Wholefoods, Plant Based Connection to reduced Levo

[patash]

Today I had my Levo reduced from 100mg to 75mg. I have been on Wholefoods and Plant Based for 2 months. Does anyone know if there's a connection?

[Kes8]

By consuming a Wholefood and plant based diet you may have consumed, digested and absorbed an increased quantity of nutrients required to obtain optimum thyroid health.

[SlowDragon Administrator]

Improving the gut is central to improving hypothyroid, especially Hashimoto's

Do you have Hashimoto's? Diagnosed by high thyroid antibodies

Gluten intolerance is extremely common with Hashimoto's.

Many people find improvements with clean, whole unprocessed and varied diet. Increasing gut bacteria, for example with probiotics, fermented foods important too

Dr Chatergee new book The four pillar plan explains some of this

As does Dr Michael Moseley Clever Gut Diet

[SlowDragon Administrator]

If you post your results TSH, FT4 and FT3 plus vitamin D, folate, ferritin and B12

It's very common to have low vitamin levels, especially if under medicated

The dose required can need to be within a very fine range

For full evaluation you ideally need TSH, FT4, FT3, TT4, TPO and TG antibodies, plus vitamin D, folate, ferritin and B12 tested

See if you can get full thyroid and vitamin testing from GP. Unlikely to get FT3

Private tests are available

thyroiduk.org.uk/tuk/testin...

Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have money off offers.

All thyroid tests should be done as early as possible in morning and fasting and don't take Levo in the 24 hours prior to test, delay and take straight after. This gives highest TSH, lowest FT4 and most consistent results

[patash in reply to SlowDragon]

Thanks for the help there. I took my Levo before my blood test so I will have it done again and see if the results are the same. Also, I asked for the results and was told to ask at reception. You would have thought I'd asked for the crown jewels! Was told no and when I said I'm legally within my rights to have a copy I was told to ring back today to see what her manager said. I will put them up if received.

[SlowDragon Administrator in reply to patash]

Not necessary to redo blood test, unless they want to reduce your dose because it suggests over medicated

But remember next time.

There is ridiculous over emphasis on dosing by TSH, so we have to aim to get a TSH as high as possible otherwise they want to reduce dose

Endocrinologists who specialise in thyroid will usually say don't take Levo in 24 hours before test.

Graph showing TSH daily variation

healthunlocked.com/thyroidu...

General population Median TSH graph

healthunlocked.com/thyroidu...

[patash in reply to SlowDragon]

Hi again slowDragon. It's taken me all this time to get hold of my test results - what a battle getting them!!!! Looks like over the last 2 years I've only been tested for T3 once, that was Jan 2017 and the reading was 4.0 pmol/L (3.5 - 6.5)

The test done in Jan 2018 read - serum free T4 (VaERr) = 21.7 pmol/L (11.0 - 22.6)

TSH (XaELV) Below range - 0.02 mu?L (02 - 04) and none of the other tests you've mentioned. I have had a B12 blood test and he said they were normal so if you don't mind could you also let me have your thoughts on the results please?

Protein electrophoresis (XE25U) = Immunofixation results to follow. Immunofixation (XaldV) = Paraprotein detected, Immunofixation shows monoclonal lgG lambda paraprotein. Please send urine test for BJP analysis. Consider referral to clinical haematology. QUANTATIVE PARAPROTEIN = 4 g/l.

This looks worrying to me and he told me the test was normal. Your help would be greatly appreciated. Thanking you in advance.

[SlowDragon Administrator in reply to patash]

Looks like they just told you to reduce dose based on TSH then (which is incorrect)

See this post from this afternoon, similar situation

healthunlocked.com/thyroidu...

You need to get full testing done privately after 6 weeks on reduced dose. May/likely show you are now under medicated

TSH is largely irrelevant once in Levothyroxine. The important results are FT4 and FT3.

FT4 should be near top of range and FT3 at least half way in range

For full Thyroid evaluation you need TSH, FT4, TT4, FT3 plus TPO and TG thyroid antibodies. Plus vitamin D, folate, ferritin and B12.

Essential to test thyroid antibodies, FT3 plus vitamins

Private tests are available

thyroiduk.org.uk/tuk/testin...

Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have money off offers.

All thyroid tests should ideally be done as early as possible in morning and fasting and don't take Levo in the 24 hours prior to test, delay and take straight after. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, GP will be unaware)

If antibodies are 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

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 at

[e-mail]

Suggest you also ask for list of recommended thyroid specialists

Professor Toft recent article saying, T3 may be necessary for many otherwise we need high FT4 and suppressed TSH in order to have high enough FT3

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

Official NHS guidelines saying TSH should be between 0.2 and 2.0 when on Levothyroxine

(Many of us need TSH nearer 0.2 than 2.0 to feel well)

See box

Thyroxine replacement in primary hypothyroidism

pathology.leedsth.nhs.uk/pa...

The other bit....not seen before

It's nothing to do with thyroid, but seems to suggest more testing to rule anything unexpected out

bmj.com/content/344/bmj.e3033