Thyroid UK

Thyroid results for girlfriend

Please see this thread healthunlocked.com/thyroidu...

December 2017 results on 75mcg levo

TSH 4.85 (0.2 - 4.2)

FT4 14.8 (12 - 22)

FT3 3.3 (3.1 - 6.8)

TPO antibody 804.6 (<34)

TG antibody 355.3 (<115)

Ferritin 61 (30 - 400)

Folate 2.3 (2.5 - 19.5)

Vitamin B12 331 (190 - 900)

Vitamin D total 53.1 (50 - 75 adequate)

Prescription for T3 given after

TSH 1.20 (0.2 - 4.2)

FT4 19.3 (12 - 22)

FT3 4.0 (3.1 - 6.8)

Prescription for ferrous fumarate 3x given after

Ferritin 15 (30 - 400)

Prescription for B12 given after low B12, level unknown

Prescription for folic acid 5mg given after

Folate 1.9 (2.5 - 19.5)

Prescription for vit D 800iu given after

Vitamin D 25.6

Endo has told my girlfriend no increase and he has stopped her medicaiton. Thank you

10 Replies
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Find another endocrinologist urgently

Email Thyroid UK for list of recommended thyroid specialists

please email Dionne at


tukadmin@thyroiduk.org

These results show your girlfriend is seriously under medicated

What did endocrinologist say was reason not to increase and even worse to stop taking Levothyroxine?

Is she small and petite? Many Endo's seem to think we must be fat to be hypo.

Many, with Hashimoto's, especially perhaps in 20-30's struggle to maintain weight

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

Dose should be increased in 25mcg steps (retesting 6-8 weeks after each dose increase) until TSH is around one and FT4 towards top of range and FT3 at least half way in range

Her antibodies are very high 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

Her vitamin levels are too low because she is under medicated and will get much much worse with no Levothyroxine

Typical post with Low vitamins due to under medication and detailed supplements advice on how to improve

healthunlocked.com/thyroidu...

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 connection to gut 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

Persistent low vitamins with supplements suggests coeliac disease or gluten intolerance

gluten.org/resources/health...

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...

Professor Toft recent article saying, T3 may be necessary for many

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

With Hashimoto's we must get vitamins optimal and Levothyroxine dose high enough to bring TSH down to around one and FT4 towards top of range

Strictly gluten free diet helps many or may be essential

If FT3 remains too low then, like many with Hashimoto's she may need the addition of small dose of T3

Some Thyroid specialists are T3 friendly and recognise this

Many CCG areas however are still refusing to prescribe

So it depends where you live

british-thyroid-association...

1 like
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Endo has said if she takes any more she runs the risk of overdosing and my girlfriend insisted a dose increase was in order. The endo told her not to order him about and stopped her medication.

She is small and petite, about 53kg.

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Your girlfriend was correct. She needs dose increased

Endo likely only a Diabetes specialist, many are.

He wouldn't be surprised if a coeliac patient was small and petite.

Gut malabsorption is extremely common.

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She was on T3 briefly and did well on it, sorry I added that in last thread

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Aha well yes

100's had similar start and stopping

It's largely financial

But to be on T3 very likely essential to be strictly gluten free first

Also MUST have good vitamin levels first, they typically crash right out after T3 stopped

Typical posts after T3 stopped demonstrating this amongst other things

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Get a decent endo

Would also report this one for stopping an essential medication

2 likes
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SlowDragon has given you the best advice, she is spot on, the endo needs shooting. Find another one.

As for vitamins and minerals, it is essential that they reach optimal levels.

Ferritin 61 (30 - 400)

This needs to be at least 70 for thyroid hormone to work. Hopefully she is taking each iron tablet with 1000mg Vit C to aid absorption and help prevent consipation, and iron should be taken 4 hours away from thyroid meds and 2 hours away from any other medication and supplements as it affects their absorption.

She can also help raise her level by eating liver regularly, maximum 200g per week due to it's high Vit A content, and including lots of iron rich foods in her diet apjcn.nhri.org.tw/server/in...

Presumably she was diagnosed with iron deficiency anaemia to be prescribed 3 x FF daily. Ensure this is monitored and that she doesn't drop back into iron deficiency. Some haematologists say to refer patient back if ferritin falls below 50, so that may be something to bear in mind.

**

Folate 2.3 (2.5 - 19.5) Prescription for folic acid 5mg

Folate should be at least half way through it's range, she is still deficient. Not sure how long she has been on folic acid, but keep an eye on this level, it shouldn't take more than 2-3 months of folic acid 5mg daily to bring it up.

**

Vitamin B12 331 (190 - 900) Prescription for B12 given after low B12

Is that B12 injections? If so they should be at least every 3 months. Some people find they need to top up between injections with either sublingual methylcobalamin or self injecting B12. If you need further advice pop over to the Pernicious Anaemia Society forum healthunlocked.com/pasoc

I have read (but not researched so don't have links) that BCSH, UKNEQAS and NICE guidelines recommend:

"In the presence of discordance between test results and strong clinical features of deficiency, treatment should not be delayed to avoid neurological impairment."

And an extract from the book, "Could it be B12?" by Sally M. Pacholok:

"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".

"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."

**

Vitamin D total 53.1 (50 - 75 adequate)

Prescription for vit D 800iu given after Vitamin D 25.6

That was the wrong prescription. According to NICE Clinical Knowledge Summary anything under 30nmol/L should be dealt with by loading doses - see NICE treatment summary for Vit D deficiency:

cks.nice.org.uk/vitamin-d-d...

"Treat for Vitamin D deficiency if serum 25-hydroxyvitamin D (25[OH]D) levels are less than 30 nmol/L.

For the treatment of vitamin D deficiency, the recommended treatment is based on fixed loading doses of vitamin D (up to a total of about 300,000 international units [IU] given either as weekly or daily split doses, followed by lifelong maintenace treatment of about 800 IU a day. Higher doses of up to 2000IU a day, occasionally up to 4000 IU a day, may be used for certain groups of people, for example those with malabsorption disorders. Several treatment regims are available, including 50,000 IU once a week for 6 weeks (300,000 IU in total), 20,000 IU twice a week for 7 weeks (280,000 IU in total), or 4000 IU daily for 10 weeks (280,000 IU in total)."

Each Health Authority has their own guidelines but they will be very similar.

It's unlikely, and probably not worth pursuing this now but she should definitely be on more than 800iu daily. I would suggest 5000iu daily for 3 months then retest, privately if necessary with a private fingerprick blood spot test with City Assays vitamindtest.org.uk/

Once she reaches the level recommended by the Vit D Council - which is 100-150nmol/L - then she'll need a maintenance dose which may be 2000iu daily, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range.

As she has Hashi's then an oral D3 spray will be better absorbed - look at BetterYou brand and as it comes in 3000iu and 1000iu dose she should start off with maybe 2 doses to give 6000iu daily for 6 days a week (virtually the same as 5000iu daily for 7 days a week).

There are important cofactors needed when taking D3

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.

D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds.

Magnesium helps D3 to work and comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds

naturalnews.com/046401_magn...

Check out the other cofactors too.

Gut function needs addressing so that nutrients can be absorbed, when nutrients are optimal thyroid hormone can do it's work.

Well done on being such a supportive partner, so refreshing after a post yesterday when a member's partner was quite the opposite.

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She has been on ferrous fumarate 3x since 2013, she is actively monitored every 3 months. Yes she has iron deficiency.

Folic acid since 2015.

B12 injections.

Thank you

1 like
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So her levels haven't exactly improved much in all that time. That will be due to gut/absorption problems caused by the Hashi's so check out the information/links that SlowDragon has given.

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Persistent low vitamins with supplements suggests coeliac disease or gluten intolerance

gluten.org/resources/health...

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Thyroid UK are collecting evidence of malpractice due to removing clinically needed T3

Please consider sending a brief outline of this. How T3 improved your girlfriends health and the subsequent disaster since it was stopped. I would include the dire vitamin levels

thyroiduk.org.uk/tuk/get_in...

Recent debate in Scottish parliament about T3

scottishparliament.tv/meeti...

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