I recently got my mum a thyroid plus check from Medichecks after reading all the info everyone writes on here as she still has symptoms... she’s been on Levothyroxine 100 per day for 4yrs.
She’s never had her vitamins checked. She also has RA.
I’m wondering about her free T4 result.. is that quite high? I know her TSH is under medicated.
TSH 3.59mIU (0.27-4.2)
Free Thyroxine 20.3pmol (12-22)
Total Thyroxine (T4) 115.0pmol (59-154nmol)
Free T3 4pmol (3.6-6.8)
Thyroglobulin antibody - 29.600IU (0-115.00) they marked this as normal
Thyroid Peroxidase Antibodies - 182IU (0-34)
She has Hashimoto’s, i thought both sets of antibodies where high with Hashi’s is that not usually the case? Just because both mine are very high.
I sent her in with the info from this forum, they are going to test her vitamin levels and they’ve sent her for a Thyroid scan due to unable to swallow food properly.
Thanks in advance x
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GeekyMummy
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All thyroid tests should be done as early as possible in morning and fasting and don't take Levo in the 24 hours prior to test, delay and take straight after. This gives highest TSH, lowest FT4 and most consistent results
Is this how test was done?
Her TSH is too high for someone on Levothyroxine
Her FT4 may be relatively high in comparison to TSH due to vitamin deficiencies and if she is not strictly gluten free
FT3 is definitely too low
Wait for vitamin results and come back with new post
Once vitamin levels are optimal she will probably be able to tolerate dose increase and/or need small dose of T3
Dr Toft, past president of the British Thyroid Association and leading endocrinologist, 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 articles from Thyroid UK email dionne.fulcher@thyroidUK.org. print it and highlight question 6 to show your doctor.
I would usually say that to have TSH 3.59 on 100mcg Levothyroxine indicates undermedication but FT4 is high in range although FT3 is low in range. TSH rises in the elderly so it may be that TSH 3.59 is okay for your mother. If she is symptomatic then a dose increase to 100mcg/125mcg alternate days may be suitable. Some people do need FT4 over range to deliver reasonable FT3.
The goal of Levothyroxine is to restore the patient to euthyroid status. For most patients that will be when TSH is 0.3 - 1.0 with FT4 in the upper range. FT4 needs to be in the upper range in order that sufficient T3 is converted. Read Treatment Options in thyroiduk.org.uk/tuk/about_... Email dionne.fulcher@thyroiduk.org if you would like a copy of the Pulse article to show your GP.
Thyroid peroxidase antibodies are positive for autoimmune thyroid disease (Hashimoto's). There is no cure for Hashimoto's which causes 90% of hypothyroidism. Levothyroxine treatment is for the low thyroid levels it causes. Many people have found that 100% gluten-free diet is helpful in reducing Hashi flares, symptoms and eventually antibodies but I think it is debatable whether your 87year old mother is willing or likely to benefit from dietary changes.
I’m hoping that if she has Vitamin Deficiencies it may bring her TSH down further once she is at optimal levels.. however she saw a GP who’s sister has the same problem so she was willing to help. She is very symptomatic, her Thyroid is swollen and also she suffers when swallowing and sometimes feels restricted when breathing, also very hoarse voice.
Sorry why would you think my mother is 87? Lol. I’m only 29 and she’s only 49. I didn’t mention ages.
As said above to Seaside susie.... my mother has asked for my help with diet changes and meal plans after Christmas as I have always done my own meal plans and started the gym 10 year’s ago. Hopefully that’ll help too.
I must have been thinking of somebody else. Your mother definitely needs a dose increase, she is undermedicated with TSH 3.59. If it hasn't already been done it would be sensible to have a thyroid ultrasound scan to examine the thyroid as she's developed hoarseness and is having trouble swallowing.
Yes she did it that way as I advised her too, I had purchased the test for her to hopefully get the Doctors looking at her vitamins/medication.
She isn’t strictly gluten free, I’ve told her about it and she said she would like my help after Christmas with meal plans to help (I know all about nutritional information etc as I’ve been going the gym and did my own meal plans since I was 19).
Hi, For someone on levothyroxine for 4 years her TSH is too high so she might need an increased dose. Don't worry about the Free T4. It should be at the top end. Mine is bang on the top and my Free T3 is smack right in the middle of the reference range, although I would like it a little higher. Her Free T3 looks slightly low. If there is a conversion problem (T4 to T3) she might need a very tiny bit of T3, in which case the T4 could stay at 100mcg or even be reduced slightly. If the scan shows nothing untoward she will need an endoscopy. I had the same problem and it turned out to be a hiatis hernia causing acid to rise up through the oesophagus. If that continues the oesophagus will get scarred and will stop food going down. I put it down to my thyroid condition but I was assured by thyroid experts it was nothing to do with it. If she has a HH she will need anti-acid medication and it cleared my problem up. I don't have Hashimotos - so I don't know about antibodies. My thyroid failure is genetic and occurred exactly the same age as my father's. I don't know how relevant vitamins are in terms of the thyroid gland when you are on levo. The drug replaces what the thyroid gland would produce if it were healthy, so I don't really see the connection, but I'm not an expert. Good luck!
Hi, After I posted, I have just noticed you say her thyroid is swollen. That may well change the treatment of the difficult swallowing. Sorry, I should have read it all through beforehand.
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