CharliJ87 Well, I don't know whether to cry or burst with anger. You have such a total jerk for a GP, FGS what is he doing, he should be in another job where he can't hurt people!
TSH *7.2 mIU/L (0.2 - 4.2)
Free T4 13.6 pmol/L (12 - 22)
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. Go and ask (politely if you can manage it, I certainly wouldn't be able to).for an increase of 25mcg immediately, followed by a retest in 6-8 week's time and another increase of 25mcg, then repeat and repeat until your levels are where they should be and you feel well. In support of your request for an increase see 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. However, I don't know if this is in the current edition as it has been reprinted a few times.
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 firstname.lastname@example.org print it and highlight question 6 to show your doctor.
endo doesn't think I have thyroid antibodies. Thyroid peroxidase antibodies >1500 IU/mL(<34) Thyroglobulin antibodies 256.3 IU/mL (<115)
As Nana says, what does he think these are then (but I wouldn't have been so polite, a naughty word might have just crept in!).
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.
Most doctors know little to nothing about Hashi's and attach no importance to antibodies. However, they do affect the patient so you need to read and learn, educate yourself so you can help yourself as you're certainly getting no help from your GP.
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...
Hashi's and gut/absorption problems go hand in hand and very often low nutrients are the result, yours are absolutely dire and need immediate and appropriate treatment.
Ferritin *14 ug/L (30 - 400)
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 also need an iron panel and full blood count to see if you have iron deficiency anaemia, which low ferritin often suggests.
Folate *1.7 ug/L (2.5 - 19.5) Vitamin B12 *153 pg/L (180 - 900)
Please go straight over to the Pernicious Anaemia Society for further advice healthunlocked.com/pasoc Quote your folate/B12/Ferritin results (and any iron deficiency information) and any signs of B12 deficiency you might be experiencing from this checklist: b12deficiency.info/signs-an... You are folate and B12 deficient, as shaws says you should have intrinsic factor antibodies tested as you could have Pernicious Anaemia and you may need B12 injections. You will need folic acid prescribing for the folate deficiency but you must not start this until other investigations have been completed, and B12 must be started before folic acid.
I have read (but not researched so don't have links) that BCSH, UKNEQAS and NICE guidelines recommend:
"In the presence of discordance between test results and strong clinical features of deficiency, treatment should not be delayed to avoid neurological impairment."
And an extract from the book, "Could it be B12?" by Sally M. Pacholok:
"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."
Total 25 OH vitamin D 27.7 nmol/L
You are 2.2 away from severe deficiency, you need loading doses of D3 (refuse to accept a prescription for 800iu, it must be the loading doses) - see NICE treatment summary for Vit D deficiency:
"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/
There are important cofactors needed when taking D3
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
Check out the other cofactors too.
When you start buying your own D3 you should use an oral spray for better absorption. BetterYou do a D3 one and also D3/K2-MK7 combined.
As for the absorption problem associated with Hashi's, please see the reply by SlowDragon in this thread which has information and links on how to deal with it. This problem needs to be sorted so that your supplements can be absorbed, then once vitamins and minerals are at optimal levels thyroid hormone can work.
Personally I would give this d**k of a doctor a very wide berth, see a different one, get treatment sorted and then seriously consider making a formal compaint against this one who has ignored these results.