What to do now? unexpected TSH results

[tonyturnip01]

Suprising test results.................

yet I still feel awful

My Medichecks results arrived this afternoon, they are as follow

ENDOCRINOLOGYThyroid Function

THYROID STIMULATING HORMONE *0.206 mIU/L 0.27 - 4.20

FREE THYROXINE 19.5 pmol/L 12.00 - 22.00

TOTAL THYROXINE(T4) 119.0 nmol/L 59.00 - 154.00

FREE T3 4.93 pmol/L 3.10 - 6.80

THYROGLOBULIN ANTIBODY *890.000 IU/mL 0.00 - 115.00

THYROID PEROXIDASE ANTIBODIES*>600 IU/mL 0.00 - 34.00

HAEMATOLOGYVitamins

VITAMIN B12 *777 pmol/L 140.00 - 724.00

FOLATE (SERUM) 19.98 ug/L 2.91 - 50.00

BIOCHEMISTRY

Inflammation MarkerCRP - HIGH SENSITIVITY 0.1 mg/l 0.00 - 5.00

Iron Status

FERRITIN 54 ug/L 13.00 - 150.00

The comments/advice was

We note that you are taking this test to investigate symptoms. I understand that you have an underactive thyroid and that you have been taking 25mcg of levothyroxine for the past ten years. You continue to experience lethargy, gritty eyes, ear problems, joint pains, palpitations, pins and needles, dizzines, brain fog, low body temperature and new onset acid reflux. I understand that you struggle to swallow your own saliva and that you have lost two stone in weight.

Reviewing your symptoms I am concerned by the recent development of acid reflux, swallowing difficulties and loss of weight. I recommend that you discuss these promptly with your GP as these are likely to need further investigation.

Your thyroid stimulating hormone is low whilst you have normal levels of thyroxine and T3. This suggests that your dose of levothyroxine is too high. If you are free of symptoms of an overactive thyroid then you may prefer to repeat the test in three months to assess the trend. If you are experiencing symptoms then you should discuss this result with your GP.

Having very low levels of thyroid stimulating hormone for several years has been associated with the development of osteoporosis. If your thyroid stimulating hormone always tends to be substantially below the normal range then it may be worth discussing with your GP whether a bone density scan is advised to monitor for the development of osteoporosis. You do not need to worry about the occasional low reading, only if you get repeated very low levels.

Your thyroglobulin antibodies are positive. This can be associated with autoimmune thyroid disease and in particular Hashimoto’s disease.

Your thyroid peroxidase antibodies are elevated. This antibody is commonly associated with autoimmune thyroid disease. It is frequently seen in conditions such as Hashimoto’s disease (where the thyroid becomes underactive) but confusingly can also be seen in Grave’s disease (where the thyroid becomes overactive).

You have high levels of vitamin B12, if you are taking a B12 supplement then I recommend decreasing your dose. If you are not taking a supplement then I recommend checking your full blood count and liver function to assess whether this is significant.

You have normal levels of folate.

Your CRP level is normal, suggesting low levels of inflammation within the body.

Your ferritin level is normal indicating healthy iron stores.

My NHS ones which I got this morning are

Thyroid function test-Abnormal

see task.

For primary hypothyroidism,levothyroxine replacement should be targeted toward a TSH within the reference range,after dose adjustments allow 8 weeks to stabilise.

Serum TST level 0.09 mU/L 0.35-5.50 mU/L

serum T4 level 13 pmol/L 7.00-17.00pmol/L

I have absolutely no idea what is going on, my symptoms are the same and i do not experience any hyper symptoms, the only change I have made is when I take the Levothyroxine, a week ago I started taking it at night with water and not in the morning with my multivitamins etc, still the same dose 25mcg, I can't understand why my levels have changed but not the horrible symptoms.Last tests results were

Serum TSH Levels 3 mU/L 0.35-5.50mU/L

, Serum free T4 level 10.9 pmol/L 7.00-17.00pmol/L October 2017.

[Clutter]

TonyTurnip01,

Your NHS TSH is flagged abnormal because TSH 0.09 is below range. You are not overmedicated because FT4 13 is less than halfway through range.

Taking Levothyroxine with a multivit which may have contained iron and calcium will have reduced absorption of Levothyroxine and that is why FT4 is now higher and TSH lower. Research also shows that TSH may be lower when Levothyroxine is taken at nighttime and it is thought that this may be due to improved absorption at night.

Looking at your Medichecks results, TSH is suppressed, FT4 is in the upper range and FT3 is just shy of halfway through range, so results confirm you are not overmedicated.

Thyroid peroxidase and thyroglobulin 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_...

B12 is mildly over range. I don't think you need to stop or reduce supplements.

Folate is fine.

Ferritin is optimal halfway through range. You can either eat more iron rich food (liver is good) or supplement some iron. If you supplement take 1,000mcg vitamin C with each iron tablet to aid absorption and minimise constipation. Take iron 4 hours away from Levothyroxine.

[tonyturnip01 in reply to Clutter]

I don't have to stop Levothyroxine then? that is why I was worried, and I have no idea why tests results changed because I still feel exactly the same symptom wise, no better and no worst. I have thrown my B12 supplement to the back of the cupboard and I won't take any more....Thank you very much

[tonyturnip01 in reply to tonyturnip01]

Strange that there is a variance in the figures, I did them within an hour of each other on an empty stomach...Thank you Clutter, I appreciate your comments, I was worried

[Clutter in reply to tonyturnip01]

TonyTurnip01,

As I said, you aren't overmedicated despite TSH being low, so no, I don't think you need to stop taking Levothyroxine.

If your B12 was low before you started supplementing you might want to reduce dose rather than stop taking it.

[tonyturnip01 in reply to Clutter]

Clutter...may I just ask, today I have hyperactive symptoms, I have never had this before, heart beating fast and thumping in my chest, palpitations all over my body, shaking hands and feeling jittery and anxious...should I skip my Levothyroxine until these symptoms subside or still take my usual dose tonight? feel like I am about to have a heart attack at the moment, gosh I feel sorry for people with an overactive thyroid if this is what they have all the time, it is scary!! Thank you.

[Clutter in reply to tonyturnip01]

TonyTurnip01.

It won't hurt to skip tonight's dose but I very much doubt it will improve anything as you aren't biochemically overmedicated.

[SlowDragon Administrator]

Your test results suggest you are definitely NOT over medicated

FT3 is on low side

You have extremely high thyroid antibodies.

This is Hashimoto's also called autoimmune thyroid disease

About 90% of all hypothyroidism in Uk is due to Hashimoto's

Essential to test vitamin D

betteryou.com/vitamin-d-tes...

vitamindtest.org.uk

Vitamin D is actually a hormone, not a vitamin and it's extremely common to be too low with Hashimoto's

I would suggest taking a good vitamin B complex instead of B12 for the moment. You may need to restart B12 supplements later

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

Low vitamin levels affect 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

Ask GP for coeliac blood test first

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...

thyroidpharmacist.com/artic...

Low stomach acid can be an issue

Lots of posts on here about how to improve with Apple cider vinegar or Betaine HCL

thyroidpharmacist.com/artic...

drmyhill.co.uk/wiki/hypochl...

scdlifestyle.com/2012/03/3-...

[tonyturnip01 in reply to SlowDragon]

Thank you SlowDragon, I do have acid reflux?LPR and it is horrible, I was given a blood test for Celiac and informed it was negative, that was just before I had an endoscopy. I have had tests for acid reflux such as ph studies and manometry, I was given PPI's but couldn't tolerate them, they made me feel worst and I had to stop them...I had no idea until a couple of days ago after joining this forum the implications of Hashimoto, I was never given any advice when first diagnosed ten years ago, it was then I learned about gluten and soy and low stomach acid etc...I have learned so much from you, not a single Dr I saw in hospital mentioned the thyroid connection at all...Thank you

[SlowDragon Administrator in reply to tonyturnip01]

Yes snap 22 years wasted on my part believing the misinformation fed to us

More on my profile

Gluten free diet extremely likely to help

Also look at Apple cider vinegar or Betaine HCL

Bone broth etc

Probiotic too

Fermented foods too

Sauerkraut kefir etc

[SilverAvocado]

I think you could do with a dose increase as you freeT3 is only halfway through the range, and its better in the top third.

It's really shocking that the NHS would flag a result like this as over medication! No wonder they keep so many people unwell!

One option is to start taking half a tablet extra a few times a week, and if you feel an improvement in symptoms refuse any further NHS tests

The current B12 ranges are very low, so many members have over range B12. If you were taking your supplements right up to the blood test that will have inflated your number, too. So you may not need to throw them away.