Would you like to post your latest thyroid blood test results along with laboratory ranges? Include any thyroid antibodies test results and vitamin levels then members can give you good advice and help you work out what's going on.
Jenna, I think some of your symptoms may be attributed to low nutrient levels. Easy bruising may be B12 deficiency. Dark circles under eyes might be low iron. I'll comment on them in a minute.
As for your thyroid results.
TSH 0.02 (0.2 - 4.2) Your TSH is low but it's a pituitary hormone, not a thyroid hormone. It means your pituitary gland is not signalling the thyroid to produce more thyroxine, likely because you have sufficient.
Free T4 24.8 (12 - 22) FT4 is slightly over-range but not enough to worry about if you were symptom free because FT3 is lowish. FT4 is a pro-hormone and has to be converted to T3 to become active and taken up by thyroid hormone receptors.
Free T3 4.0 (3.1 - 6.8)as you can see, FT3 is in range, in fact it's low in range. If you were overmedicated it would be high and above the top of the range...so higher than 6.8 which is the top of the range. FT3 is best in the top third of the range.
TPO antibodies 677.3 (<34), TG antibodies 359.5 (<115) Antibodies evidence autoimmune thyroiditis otherwise known as Hashimotos.
Here is a document by Professor Toft, previous president of the British Thyroid Association BTA which is the organisation the thyroid surgeons and Endocrinologists subscribe to. It explains the options that are being disputed for thyroid treatment today. Perhaps you could give a copy to your GP?
Professor Toft - Counterblast to Thyroid Guidelines
Don't understand how blood tests can be done without your knowledge ??
However -
following these blood results approx 7 weeks ago, your dose was dropped from 175mcg to 100mcg. Is that correct?
I would see a different GP today. Ask for repeat bloods. Query why you were dropped by 75mcg in one go as dose change should only be gradual by increment or decrease of 25mcg at a time.
I would say that I need to take 125mcg now, be retested again in 4 to 6 weeks and following next results possibly increased to 150mcg.
If your doctor wanted to reduce your dose following the early November results then it should only have been by 25mcg.
Therefore to 150mcg and NOT 100mcg.
ps
Whilst constipation is a Hypo symptom, hard stools can also be caused by medications such as codeine and iron pills. Drinking extra water is necessary and increasing dietary fibre intake by eating more fresh fruit and root veg. A simple natural way is regular Fybogel sachets, adding a little fresh orange juice to stop them setting before you can finish them. Lactulose medicine helps as a natural softener if needed. Both are available on prescription so don't buy them - ask GP.
As already mentioned Your low nutrients ALL need addressing.
Your Vitamin D daily maintenance dose of 800IU hasn't worked has it? As years later it is still insufficient (according to NICE guidelines ). So I would ask the GP to increase the dose to between 1000 and 2000 IU (in accordance with NICE guidelines) and ask for retesting in a few months.
I have been asked by endo to increase to 125mcg levothyroxine and they were done last week. I have spoken to GP on the phone yesterday who advised I need to increase to 125mcg
Good. So glad to hear you've made a breakthrough. Well done!
After retests in 4 to 6 weeks You may go up to 150mcg.
I would keep an eye on your care now. Ask for copy of tests being done on Friday and ask for a printed copy of results.
Don't be intimidated by anyone in the NHS. It shouldn't have to be such an 'uphill ' struggle to get things done properly but sadly it is. So we battle on.
Hope you start to feel better soon.
Now your getting your Levo sorted, remember to mention nutrients. I would want to be tested for Pernicious Anemia also.
Ferritin 25 (30 - 400) Considering you've been supplementing 3 ferrous fumerate a day since 2013, these results are very low and as you can see, below range. YOu need to return to your GP and ask him/her why they think your levels are so low and investigate an absorption problem.Ferritin needs to be at least 70 or mid-range for thyroid hormone to work effectively.
Folate 2.2 (2.5 - 19.5) as you can see this is below range but you need to investigate your low B12 level and rule out pernicious anaemia before taking folic acid supplements. Taking folic acid can mask a B12 deficiency.
Vitamin B12 188 (180 - 900) although B12 is in range, it's right at the rock bottom of the range and considering your other absorption issues this needs further investigation. Your GP need to check for intrinsic factor antibodies.
Vitamin D total 32.2 (25 - 50 deficient) as SeasideSusie often says on this forum, 800iu vitamin D isn't ever going to raise your levels. It's not even enough to rescue a mouse. If your vitamin D level was lower than 30 when you were first diagnosed deficient, you should have been given loading doses and then sufficient maintenance dose to keep your levels in sufficient range. Are you in the UK? If so there are guidelines your GP must follow
You need to take magnesium and K2-MK7 with vitamin D3 in order to absorb the vitamin D effectively and deposit it in bones where it need to be. Magnesium citrate is ok but there are other choices for magnesium.
Have you got symptoms of B12 deficiency because if so, I advise you to post your B12 and folate results along with an outline of your thyroid condition and symptoms, low ferritin etc on the HealthUnlocked Pernicious Anaemia forum healthunlocked.com/pasoc and ask their advice about what your GP should be doing.
Book an appointment with your GP and ask for things to be looked into further as your iron is deficient despite supplementation as is your folate, vitamin D and B12 needs investigating further.
Its likely your deficiencies that are causing your symptoms but you should not reduce thyroid meds by more than 25mcg at a time or it can also cause you to feel unwell. YOu would have been best to go from 175 to 150 but according to results you didn't really need to reduce as your FT3 was low in range. If it were me, I would increase to 125 now and retest in 6 weeks and then adjust again if necessary and so on until back on track.
Make sure you always take your thyroid meds on an empty stomach with a full glass of water and leave an hour before eating or drinking anything except for water.
Leave 4 hours before taking any other medication, especially iron.
Hashimotos affects the gut and SlowDragon has good advice about improving gut function.
Thanks these results were not taken when I fasted or left 24 hours between dose and blood draw and it was taken in afternoon but bloods are usually taken with those precautions
Welcome to the forum! Your doctor should be helping you with low vitamin levels but it's something you can do for yourself. Many of ussupplement to get these levels higher and then a main ten every dose to kept them there. The result on your body thyroid wise is that you aren't converting the T4 into enough T3 to make you feel well hence the height FT4 result and the low FT3. Getting your vitamin levels higher will help this and also get rid of some of your thyroid symptoms. Doctors aren't very good at advising on this but if you search Seaside Susie's post she has excellent info regarding that. It takes time but well worth the effort.
I hope you are getting blood test early in morning and fasting and don't take Levo in the 24 hours prior to the test, delay and take straight after.
This gives highest TSH, lowest FT4 and most consistent results
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
Hashimoto's affects the gut and leads to low vitamin levels
Low vitamin levels stop Thyroid hormone working
Then bloods appear to show adequate or over treatment, and dose is often incorrectly reduced. You very likely had low vitamins on 175mcg, and actually were still slightly hypo
Have you had T3 started and then stopped?
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
Gluten free diet helps very many. Strongly suggest trying it for 3-6 months, if it helps stick on it.
Dose of Levo will need increases back in 25mcg steps, retesting 6-8 weeks after each dose increase, until TSH is around one and FT4 towards top of range and FT3 at least half way in range
If T3 remains low, despite all this, then like many with Hashimoto's you may need the addition of small dose of T3. But vitamin levels and gluten and dose Levo need correcting first
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.
Also ask for list of recommended thyroid specialists
Thanks these results were not taken when I fasted or left 24 hours between dose and blood draw and it was taken in afternoon. Nurse didn't tell me what was being tested but bloods are usually taken with those precautions and yes T3 was stopped
I recently had blood test for diabetes .I specifically asked whether that was all that was being tested and was told "Yes" . But TSH was tested .I had not fasted and had had my levo .It may have been a mistake but I intend to complain.
Not if it had led to reducing the dosage because it was taken at mid day,after food and after dosing when all previous tests have been early am,after fasting and 24 hours after a dose of levo.I strive for consistent testing circumstances to make a fair comparison of the results.
They are supposed to get your 'informed consent' for tests. If they don't tell you then they haven't got that consent, but what's worse is that it appears as though Treepie may have been lied to. The nurse who took the blood must have known what tests the blood was being drawn for to know how many tubes were needed, it would have been on the computer, form, or whatever method is used at their surgery.
I don't think you need more Levi: you're over range in T4, but low in T3, vit d, b12 and folate. I don't know enough about iron to comment. Firstly, you could safely raise your supplements for d3. I only feel well on 5000 iu a day. I take MK7 with it in order to make sure the calcium produced by the vit d goes to my bones and not my arteries! Also, you need b12, probably in injection form from your GP. If you're not taking selenium you must start: this will help you convert your Levo into T3. Also, you need to address your Hashimotos: even if your other levels were fine, with antibodies that high, you'll never feel well. The best advice I got for Hashi's was to stop consuming gluten, dairy products and soy. I strongly suggest you give that a serious try: it's not as hard as it might appear and can be so helpful. But first: selenium, vit d3, and b12 asap. Best of luck.
Jenna, this is very confusing because you said above that FT4 was 24.8 If you don't give us ALL the information as we asked, how can we give you correct information? You've now added additional information on new blood tests to your post saying FT4 is 12.1 which confirms that you did not need to alter your thyroid meds or if so, only by 25mcgs. You've also now said that T3 was added but you did not tell us that originally. So I presume T3 was removed but when? You need to give us all the information or you'll get incomplete advice.
I didn't mean to give incomplete information; I was meant to be taking T3 but I have been advised against taking it by endo who said it would kill me if I took it so didn't include this info in case he was right
Jenna, it sounds like your Endo scared you into stopping T3 so he achieved his intention perhaps of saving money from the medicines budget. Who prescribed T3 in the first place? Thyroid cancer patients are all prescribed T3 instead of Levothyroxine before RAI treatment because it's helpful so if it was going to kill you, why are other patients prescribed it?
I thought I'd heard all the Endo's rules but clearly not. I'm sorry your Endo scared you and now you're unwell as a result of not enough thyroid meds.
What's your T3 now? I got that exact reading of my last T4 test, along with a TSH of 1.7 and T3 which was in the upper half of the range. GP would never give me more Levo with my TSH at that level, but I am self medicating with T3 and decided I could take a little more with the TSH still quite high for someone taking T3. I'm conservative, though with Levo as over prescription of it led to heart issues for me.
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Newbie thyroid results 
