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Would appreciate help interpreting results and deciding on order of actions!

Help lovely peeps. I followed Clutter's advice in previous post regarding testing and now have some results to look at ( I am on 125mcg Levi daily, taken at night):

TSH 0.159 mIU/L (0.27 - 4.20)

Free T4. 22.1 pmol/L (12.00-22.00)

Free T3. 4.36 pmol/L (3.10-6.8)

Thyroglobulin antibody 11.200 IU/mL (0.00-115.00)

Thyroid Peroxidase Antibodies 141 IU/mL (0.00-34.00)

Active B12 81.4 pmo/L (25.10- 165.00)

Folate (serum) 15.36 ug/L. (2.91-50.00)

25 OH vit D 35 nmol/L (50.00-200.00)

CRP 1.1 mg/l (0.00-5.00)

Ferritin 61.9 ug/L (13.00-150.00)

I also had cortisol saliva test (4) done which has a note on saying 'reassuringly normal' so I haven't posted those.

I often wake at around 3 a.m. with HR of about 120 BPM but usually fall asleep again after a few minutes.

I have such aches and fatigue, apart from sorting out vit D what else should I do? Should I get rt3 tested? How does the high TPoA level affect how I feel and what can I do about it?

How would should I prioritise the issues?

Thank you for reading this.

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Clover29,

TSH is low but not suppressed, FT4 is mildly over range and FT3 4.36 is okay but could be higher. You appear to be optimally dosed on 125mcg.

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.

chriskresser.com/the-gluten...

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

Vitamin D is deficient. If you can get a GP appointment 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 sister's GP prescribed 2 x 20,000iu daily per week when her vitD was 40. If you can't get an appointment for a while you can buy vitamin D3 and self supplement. I suggest 10,000iu daily x 4-6 weeks and then reduce to 5,000iu daily and retest in Mar/Apr. VitD must be taken 4 hours away from Levothyroxine.

If you buy on Amazon please use the affiliate link healthunlocked.com/thyroidu...

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If it were me, I would prioritise vitamin D. I wouldn't bother paying for RT3, personally. I don't have antibodies so can't comment on whether they affect the way you feel.

Ferritin could still do with a little boost to around 70 so eat plenty of iron rich foods to increase level a little.

I don't understand active B12 tests but from the range B12 looks OK. I take a good B complex once a week now my levels are good.

Are you taking 100 to 200 mcg of a good selenium daily? It may help to reduce antibodies and support conversion from T4 to T3 which is selenium dependent.

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I also had cortisol saliva test (4) done which has a note on saying 'reassuringly normal' so I haven't posted those.

I think you should post them anyway. Optimal levels are at different places in the reference range depending on time of day.

From this link : rt3-adrenals.org/cortisol_t...

see Example 1 :

Optimal levels

• Morning at the top of the range

• Noon approximately 75% of the range

• Evening close to 50% of the range

• Nighttime at the bottom of the range

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Clover29

Those results show that your FT3 is too low in relation to FT4 so your conversion of T4 to T3 is poor. Good conversion takes place when FT4: FT3 ratio is 4:1 or less, yours is 5.06 : 1 so you could do with the addition of some T3 with maybe a small reduction in Levo.

**

Your raised antibodies confirm autoimmune thyroid disease aka Hashimoto's which is where antibodies attack the thyroid and gradually destroy it and cause fluctuations in symptoms and test results. You can help reduce the antibodies by adopting a strict gluten free diet which has helped many members here. Gluten contains gliadin which is a protein thought to trigger antibody attacks and you don't have to be Coeliac for a gluten free diet to help reduce antibodies. Supplementing with selenium L-selenomethionine 200mcg daily can also help reduce antibodies, as can keeping TSH suppressed.

chriskresser.com/the-gluten...

hypothyroidmom.com/hashimot...

stopthethyroidmadness.com/h...

stopthethyroidmadness.com/h...

**

Ferritin isn't far off the 70 needed for thyroid hormone to work, half way through range is recommended. You can raise and maintain ferritin by eating liver regularly, maximum 200g per week.

**

B12, although in range, is too low for my liking, I'd want it nearer the top of the range. Supplementing with sublingual methylcobalamin lozenges 1000mcg daily will raise that.

When supplementing B12 we need a good B Complex to balance all the B vitamins and one containing 400mcg methylfolate will help measure your folate level which should be at least half way through it's range, look at Thorne Basic B.

**

Vit D is recommended to be 100-150nmol/L according to the Vit D Council. I would suggest you supplement with 5000iu D3 daily for 3 months then retest. When you've reached the recommended level you'll need a maintenance dose which may be 2000iu daily, it's trial and error.

When taking D3 there are important cofactors needed vitamindcouncil.org/about-v...

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. Take D3 four hours away from thyroid meds.

Magnesium helps D3 to work. It comes in different forms, see which would suit you best and as it's calming it's best to take it in the evening naturalnews.com/046401_magn...

Check out the other cofactors too.

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Did you miss off the TT4 result ?

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Oh Yes... I will post it..

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Thank you all: lots to digest there and I'm a bit foggy so might need to come back to you!

I did miss TT4. It's 109.0 nmol/L (59.00-154.00)

Cortisol:

Waking 7.080 nmol/L (6.00-21.00)

12.00 3.120 nmol/L (1.50-7.60)

16.00 1.720 nmol/L (0.00-5.49)

Before bed <1.5 nmol/L (0.00-1.99)

I have been taking vit D with A and fish oil for years but only supermarket ones so obviously not strong enough a dose!

Thank you so much for helping. I have felt it's all in my head when I speak to my GP and needed some evidence to take.

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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

Did you do this?

TT4 suggests there is room for dose increase in Levo.

Especially as once you correct low vitamin D you should be using more

I agree with SeasideSusie your B12 looks low. Supplementing B12 sublingual lozenges and also good vitamin B complex likely to help

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.

Prof Toft - article just published now saying T3 is likely essential for many or alternatively we need very high T4.

rcpe.ac.uk/sites/default/fi...

Your high antibodies confirm you have Hashimoto's also called autoimmune thyroid disease

You might be astonished at improvements if you changed to strictly gluten free diet (can help brain fog too)

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...

Only make ONE change at a time

Suggested order

First start vitamin D

Then add magnesium followed by K2

Then look at B12 followed by B complex

If not already taking selenium this is good supplement to take too

Then consider gluten free diet (New Year)

Then perhaps wait at least 6 weeks for everything to settle and get full testing redone

I would expect you may then need increase in Levo

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Thank you Slow Dragon. I take my Levo at night, so I missed Thursday's dose, had my blood test done as soon as the clinic opened, then took the Levo. Had breakfast an hour later.

I am interested that you say you expect I may need an increase in Levo: why is that?

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Low vitamins stop us being able to use thyroid hormones very well.

So when vitamins are very low if have Thyroid blood test, it suggests adequately treated, but it's just sat there not doing much

You feel hypo, but GP either thinks your correctly medicated or worse says you're over medicated and to reduce dose (and we see this very often especially after T3 is stopped )

Then vitamin levels fall futher......vicious circle

When vitamins are at good level, Thyroid hormones get used better, we have more energy, start being more active, warmer etc. Then often need increase in Levo as metabolism picks up

Improving vitamins is essential to break that cycle

How you did the test was perfect.

Taking Levo at nighttime seems to work best for many of us

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Slow Dragon I wonder what you know about this in regards to TSH? In the report that came with the results the doctor said,'Having very low levels of TSH for several years has been associated with the development of osteoporosis.'

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Being medicated to correct hypothyroidism, keeping TSH low but FT4 and FT3 in range is not the same as being hyperthyroid where TSH is low and FT4 and FT3 are out of range

Prof Toft - article just published now saying T3 is likely essential for many or that we need high FT4 and suppressed TSH

Also says in 3rd paragraph there is no evidence that suppressed TSH (with in range FT4 and FT3) causes osteoporosis or AF

rcpe.ac.uk/sites/default/fi...

I have had "debate" in past with my endo when keeping my blood test results where they wanted, (i.e. Under medicated) meant no energy to do anything at all.

Exercise is the best thing for strong bones.

diogenes Has also written about this ...... from a previous post of his (Sorry don't have the link to page)

Well this endocrinologist seems to have a fund of "information?" not available to anyone else. He/she should be asked to provide publication backup for what they say.

First, you are certainly not 5 times more likely to get heart problems.

Low TSH doesn't cause heart problems; too high FT4/FT3 will, but even then only slightly with therapy. One has to be clearly hyperthyroid for this to be serious. Similarly, suppressed TSH with too high FT4/3 will cause 1 extra fracture from osteoporosis every 1000 patient years. So even if there were to be future problems (and that's uncertain for an individual) I think everyone would opt for a decent life now against such small possibilities.

My wife has been on 125/150 T4 for now nearly 50 years with no detectable TSH ever, and still has strong bones and good working heart. I don't think she'd have opted for 50 years of poor QoL with normal TSH and lower FT4/3 just in case a fracture or AF might occur in the future..

There is too much hysteria about in this area - small possibilties have been built up into racing certainties from no evidence at all.

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Whoever called your cortisol 'reassuringly normal', doesn't know much about cortisol! Your waking cortisol is much too low! I bet you have a hard time getting out of bed! You don't yet have adrenal fatigue, but you're on the way. Time to start taking care of your adrenals!

You need to have a high protein breakfast as soon as you get out of bed. Adrenals need good protein. They also need lots and lots of vit C - you can take up to 5000 mg spread out through the day. You can even take 1000 mg at night, with your levo, and it will help absorption.

Adrenals need plenty of B vits, so a good B complex, with methylcobalamin and methylfolate. And they need plenty of salt. Do not skimp on the salt. You could also try a glandular, like NutriAdrenal (if they are available) to support your adrenals - but not one that is full of adaptogens and things, just pure dried adrenal.

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I thought the same thing about the morning cortisol. In range, but not optimal. Also, if cortisol falls too low during the night your body cannot maintain blood glucose levels and releases adrenaline to compensate. I wonder if that is why the waking with elevated heart rate? Just my two cents.

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An interesting thought Scottbnk, another question to put to the GP! I will see if I can find any into about that. Thanks.

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Thank you Grey Goose: I don't know anything about adrenal fatigue so need to get researching. What are the odds that if I showed my GP the cortisol results he would think them normal too? After all, they are within the ranges. I will have a look at the link then try to get up to speed with it all. I find I can explain to my husband or friend but as soon as i am sitting in front of my GP I find it hard to remember details or I am fumbling bits of paper and feeling like an idiot! Maybe I should take my husband with me..!

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Clover29,

If results are with the ranges that is what makes them 'normal'.

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It's often a good idea to take a supportive friend or family member with you

GP's tend to take the situation more seriously, are less dismissive and there's a witness. Plus if you struggle to remember they can help out

A short list of points you want to discuss is good too. Your husband could have a copy too, then give you a prompt if you get muddled

Brain fog is classic sign of under medication

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Yes, will get him to read everything with me and draw up a list/plan together. And then actually come with me! Thank you

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It might take quite a bit of searching to find a GP that knows anything about adrenal fatigue. In the US functional & alternative medicine doctors seem to have heard of it.

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It's very doubtful that your GP would know the first thing about adrenals. I've never met a GP that even knows where they are! (Only half joking, there.) He certainly wouldn't know what to do about them, and, as all the results are within range, he will consider them 'normal'. And that's all that 'normal' means : in range. It doesn't mean that everyone has their cortisol at that level, and it doesn't mean that a cortisol at that level will make you feel healthy. Doctors have no idea that the ranges are too broad, and that it's where your result falls in the range, that counts.

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