New blood results look fine (I think). Could someone advise on supplements for the lingering symptoms and anything to help with antibodies?

Hi everyone,

I am on 50mcg levothyroxine for hypothyroidism. This was prescribed at a point where I had a whole page of symptoms but TSH<10 so had to fight for this. From research I know I have Hashimotos.

I was fortunate that many of the symptoms improved when strating medication but it has been nearly a year and some symptoms are coming back so I have paid for another blood test (I am losing faith in GPs and wanted the full test). It looks okay and markedly better than last year (apart from the antibodies) but advice would be appreciated:

TSH 1.99 (0.27-4.2)

T4 103 (59-154)

Free T4 15.3 (12-22)

Free T3 4.8 (3.1-6.8)

Folate ERROR to be repeated

Ferritin 103 (13-150)

C reactive protein 1.1 (<5)

Vitamin B12 646 (197-771)

Vitamin D 54 (50-200)

Thyroglobulin antibodies 68.9 (0-115)

Thyroid Peroxidase Antibodies 137 (0-34)

Current symptoms:

- Fatigue, sleeping 12+ hours, extreme difficulty waking up in the morning

- weight gain. Have put on 16lbs in 4 months

- dry skin

- numerous allergic reactions and intolerances which result in symptoms from vomitting, IBS issues, rashes etc. Still struggling to work out all the causes

- terrible lower back pain. Don't know if it is related or what the cause is.

I have been completly gluten free for 3 years and am going to attempt autoimmune paleo diet. I wonder if anyone can give any other suggestions on supplements for the above results? Or any other suggestions on lowering antibodies?

Thanks!

[Nanaedake]

You have got room to increase your thyroid medication slightly. To support adrenal function you could take 1000mg vitamin C daily. Vitamin D is still a little low, you want to aim for mid-range, also take magnesium and K2-MK7 which are vitamin D3 co-factors. You could take 50-100mcg of selenium daily which may help reduce antibodies.

Selenium daily allowance recommendations

webmd.com/a-to-z-guides/sup...

Selenium Research NCBI

ncbi.nlm.nih.gov/pmc/articl...

[Hidden in reply to Nanaedake]

Thank you. I get muddled by the advice on when to take supplements during the day. Can you advise?

[Nanaedake in reply to Hidden]

Best to leave 4 hours after taking levothyroxine before supplementing except for vitamin C. Take vitamin D3 with the fattiest meal of the day, 4 hours (or more) after thyroid meds as Vit D is best absorbed with some fats. Take iron separately from other vitamins as it can affect absorption of others. I take vitamin C in the morning with my levothyroxine, it can aid the absorption of levothyrxoine. Or you may prefer to split the dose and take some in the morning and then take the rest with iron later in the day.

[Hidden in reply to Nanaedake]

That is really helpful. Thank you.

[Clutter]

Sleepyjen,

There is scope to increase your Levothyroxine dose to raise FT4 and FT3. If your GP won't agree to 75mcg try to negotiate 50mcg/75mcg alternate days which averages 62.5mcg.

The goal of Levothyroxine is to restore the patient to euthyroid status. For most patients that will be when TSH is 0.27 - 1.0 with FT4 in the upper range. FT4 needs to be in the upper range in order that sufficient T3 is converted. Read Treatment Options in thyroiduk.org.uk/tuk/about_... Email [e-mail] if you would like a copy of the Pulse article to show your GP.

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_...

Ferritin, CRP and B12 are good.

VitD is inadequate. >75 is replete and 100-150 is optimal. I would supplement 5,000iu D3 for 6 weeks and then reduce to 5,000iu alternate days and retest in April. Take vitD 4 hours away from Levothyroxine.

[Hidden in reply to Clutter]

Also Clutter , can you advise on T4 and T3? Are they ideally placed at the top of the range?

[Clutter in reply to Hidden]

Sleepyjen,

No, they're nowhere near the top of range which is why there is scope to raise them by increasing dose.

[Hidden]

Thanks Clutter. I had to really argue to get 50mcg in the first place so I am anxious about whether they will agree to the increase but I will certianly try!

[SlowDragon Administrator in reply to Hidden]

I would push for 25mcg increase

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:
[e-mail]

Your vitamin D definitely too low

Magnesium supplements can help vitamin D too

Do you supplement selenium, vitamin A or zinc?

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.

Prof Toft - article just published now saying T3 is likely essential for many, otherwise they need high FT4 and suppressed TSH in order to get high enough FT3

Your FT3 is very likely too low

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

[Hidden in reply to SlowDragon]

Thank you SlowDragon . No I don't supplement properly at the moment so I am writing a list of what I will need to buy and why these are needed. Why Vitamin A and Zinc? Thanks.

[SlowDragon Administrator in reply to Hidden]

Both are often low with Hashimoto's

thyroiduk.org.uk/tuk/treatm...

I use zinc picolante - nice small tablets - alternate days

Liver or fish oil capsules good source of vitamin A. I take vitamin A from Solar just twice week. Important not to take too much

Can't say I noticed any difference taking them.

Unlike magnesium, vitamin D and B vitamins which all gave significant improvements

Other possible things

Avoid ALL soya including soya lecithin if possible

Flouride free toothpaste

[Hidden in reply to SlowDragon]

Thanks SlowDragon . It is a long list of supplements but I am willing to do anything that will help so will certianly get on this...

[Hidden]

Hidden I was eating dairy but just started AIP and have eliminated now. I have cut out in the past and didn't notice a difference but will absolutely preservere.

I haven't seen any research about aluminium having an effect before so that's alarming! What is the thinking behind this?

[Hidden]

Thanks. I will certainly look into that!

[SilverAvocado]

Your thyroid hormone is still quite low. The rule of thumb is you want your freeT3 in the top third. Yours is around the middle. Your TSH is also quite high, so hopefully you can use that to persuade your doctor, as they tend to care about TSH only.

The vitamin D is a bit low. You want it closer to 100.

[Hidden in reply to SilverAvocado]

I have made an appointment so we shall see what they say. Thanks for your help.