Thyroid results

[Nazbe]

TSH 22.5 (0.2 - 4.2)

Free T4 10.7 (12 - 22)

TPO antibody 840 (<34)

Ferritin 14 (15 - 150)

Folate 2.0 (2.5 - 19.5)

Vitamin B12 197 (190 - 900)

Vitamin D 28.8 (25 - 50 deficiency)

Newly diagnosed started on 50mcg levo when will I feel better?

Thanks

[SlowDragon Administrator]

Welcome to the forum

How long have you been taking Levothyroxine and which brand are you taking?

What has your GP done about the very low vitamins

Low vitamins stop thyroid hormones working so it's essential to improve them at same time as get on Levothyroxine

Ferritin is so low you certainly need full iron panel and very likely an iron infusion followed by iron supplements

Vitamin D is very low, LOADING dose should be started

B12 needs full testing for Pernicious Anaemia before starting B12 injections

Folate - folic acid supplements should be prescribed and started AFTER first B12 injection

See this detailed reply to similar levels by SeasideSusie - she's the vitamin guru here

healthunlocked.com/thyroidu...

Always take Levo on empty stomach and then nothing apart from water for at least an hour after. Many take on waking, but it may be more convenient and possibly more effective taken at bedtime

verywell.com/should-i-take-...

Many people find Levothyroxine brands are not interchangeable. Once you find a brand that suits you, best to make sure to only get that one at each prescription.

Your high TPO antibodies confirms you have Hashimoto's.

Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels

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...

Read as much as possible about Hashimoto's

Vitamin levels are key, plus addressing food intolerances

You should have bloods retested 6 weeks after any dose change. Aim is to increase the dose in 25mcg steps (retesting 6 weeks later each time) until TSH is around one and FT4 towards top of range and FT3 at least half way in range

[Nazbe in reply to SlowDragon]

Been taking 50mcg levothyroxine for 3 months and nothing done about vitamins thanks

[greygoose]

Probably not for a while yet, for several reasons...

50 mcg is just a starter dose. You should be retested in six weeks after starting, and your dose increased by 25 mcg. And, this should be repeated until you do feel well.

In the meantime, you need to do something about your nutrients, which are dire. Did your doctor not prescribe any supplements? You won't feel well until they are optimal.

Your ferritin is below range, it needs to be at least mid-range to be optimal.

Your folate is below range, and your B12 is just at the bottom of the range. Folate should be at least mid-range, and B12 at least over 500. Your B12 is so low that you should be tested for Pernicious Anemia before starting any supplements. You should be having B12 injections.

Your vit D is right at the bottom of the range, and should be around 100. Is your doctor not doing anything about that?

Low nutrients not only cause symptoms, but stop your thyroid hormone from working, making it difficult for you to increase your dose, and affecting your conversion of T4 to T3. So, something needs to be done. If your doctor won't help, repost your levels, and someone will tell you what you can supplement for yourself.

Also, you have Hashi's, according to your high antibodies - did your doctor tell you about that? He might have called it Autoimmune Thyroiditis. There is no cure, but you could help yourself by going 100% gluten-free and taking selenium, to lower antibodies, and help with conversion.

I'm afraid there's a lot to be done before you can start to feel well.

[Nazbe in reply to greygoose]

Thanks nothing prescribed for low vitamins

[greygoose in reply to Nazbe]

Then he's being extremely negligent! You need to get on to him about it.

[Clutter]

Nazbe,

Has your GP prescribed anything for deficient ferritin, folate, vitamin D and low B12?

[Nazbe in reply to Clutter]

No he hasn't

[Clutter in reply to Nazbe]

Nazbe,

If your GP has seen those results and not prescribed treatment you should write to the practice manager and make a formal complaint about GP's negligence. In the meantime, make an appointment to see another GP at the practice.

B12 is almost bottom of range which can indicate B12 deficiency. Folate is deficient. Ferritin is deficient. GP should order a full blood count and iron panel to rule out iron deficiency anaemia and B12 and folate deficiency anaemia.

If B12 deficiency is confirmed B12 injections should be initiated 48 hours prior to you starting folic acid 5mg. GP should also investigate whether B12 and folate deficiency is caused by pernicious anaemia. Symptoms of B12 deficiency are b12deficiency.info/signs-an... healthunlocked.com/pasoc are the experts on PA, B12 and folate if you want more advice.

Iron deficiency anaemia is usually treated with 3 x 210mg Ferrous Fumarate. Take each tablet with 1,000mg vitamin C to aid absorption and minimise constipation. Take iron 3 hours away from Levothyroxine.

VitD is deficient. Your GP should refer to local guidelines or the cks.nice.org.uk/vitamin-d-d... Do NOT accept a prescription for 800iu which is a maintenance dose prescribed after vitD is replete >75. My GP pre-scribed 40,000iu daily x 14 followed by 2,000iu daily x 8 weeks which raised vitD from <10 to 107. Vitamin D should be taken 4 hours away from Levothyroxine.

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.

For maximum absorption Levothyroxine should be taken with water 1 hour before, or 2 hours after, food and drink, 2 hours away from other medication and supplements, and 4 hours away from calcium, iron, vitamin D supplements, magnesium and oestrogen.

It takes 7-10 days for Levothyroxine to be absorbed before it starts working and it will take up to six weeks to feel the full impact of the dose. Symptoms may lag behind good biochemistry by several months.

You should have a follow up thyroid test 6-8 weeks after starting 50mcg Levothyroxine. Arrange an early morning and fasting (water only) blood draw when TSH is highest, and take Levothyroxine after your blood draw.

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

[Nazbe in reply to Clutter]

Thanks complete blood count showed below range MCV and above range MCHC and below range haemoglobin and GP said not clinically significant, also below range iron and low transferrin saturation

[SlowDragon Administrator in reply to Nazbe]

Make an urgent "on the day" appointment with different GP

It is ESSENTIAL to get these treated

See this reply to similar low levels

healthunlocked.com/thyroidu...

Your GP is grossly negligent to not have done anything

[Clutter in reply to Nazbe]

Nazbe,

It is clinically significant and confirms iron deficiency anaemia and perhaps B12 deficiency.

Please see another GP at your surgery for treatment ASAP and make a formal complaint to the practice manager about your GP's negligence.