TSH/FT4/FT3/thyroid antibodies/Vitamin D/complete blood count

[Vicki22]

Hi here are thyroid (TSH, FT4, FT3, thyroid antibodies) complete blood count and vitamin D results as requested.

I take 175mcg Levo, diagnosed in 2011 with hypothyroidism. Current results I have been told over the phone with my endo show undermedication.

I am breathless, have dry skin, feel cold and tired, losing a lot of weight, ears randomly ringing.

Ferritin, folate, B12 have not been checked by the GP. Please note that I take my Levo with a full glass of water leaving 1-2 hours before food/drink and 4 hours before supplements.

* Iron anaemia diagnosed 2013 - treated with iron infusion 2016 - given 1 ferrous fumarate to take each day. Haematologist would like ferritin level >50

* Folate anaemia diagnosed 2016 - treated with folic acid 5mg once a day

* Low B12 found 2017 - treated with B12 injections every 3 months started January 2018

* Vitamin D deficiency diagnosed 2013 - treated with vitamin D 800iu - monitored every 6 months. Haematologist would like vitamin D level >75

Thanks for reading.

22-Dec-2017 (on 175mcg Levo)

TSH level 4.70 (0.2 - 4.2)

Free T4 level 14.8 (12 - 22)

Free T3 level 3.3 (3.1 - 6.8)

Thyroid peroxidase antibodies 2700 (<34)

Vitamin D total 60.1 (50 - 75 vitamin D suboptimal. Advise on safe sun exposure and diet)

Red blood count 4.41 (3.80 - 5.80)

White cell count 4.50 (4.0 - 11.0)

MCV 80.3 (80 - 98)

MCHC 365 (310 - 350)

MCH 28.2 (28 - 32)

Haemoglobin estimation 145 (115 - 150)

Haematocrit 0.41 (0.37 - 0.47)

Platelets 247 (140 - 400)

[SlowDragon Administrator]

Well the first thing is you look under medicated. Dose needs increasing in 25mcg steps until TSH is around one and FT4 towards top of range and FT3 at least half way in range

You likely have poor gut absorption. Ask endo about taking Levo with vitamin C. It can help.

But you also have very high thyroid antibodies

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 stomach acid and then low vitamin levels

Low vitamin levels affect Thyroid hormone working

Your vitamin D is too low and as is obvious, 800iu is not enough. GP can only prescribe that. So you need to self supplement. Better You vitamin D mouth spray is good as it avoids poor gut function of Hashimoto's. Suggest you try 3000iu spray, once daily. Retesting in 2-3 months via vitamindtest.org.uk. £28

You may need more than 3000iu.

It's trial and error, we are all different. Test twice yearly.

Once you get level around 100nmol you will need to change to maintenance dose. Perhaps 1-2000iu daily.

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

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[Vicki22 in reply to SlowDragon]

Thanks, I just don't understand why my GP hasn't checked anything else - for a month. I requested all bloods and the receptionist said ferritin, folate and B12 haven't been read by the GP. Then she just sat there smiling at me.

[SlowDragon Administrator in reply to Vicki22]

Ring up and request copies of missing results. If they get difficult, point out you are entitled to copies by law.

You may be able to view test results online - ask about this. If you can, then apply for online access to your account. You may need enhanced access to view blood test results. All GP practices are supposed to offer online access including test results, in reality very few yet have blood test results available online.

Sounds like another receptionist playing at being GOD

[Vicki22 in reply to SlowDragon]

GP has said the practice doesn't give patients enhanced access to results, the receptionist has suggested I call practice tomorrow for the rest of them or request a call back about them

[Vicki22 in reply to SlowDragon]

I started taking 9000iu (oral spray 3000iu x3) 3 weeks ago, it has MK7 and K2 in it. Boyfriend has commented my eyes look better and I seem happier

[Vicki22 in reply to SlowDragon]

Haematologist has said I would need loading dose of vit D if it is nowhere near 75

[SlowDragon Administrator in reply to Vicki22]

Sounds like a good haematologist

[Vicki22 in reply to SlowDragon]

Well he's left now, the one I saw after he left was just as good. He said B12 wasn't a good indicator of B12 deficiency and given that my level was initially under 500 and I had low B12 symptoms at the time, I would benefit from B12 injections

[SlowDragon Administrator in reply to Vicki22]

Pity many GP's think B12 at 200 is fine