Newbie: Hi I am considering adding T3 back in, my... - Thyroid UK

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Newbie

Hi

I am considering adding T3 back in, my heart is beating really low despite at rest for a few minutes and my concentration and memory has really gone downhill. Diagnosed 2011 could anyone advise please. Taking 175mcg levo thanks

TSH 9.5 (0.2 - 4.2)

Free T4 12.7 (12 - 22)

Free T3 3.4 (3.1 - 6.8)

TPO antibodies 96 (<34)

TG antibodies 363.5 (<115)

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jsal As you have Hashimoto's (confirmed by your high antibodies), I expect your nutrient levels are low or deficient and unless these are optimal thyroid hormone can't work properly. Have you had the following tested? If so please post results and say if you are supplementing, with what and the dose:

Vit D

B12

Folate

Ferritin

You probably also have gut/absorption problems as these go hand in hand with Hashi's. SlowDragon has information and links to help.

To help reduce the antibodies, you should adopt a strict gluten free diet. Gluten contains gliadin which is a protein thought to trigger antibody attacks. Supplementing with selenium L-selenomethionine 200mcg daily and keeping TSH suppressed can also help reduce the antibodies.

chriskresser.com/the-gluten...

hypothyroidmom.com/hashimot...

stopthethyroidmadness.com/h...

stopthethyroidmadness.com/h...

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Ok they will go in a new post thanks

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So how much T3 were you taking. Why was it stopped?

When T3 is stopped it's very common for vitamin levels to crash

With Hashimoto's you need to address low vitamin levels first before adding T3 back

Plus gluten is highly likely an issue, and needs looking at first too

Hashimoto's 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.

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...

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10mcg T3, endo said he didn't support its use

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Different endo from the one that started you on it I assume?

We have had loads of similar Hashimoto's patients turn up here with same

Do you have vitamin test results?

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No same one

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So was Levo dose kept unchanged?

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GP said he is worried about my folate and B12 and ferritin and I take 800iu vitamin D3 any advice appreciated thanks

FOLATE 2.8 (4.6 - 18.7)

VITAMIN B12 181 (180 - 900)

VITAMIN D TOTAL 24.4 (<25 SEVERE VITAMIN D DEFICIENCY. PATIENT MAY NEED PHARMACOLOGICAL PREPARATIONS)

FERRITIN 16 (15 - 150)

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As you've put these in a new post I'd delete this one or you're going to get replies in two threads and it will get confusing.

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I deleted new post

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jsal l If your GP is worried about them, what is he intending to do?

FOLATE 2.8 (4.6 - 18.7) VITAMIN B12 181 (180 - 900)

It is very important that you take these results and post them on the Pernicious Anaemia Society forum for further advice healthunlocked.com/pasoc

You are folate deficient and have just scraped into the bottom of the range for B12. Do you have any signs of B12 deficiency b12deficiency.info/signs-an...

When posting on the PA forum inclde your ferritin result and any results you may have from a full blood count and iron panel. Also state any signs of B12 deficiency you may be experiencing.

If your GP prescribes folic acid, it is very important that you don't start taking it until any other tests have been carried out. You probably need testing for Pernicious Anaemia and you may need B12 injections.

**

VITAMIN D TOTAL 24.4 (<25 SEVERE VITAMIN D DEFICIENCY. PATIENT MAY NEED PHARMACOLOGICAL PREPARATIONS)

You have severe Vit D deficiency and need loading doses of D3, not 800iu - ask why your GP has not followed the guidelines - 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 (more than 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.

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FERRITIN 16 (15 - 150)

For thyroid hormone to work (that's our own as well as replacement hormone) ferritin needs to be at least 70, preferably half way through range. You need an iron supplement and as your level is so low you should ask for an iron infusion which will raise your level within 24-48 hours, tablets will take many months. You can also 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 should also ask for an iron panel and full blood count to see if you have anaemia.

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

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Yes I have symptoms of B12 deficiency, I was hoping the GP would tell me what he would do but he didn't

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So he needs to test for Pernicious Anaemia and intrinsic factor before starting you on B12 injections

Do not start folate first

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Iron under range 5.4 (6.0 - 26.0) transferrin 15 (12 - 45)

Complete blood count only showed under range MCV 76.2 (80 - 100) MCHC over range 379 (310 - 350)

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So this points to iron deficiency anaemia - ask your GP for the appropriate treatment - see 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.

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I was hoping the GP would tell me what he would do but he didn't

Now you know what is needed. You either need to see a different GP or see this one and ask why he hasn't done anything about these results and ask him to start appropriate treatment immediately. Unfortunately, this is all too common and I don't know why, it seems as though we patients are having to become more and more proactive, find the solutions ourselves then present them to the doctors with the request that they treat us.

Some are just downright negligent and they need reporting.

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