TPO 1800 (<34)
TSH 7.8 (0.2 - 4.2)
FT4 12.7 (12 - 22)
FT3 3.3 (3.1 - 6.8)
Ferritin 27 (30 - 400)
Folate 1.8 (2.5 - 19.5)
Vitamin B12 201 (190 - 900)
Vitamin D 25.5
Hi
Results found on online health record
I have symptoms of dry skin, goitre,hard stool, losing hair. I am 27.
Diagnosed 2012
Taking 125 levo
Thanks
Hi Annie, see advice given to similar post on vitamins, scroll down to find vitamins advice and links to NICE guidelines.
healthunlocked.com/thyroidu...
If these are recent results you need a 25mcg increase in levothyroxine and retest in 6 weeks and increase and so on until TSH is around 1 or a little lower which is where most people feel well. If not recent results then get a new blood test done for thyroid levels.
You have Hashimotos as you have elevated TPO thyroid antibodies. SlowDragon might respond re. good advice about gut function and gluten.
The TPO result shows you have autoimmune hypothyroidism which affects your thyroid gland. Your gland is probably not functioning by now, which is not bad news as with these high antibody levels it might have been irratic in its hormone secretion. You are clearly undermedicated and this would explain your signs and symptoms.
Folate is low, if you supplement you should get a combined folate / B12 supplement as folate only can mask B12 deficiences.
Your vitamin D is low, quite common in the UK. I would supplement with a high dose vitamin D3 tablet, at least during the winter months.
Ferritin is also low. This tends to happen in hypothyroidism and improves when the hypothyroidism is successfully treated. However, I would also supplement with iron tablets, but make sure you take these at a different time to your levothyroxine.
I'm not one for taking lots of supplements but you should supplement these. Maybe you can get a multivitamin / mineral that covers all three but also add in a high dose vit D3 as you need lots to make a difference.
You are undermedicated, this is the main message. It would make sense to increase your levothyroxine to 175 mcg and then reassess you. Some doctors thing that once your TSH iis within its reference interval the job is done, this is not true, it should be around 1.0 or 2.0 or lower. Your antibodies are very high but these usually come down naturally a year or two after the thyroid has packed in.
I would just take and extra 25 as increases are generally done like that as the last thing you want are hyper symptoms us with increasing low vitamins that will umprove the potency of your thyroid meds though that could take time. Multivitamins aren't a good idea as they don't really have sufficient of anything in them and some contain iron which nullifies the others in any case. If taking iron take 4 hours away from thyroid meths and other vitamins.
Not taking any supplements so GP doesn't understand why levels are so awful
Thanks
You need low vitamin levels addressing, 25mcg dose increase in Levo and testing for coeliac before changing to strictly gluten free diet for minimum of 3-6 months, if you find it helps (most/many do) stick on it
Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels
Low vitamin levels stop Thyroid hormone working
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...
Other things to help heal gut lining
Bone broth
thyroidpharmacist.com/artic...
Probiotics
carolinasthyroidinstitute.c...
Importance of magnesium
hypothyroidmom.com/two-vita...
Similar Low vitamins due to under medication and detailed supplements advice
healthunlocked.com/thyroidu...
When do you take your Levo?
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.
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 print it and highlight question 6 to show your doctor please email Dionne: tukadmin@thyroiduk.org
If after getting vitamins and Levo dose optimal and strictly gluten free your TSH low, FT4 high but FT3 remains low, then you may need to consider addition of small dose of T3
Thyroid UK have list of recommended thyroid specialists, some are T3 friendly
Prof Toft - article just published now saying T3 is likely essential for many
Levels are awful because dose is too low - it's not rocket science. And vitamins are awful either because of diet or more likely because of problems with absorption that go hand in hand with Hashis |(aka autoimmune thyroiditis)
Levels are low because the dose is too small! It's very simple. There's a rough guide to levothyroxine dose 1.6 mcg per Kg the patient weighs. However, this is just an approximation for starting patients on a full dose. Individual absorption of levothroxine varies considerably, one patient may absorb 60% and another 40%. So these two patients prescibed 100 mcg would have 60 mcg and 40 mcg in their body, a big difference.
Your fT4 is 12.7 on 125 mcg so on 175 it would be around 18. Doctors used to slowly titrate up in 25 mcg increments but more recent recommendations are to start patients on 100 mcg and get them to normal hormone levels quickly. There's no point in delaying recovery.
Ferritin and vitamin levels are often low in hypothyroids, it makes sense to supplement low levels but they tend to stay low until the hypothyroidism is rectified. Vitamins do not affect thyroid hormone action to any practical extent, if they did everyone with vitamin deficiency would be hypothyroid and of course this isn't so. When reading advice from alternative gurus on the internet it's best to apply a simple reality check.
I'm surprised you GP doesn't understand why your levels are low, they seem to think a one-sized tablet will treat every patient.
Vitamin levels do affect patients on T4 mono therapy.
See Box 1. Towards end of article
Some possible causes of persistent symptoms in euthyroid patients on L-T4
You will see low vitamin D, folate, ferritin and B12 listed
onlinelibrary.wiley.com/doi...
That is possibly why so many people find just T4 leaves them with terrible symptoms and poor quality of life.
Low vitamins are not easily improved on just T4, even at "adequate" dose.
It's why routine testing of vitamins should always go hand in hand with thyroid testing
The common response to withdrawal of T3 is a collapse in vitamin levels
T3 either circumvents vitamin issues or improves gut function
It's perhaps why patients improve and feel mush more stable and stronger on T3
Typical posts after T3 stopped
healthunlocked.com/thyroidu...
healthunlocked.com/thyroidu...
healthunlocked.com/thyroidu...
healthunlocked.com/thyroidu...
Low vitamins causing low TSH high FT4 and low FT3
healthunlocked.com/thyroidu...
healthunlocked.com/thyroidu...
You misunderstand the reference you cited. It states that if the patient has normal hormone levels reinstated and still has symptoms they might be due to vitamin deficiency. The paper is not suggesting low vitamin levels affect thyroid hormone activity. (I don't fully agree with this paper. By all means check for other causes of symptoms but normal thyroid hormone levels do not guarantee the patient is not hypothyroid.)
Some patients need some T3. The posts you quote show that when this T3 is removed and the patients become hypothyroid again their vitamin levels fall. Hpothyroidism can affect vitamin and mineral levels, which is hardly surprising.
I don't know where this idea that vitamins have a noticable effect on thyroid hormone action comes from but it seems to get passed around as gospel with no common sense applied.
The only vitamin that I've seen to have any effect on thyroid hormone action is vitamin A. Thyroid hormones usually bind to a thyroid receptor (TR) and one of the vitamin A receptors (RXR) these then bind to the thyroid response element (TRE), part of the DNA. In cases of endocrine disruption low vitamin A can aggravate the disruption. Even so this is obscure research and there is no evidence of actual effects in humans.
The essential point is correlation does not prove causation.
Vitamins are low in hypothyroidism because of the widespread effects of hypothyroidism. You can have multiple vitamin deficiencies and have perfectly normal thyroid hormone action. A large part of the UK populaton is vitamin D deficient, especially in the winter, they are not hypothroid.
But when on T4 only (as majority of patients are) if they are vitamin D deficient they will remain hypo to some extent (depending how great the deficiency) despite blood tests showing apparently adequate replacement with Levothyroxine
Low vitamin D apparently also changes gut biome and affects B vitamins too.
You are implying that if you supplement with vit d3 these patients will then do perfectly well on levothyroxine. It doesn't happen. It is the restoration of clinical euthyroidism, with T3 if necessary, that helps restore vit d levels. Not the other way around. By perpetuating these nonsensical ideas we lose creditability and all patients suffer as a consequence. Just use a common sense reality check. Are all vit d deficient people hypothyroid?
If there is vit d deficiency treat it, but it won't 'make thyroid hormone work'.
If you have normal functioning thyroid you already make T3 and T4.
If on Levo only and TSH is low you often have extremely low T3 as your own thyroid is turned off due to low TSH and if poor at converting, or on inadequate T4, then FT3 is very often too low
Improving vitamins improves conversion. Sometimes enough, sometimes not
But the first step is improving vitamins before adding T3
As most people on T4 can not get T3 prescribed then getting vitamin levels as good as possible is all they may be able to do. Plus gluten free if autoimmune
Many are not prepared to self medicate T3
Testing vitamins is also essential to see if there is hidden gut malabsorption
Not everyone has gut symptoms
Silent coeliac or gluten intolerance is vastly under diagnosed, because there are no symptoms, only low vitamins as result of poor gut function
In an ideal world we would be treated according to symptoms instead of dose being dictated by over reliance on TSH test and FT4 if you're lucky
We frequently see patients being told they are over medicated, with very low TSH and high FT4. But if vitamins are tested they are very often dire, yes it's almost certainly due to low FT3, but as many medics still deny any importance to T3, they are not going to prescribe that.
If vitamins are not improved, they just cut the T4 dose and patient gets even worse.
It's not ideal propping up inadequate thyroid treatment by having to supplement vitamins.
Many patients on T4/T3 or T3 find they can reduce vitamin supplements, because they are finally adequately treated and gut function improves.
I often wonder if we were correctly treated from the start with T4/T3 would gluten intolerance be less widespread.
If I understand this correctly you are saying some patients require T3 in addition to T4 and if they don't get it their vitamin levels remain low. So, supplementing with addtional vitamins will help normalise their vitamin levels. I agree with this and I think we would both agree adequate prescribing of T4 and T3 along with supplementation would be the better solution.
The point I diagree with is that vitamin deficiency has a noticable effect on deiodinase. If it did everyone with low vitamin levels (which one?) would be hypothyroid. This plainly doesn't happen. (I wish I could get my hands on the quack who presumably invented this concept - and is probably now in the Cayman Isles).
But by just improving vitamins, energy levels improve and often TSH rises and FT3 improves.
B vitamins in particular are critical for mitochondrial energy production.
Low vitamin D upsets B vitamins.
Low stomach acid upsets B vitamins too
Update - blood results 
Updated results 
Results update 
Updated results 
Results update 
