296.3 (<115)

[shaws Administrator]

Welcome to our forum jack118.

First - you are undermedicated. You need an increase in levothyroxine until your TSH is 1 or lower. GP should increase your prescription by 25mcg every six weeks till the TSH is 1.

Many doctors believe 'somewhere' in the range is fine, even if above the top of the range. In fact the top range of your test is 4.2)

Your Free T4 and Free T3 are dire and especially the only Active Thyroid Hormone FT3 is below range. No wonder you feel awful. As your levo is increased, hopefully, both will rise to be towards the upper part of the range. This is probably due to being undermedicated.

You have an Autoimmune Thyroid Disease called Hashimoto's - the commonest form of hypothyroidism. Treatment is the same but to reduce the attack of the antibodies on your thyroid gland, going gluten-free can help reduce antibodies.

All blood tests for thyroid hormones have to be at the very earliest, fasting (you can drink water) and allow a gap of 24 hours between your last dose of levo and the test and take it afterwards. This keeps your TSH higher as doctors may adjust dose unnecessarily if TSH is low (they believe a low TSH is bad) and they may say we will get osteoporosis or heart disease which isn't true.

[SlowDragon Administrator]

You are very under medicated to have TSH this high. The aim of Levothyroxine is to take high enough dose to bring TSH down to around one.

FT4 to be towards top of range and FT3 at least half way in range

Your 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.

Low vitamins that affect thyroid are vitamin D, folate, ferritin and B12. When they are too low they stop Thyroid hormones working.

Have these been tested recently, post results and ranges if you have them, plus list of supplements you take, if any

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% 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)

But don't be surprised that GP or endo never mention gut, gluten or low vitamins. Hashimoto's is very poorly understood

Changing to a strictly gluten free diet may help reduce symptoms.

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...

You are likely to find being gluten free is essential

[ITYFIALMCTT]

Nothing to add to shaws' or SlowDragon's comments (I x-posted with the latter).

It would be helpful to see the results of any vitamin or mineral levels that you have (complete with their reference ranges) along with a list of any supplements that you take, together with their dosages. (I see you've mentioned corrected anaemia in another post but it would be helpful to have a 'before and after' of that.)

[Hidden in reply to ITYFIALMCTT]

Vitamin D 28.3 (25 - 50 deficient. Supplementation is indicated)

Vitamin B12 185 (180 - 900)

Folate 2.1 (4.6 - 18.7)

Ferritin 61 (30 - 400)

MCV 76.2 (80 - 98)

MCHC 393 (310 - 350)

Iron 9.2 (6 - 26)

Transferrin saturation 16 (12 - 45)

Taking 800iu vitamin D and 1 ferrous fumarate ocne a day, no longer actively monitored for anaemia thanks

Ferritin was 193 before infusion

[ITYFIALMCTT in reply to Hidden]

I'm assuming that you've seen SeasideSusie 's many replies about vitamin D and will know that 800IU per day is not going to shift you out of the deficiency category. And, she'll probably have suggestions about maintaining the iron levels.

To state the obvious, your folate is quite a bit below the reference range and your B12 has about tripped over the bottom of its reference range. Looking at your MCV and MCHC - you need a comment from knowledgeable people like humanbean as it's possible that the out of range readings are influenced by the infusion you've had (iron?) and that's why it complicates looking at the folate/B12.

[SeasideSusie Remembering in reply to Hidden]

Hidden I've replied about these results on your other read, although you didn't mention the iron infusion on there. Assuming you were under a haematologist when you had the infusion, generally they say if ferritin falls below 50 they will do another one. However, your ferritin isn't the problem with these results, it's the MCV/MCHC results that are, indicating continuing iron deficiency anaemia, and I've mentioned that on your other thread.

[SeasideSusie Remembering]

Hidden

TSH 5.3 (0.2 - 4.2)

Free T4 13.7 (12 - 22)

Free T3 2.6 (3.1 - 6.8)

You are very undermedicated. 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 need to ask your GP for an immediate increase of 25mcg, follow this with retesting after 6-8 weeks and another increase of 25mcg Levo. Continue retesting/increasing until you feel well.

In support of your request for an increase, this information might help, from thyroiduk.org.uk/tuk/about_... > Treatment Options:

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.

**

Thyroid peroxidase antibodies 804 (<34)

Thyroglobulin antibodies 296.3 (<115)

Your high antibodies mean that you are positive for autoimmune thyroid disease aka Hashimoto's which is where antibodies attack the thyroid and gradually destroy it. The antibody attacks cause fluctuations in symptoms and test results.

If you haven't already been told this by your doctor it's not surprising, they tend to attach little importance to antibodies.

You need to read, learn and help yourself where Hashi's is concerned because you'll get no help from your GP. Hashi's isn't treated, it's the resulting hypothyroidism that is, but 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_...

**

Hashi's and gut/absorption problems tend to go hand in hand and dire nutrient levels are often the result - as I can see from your reply to my question about these in your other thread (I will answer on there). SlowDragon can help with information and links regarding these gut problems.