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[Maddy2]

Hi

Am I hypothyroid and do I have Hashimotos?

TSH 33.2 (0.2 - 4.2)

Free T4 10.5 (12 - 22)

Free T3 3.1 (3.1 - 6.8)

TPO antibody >1000 (<34)

TG antibody 286.3 (<115)

Thankyou

[SeasideSusie Remembering]

Maddy

Yes and yes!

Are these GP results? What has he/she said?

[Maddy2 in reply to SeasideSusie]

Thankyou

TSH and free T4 and Free T3 and TPO antibodies are GP results. TG antibodies are Blue Horizon. haven't been prescribed anything yet

[SeasideSusie Remembering in reply to Maddy2]

What has your GP said about the results of the tests he did?

[Maddy2 in reply to SeasideSusie]

GP hasn't said anything yet.

[SeasideSusie Remembering in reply to Maddy2]

OK, so you have primary Hypothyroidism confirmed by your TSH over range and your FT4 under range. You should be started on Levothyroxine immediately, no less than 50mcg as a starter dose, unless you are elderly or have a heart condition when it will be 25mcg.

Take your Levo on an empty stomach, one hour before or two hours after food, with a glass of water only, no tea, coffee, milk, etc, for an hour either side as absorption will be affected. Take Levo 2 hours away from other medication and supplements, four hours for some.

You will need retesting 6-8 weeks after starting Levo with a 25mcg increase in Levo, regular retesting/increases of 25mcg every 6-8 weeks until your symptoms abate and you feel well.

When booking thyroid tests always book the earliest appointment of the morning, fast overnight (you can have water) 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. This is a patient to patient tip which we don't discuss with doctors or phlebotomists.

As for the Hashi's, this is where antibodies attack the thyroid and gradually destroy it. You can help reduce the antibodies by adopting 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.

Most doctors attach little or no importance to antibodies and don't understand how Hashi's affects the patient. Read and learn so you can help yourself here:

chriskresser.com/the-gluten...

hypothyroidmom.com/hashimot...

stopthethyroidmadness.com/h...

stopthethyroidmadness.com/h...

Hashi's and gut/absorption problems tend to go hand in hand and very often low nutrient levels are the result. If not already done, ask for the following to be tested:

Vit D

B12

Folate

Ferritin

Post the results for comment and if there are any deficiencies or low levels we can advise what to supplement. All need to be optimal, not just in range, for thyroid hormone to work properly.

[Maddy2 in reply to SeasideSusie]

Thankyou I have these already and I supplement

[SeasideSusie Remembering in reply to Maddy2]

Do you want to post them so we can see if you are supplementing at the right dose? If on prescription, chances are you're not.

[Maddy2 in reply to SeasideSusie]

Ok

Ferritin 15 (30 - 400)

Folate 2.3 (2.5 - 19.5)

Vitamin B12 167 (180 - 900)

Vitamin D 29.9 (25 - 50 vitamin D deficiency. Supplementation is indicated)

Taking 1 ferrous fumarate for iron deficiency

Taking 800iu for Vitamin D deficiency

Taking 5mg folic acid for folate deficiency

Having B12 injections for pernicious anaemia

[SeasideSusie Remembering in reply to Maddy2]

Maddy

And here we have it, another doctor who isn't treating nutrient deficiencies correctly!

Ferritin 15 (30 - 400) Taking 1 ferrous fumarate for iron deficiency

Confirmed iron deficiency anaemia requires 2 or 3 ferrous fumarate daily - 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.

So you need to discuss this with your GP and get the appropriate treatment.

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.

As for ferritin, this needs to be at least 70 for thyroid hormone to work, preferably half way through range. I would ask for an iron infusion due to your extremely low level as this will bring it up within 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...

**

Vitamin D 29.9 (25 - 50 vitamin D deficiency. Supplementation is indicated) Taking 800iu for Vitamin D deficiency

800iu D3 isn't going to ever raise your level. It is hardly a maintenance dose for someone with a reasonable level.

You need 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 (more than 800iu so post your new result as the time for members to suggest a dose) 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/

If your GP refuses the loading doses, come back and tell us and we can suggest what you should buy yourself.

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.

**

Folate 2.3 (2.5 - 19.5)

Vitamin B12 167 (180 - 900)Taking 5mg folic acid for folate deficiency Having B12 injections for pernicious anaemia

As you seem to be treated appropriately for these there isn't much to say other than an extract from the book, "Could it be B12?" by Sally M. Pacholok says:

"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".

"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."

Folate should be at least half way through it's range.

When taking B12 we need a B Complex to balance all the B vitamins.

[Marz in reply to Maddy2]

Have what already ? What are you supplementing and how much ?

[Maddy2 in reply to Marz]

Ferritin 15 (30 - 400)

Folate 2.3 (2.5 - 19.5)

Vitamin B12 167 (180 - 900)

Vitamin D 29.9 (25 - 50 vitamin D deficiency. Supplementation is indicated)

Taking 1 ferrous fumarate for iron deficiency

Taking 800iu for Vitamin D deficiency

Taking 5mg folic acid for folate deficiency

Having B12 injections for pernicious anaemia

[Marz in reply to Maddy2]

Your results are dire. Please click onto SeasideSusie - here on this thread and read some of her replies to others like you. Your treatment is inadequate.

[SlowDragon Administrator in reply to Maddy2]

I would post the B12, Folate and ferritin results on Pernicious Anemia forum too

healthunlocked.com/pasoc

How often are you having injections.

Ask if you may need these more frequently

Also taking vitamin B complex may help keep other vitamin B in balance and may help improve folate. Look for B complex that has folate in, not folic acid

[Marz in reply to SlowDragon]

On the PAS Forum Maddy will be told that Folic Acid is just fine and no need to buy the more expensive Folate !

I know - so confusing 😊

[Marz in reply to Maddy2]

How long has he had these results ?

[Maddy2 in reply to Marz]

A week

[Maddy2]

GP said I look like a hyper person and not a hypo one

[SeasideSusie Remembering in reply to Maddy2]

I don't think there's a 'look'. I presume he means you're not overweight, maybe on the slim side? Doesn't matter, it's not compulsory to be overweight when hypo! And with Hashi's you can have hypo and hyper symptoms anyway. He probably doesn't know much, if anything, about Hashi's.

[Maddy2 in reply to SeasideSusie]

Thankyou yes I am slim but having trouble gaining weight and keeping it on

[SeasideSusie Remembering in reply to Maddy2]

That's probably because the Hashi's is causing absorption problems and why your nutrient levels are so dire. Check out SlowDragon 's reply in this thread which contains information and links which can help healthunlocked.com/thyroidu...

[Marz in reply to Maddy2]

That's because he doesn't know what he is talking about when it comes to Hashimotos. The same as saying he looks like a plumber and not a Dr. No offence to Plumbers 😊

[SlowDragon Administrator]

Slim hypos seem to have even more trouble with medics than the rest of us!

It's more unusual but not rare

Hashimoto's stops gut working properly, so you struggle to absorb nutrients and also dire vitamins

Your antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).

About 90% of all hypothyroidism in Uk is due to Hashimoto's

With Hashimoto's, until it's under control, our gut can be badly affected. Low stomach acid can lead to poor absorption of vitamins. Low vitamin levels stop thyroid hormones working.

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten

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, help gut heal and slowly lower TPO antibodies

thyroidpharmacist.com/artic...

thyroidpharmacist.com/artic...

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

chriskresser.com/the-gluten...

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

drknews.com/changing-your-d...

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...

drmyhill.co.uk/wiki/hypochl...

scdlifestyle.com/2012/03/3-...

Other things to help heal gut lining

Bone broth

thyroidpharmacist.com/artic...

Probiotics

carolinasthyroidinstitute.c...