"Normal" but not optimal? Advice would be appreciated

[samandala]

Hi there

I'm really appreciating this site and the information I've gleaned from it. I had blood tests done with Medichecks last week and I would appreciate some advice about the results as everything seems to be in range but I'm not feeling OK.

I was put on 50mcg of levothyroxine back in March due to high TSH levels. The doctor retested 6 weeks later and told me my results were fine (even though I'd asked for T3, they didn't even test for T4 as TSH was in range). I felt a lot wrose for quite some time on the medication but everyone told me that it takes time, so I hung in there.

I've had times over the summer of feeling that I am gradually getting better (less fatigue, more strength, better brain functioning) but in the last few weeks I seemed to crash again (hence getting the blood tests done). But the results seem to be in range (apart from one of the antibodies indicating Hashimotos).

TSH 1.69 (0.27-4.2)

Free thyroxine 18 (12-22)

Total T4 98.9 (59-154)

free T3 4.7 (3.1-6.8)

Thyroglobulin antibody 24 (0-115)

Thyroid Peroxidase 224 (0-34)

Active B12 60 (25-50)

Folate 8 (2.9-50)

Vitamin D3 63 (50-200)

CRP 0.3 (00-5.00)

Ferritin 37.2 (13-150)

Cortisol - all within range except morning one which was just above range

From what I've read some of these values could be a little higher for optimal health (like t3) but I tried to increase my dose of Leothyroxine by a quarter of a tablet (so to 62 mcg) and after about a week and a half I felt really unwell (insomnia, overheating, feeling poisoned, loss of appetite, jittery) and I realised I'd had similar symptoms when I started on Levothyroxine. So I'm reluctant to try increasing my dose again and wondered whether it might be worth trying adding a little T3 as maybe I have a conversion problem? My symptoms are internal body vibration, numbness, low energy, loss of appetite, hardness in my abdomen, not feeling able to interact with people and feeling generally unwell. I can have some good days too when I think I'm getting better. I'm supplementing iron, B12, zinc, selenium and Vitamin D since reading the advice on this site.

Would T3 be a good idea? If so I'd appreciate a PM to source it. Thank you!

[shaws]

I will add in SeasideSusie as she is great at advising on deficiencies in vitamins/minerals.

Did you have your blood test at the earliest and allow a 24 hour gap between last dose of hormones and the test? Most of us feel best when TSH is 1 or below and some suppressed. Sometimes it is deficiencies in vitamins/minerals which cause the symptoms.

[samandala in reply to shaws]

Thank you - yes I did the test as soon as I woke up and allowed a 24 hour gap. I was hoping something obvious would come up - like a mineral deficiency - as it would help me know what to try next! I don't seem to be a very normal case - like I don't have any digestive problems or weight challenges but some very weird symptoms instead.

[shaws in reply to samandala]

We are all different, unfortunately or fortunately - depends on how we are affected by hypo. The aim (which doctors do not know) is that the aim is a TSH of 1 or lower and some need it to be suppressed but 'suppressed' to most doctors suggests that we are on too much and will have a heart attack or osteo but that's nonsense. If we are too much we'll want to reduce dose ourself as we wouldn't feel good at all, whereas if on 'optimum' we should feel much better with relief of symptoms. I will give you a link and I think you might tick more than a couple of symptoms.

thyroiduk.org.uk/tuk/about_...

Also some people don't feel better on levothyroxine alone and the addition of T3 can improve their condition. Research has confirmed this fact. The reason being that we need sufficient T3 (the only Active Thyroid Hormone) in all our T3 receptor cells from our dose of T4 (levo) and sometimes that doesn't happen.

thyroiduk.org.uk/tuk/resear...

[samandala in reply to shaws]

Thanks Shaws. Yes - I'm exhibiting plenty of those symptoms! I haven't seen that page with the research articles before - I will certainly have a look at those (I'm learning fast but still have quite a way to go with the science!). I'm going to take all the dietary and supplement advice I've been given here, but I'm also feeling very drawn to experimenting with just adding a little T3 to see how I respond - it does sounds as though its really helpful for some people. I understand that you can't disclose any suppliers but can you PM me with any that are reliable? Thanks so much

[shaws in reply to samandala]

I don't have any details about where to source T3.

If you put up a new post and ask for a Private Message to be sent and those who have information will respond. Your post will then be closed just in case anything is put on the forum but a private message will be sent.

This year there has been a shortage worldwide I believe.

[Tasker]

Hi Samandala. I was interested that you mentioned internal body vibration as a symptom. I have had what I would have described as an internal vibrating or "thrumming" feeling (is that a made up word?!) which for me often went along with palpitations. I have found that going gluten free has reduced it almost to nothing - and I wasn't aware of having gut problems, but decided to try GF after reading advice on this forum. Maybe worth a try?

And I'm no expert on vits and mins, but I notice your ferritin is a lot lower than the 70+ recommended on this forum for good conversion, so might need addressing before trying T3. I have a similar problem and take 2 X 200mg ferrous sulphate daily to try to boost my levels.

Good luck, whichever options you try.

[samandala in reply to Tasker]

Thanks Tasker - I'm wheat free but not gluten free - time to take the extra step. I've just ordered some ferrous sulphate so hopefully that will help.

[Tasker in reply to samandala]

If you're already wheat free, I'm guessing going GF won't be too huge a step to take. I love all my starchy carbs - bread, cake, pasta etc - but so far have found GF much less difficult than I expected, especially as I can feel the difference it makes - and it's getting me back to doing more of my own cooking and baking which is good as well. Anyway, good luck!

[humanbean]

Adding just a quarter tablet of Levo shouldn't have had the effect it did. Your cortisol being over the range in the morning could account for you not tolerating the extra Levo.

A simple experiment you can try would be to take your Levo at a different time of day - so if you take it in the morning, try taking it just before turning the light out to go to sleep instead. You would have to have your final food and drink (apart from water) a couple of hours before bed though. If the experiment doesn't work then just go back to your preferred time of day for taking it.

You would probably feel better with more Levo or more T3 if only you could tolerate them. But with high cortisol in the morning extra thyroid meds might be impossible to tolerate. You could do some research into adaptogens, phosphatidyserine (PS), phosphorylated serine (brand name Seriphos), which are known to lower cortisol in some people.

draxe.com/7-adaptogen-herbs...

stopthethyroidmadness.com/ps/

Unfortunately, lowering cortisol is a bit hit and miss - either people can't tolerate the things they try, or they don't work, or they have unwanted side effects. It can take a lot of experimentation.

[samandala in reply to humanbean]

Thanks humanbean - I do take my meds in the evening anyway. I'll do a little more reading around cortisol/adaptogens etc - but even the morning above range value wasn't very elevated (22nmol/L with a range of 6-21) so I'm not sure cortisol is to blame.

[SeasideSusie Remembering]

Samandala

Active B12 60 (25-50)

Is there something wrong with that range? I'm sure I have seen it with a higher top end than that.

**

Folate 8 (2.9-50)

Folate should be at least half way through it's range, so 26.5+ with your range.

Are you supplementing with a B Complex? You should be if you are taking B12 as it's needed to balance all the B vitamins. Look for one with 400mcg methylfolate to help you raise your folate level, eg Thorne Basic B.

**

Vitamin D3 63 (50-200)

This is recommended to be 100-150nmol/L according to the Vit D Council. What amount of D3 are you taking? Are you also taking it's important cofactors vitamindcouncil.org/about-v... particularly K2-MK7 and magnesium?

**

Ferritin 37.2 (13-150)

This should be at least 70 for thyroid hormone to work. Eating liver once a week can help raise ferritin.

Are you taking your iron tablets with 1000mg Vit C to aid absorption and help prevent constipation? And are you taking them 4 hours away from thyroid meds and 2 hours away from any other medication and supplements?

**

Are you addressing the Hashi's by being strictly gluten free along with your selenium (L-selenomethionine - 200mcg?)

**

Your FT4 and FT3 don't suggest you need T3 as the FT4: FT3 ratio is 3.82 : 1 and good conversion takes place at 4:1 or below. If you can optimise your nutrients that might help. To try and raise your dose of levo, try cutting your tablet even smaller. Do you have 25mcg tablets, if careful you might be able to manage 1/8ths to give about 3mcg, if not try cutting half a tablet into 3 to give about 4mcg.

[samandala in reply to SeasideSusie]

Hi Seaside Suzie -

Thank you for taking the time to cover all this.

Yes - my mistake on the B12 range - it should be 25-165

I'm not currently supplementing B vitamins so I'll order the Thorne B.

I had a loading dose of Vitamin D back in April and then mistakenly assumed that I'd have some more sun over the summer and wouldn't need to supplement, so I've only just gone back to it. I have some 4000iu strength tablets, so shall take those for a while (I've now read from a post of yours to someone else that the vitamin D council say that dose is OK for 10 weeks). I also have some K2 and magnesium.

I don't think I've been taking enough iron or vitamin C.

I'm wheat free but not gluten free - time to step up the dietary changes I think!

And that last bit of info about conversion for T4 to T3 is really useful - I haven't seen that written anywhere else. It seems I need to persist with the nutritional route and try again raising Levo but by even less (I only have 50mcg tablets so its tricky but I remember reading that someone crushed their tablets and then just had a little of the powder so I'll try that).

Thanks again for your time and support - its much appreciated xxx

[SeasideSusie Remembering in reply to samandala]

Ok, so your B12 is on the low side. Maybe increase your B12 supplement for a while, is it sublingual methylcobalamin lozenges you are using?

Vit D - you can take 4000iu for as long as needed, get your level up to the recommended amount then find your maintenance dose. Mine is 2000iu all year round now to keep mine around 150. Are you taking tablets? If so they're not as absorbable as softgels containing oil or, as you are Hashi's, then an oral spray would be even better absorbed eg BetterYou. D3 is fat soluble (as is K2-MK7) so must have some kind of fat to be absorbed so fattiest meal of the day normally. Keep D3 away from Kevin by 4 hours.

Crushing tablets - good idea. I think I read someone mentioned dissolving it in water, might be worth a try.

[ITYFIALMCTT]

I agree, SS - Active B12 range from Medichecks is something like 25.1 - 165.

[Clairewalker751]

Just a thought what brand of levo are you taking?

[samandala in reply to Clairewalker751]

I'm on Almus - I'm not normally too sensitive to additives and things but I'd be interested if some people react to this brand?

[Clairewalker751 in reply to samandala]

I think almus is activis repackaged I think this is one of the better brands? I've read on here people not doing well on the Teva brand?

[SlowDragon Administrator]

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...

Importance of magnesium

hypothyroidmom.com/two-vita...

Getting vitamins correct is vital

Great little film

drbradshook.com/understandi...

[samandala]

Thanks for this - I've read about the significance of gluten but as my digestion is generally pretty good, I hadn't fully gone gluten free. But I shall now