Hello again everyone. I’d be grateful for advice on next steps in regaining my health, please. My symptoms have definitely improved since diagnosis in Sept 2017, but I am still not fully well – energy levels variable, lots of aches and joint stiffness, etc. I have some good days and think I’m doing okay, and then a run of less good days – on average better than last autumn, but still having a significant negative impact on work and life generally. Based on my latest bloods (see below) I don’t think there’s any point in asking the GP to increase my levo from the 50mcg that I am currently on, so I’m considering what else I should do, and would welcome your collective wisdom!
I have been gluten-free since Oct 2017, and also since then supplementing vits and mins based on the advice on this forum, and making my own kefir to help my gut.
Results as follows:
31 Aug 2017 – pre-diagnosis:
TSH 6.89 (0.27-4.2)
FT4 11.1 (12.0-22.0)
After these started on 25mcg levo.
30 Oct 2017:
TSH 3.58 (0.27-4.2)
FT4 14.3 (12.0-22.0)
Dose increased to 50mcg after these – had to really push GP to increase as her view was that bloods were “normal” as back in range.
13 Jan 2018:
TSH 0.65 (0.27-4.2)
FT4 17.7 (12.0-22.0)
This test was done at 9.45am, fasting, and having missed my levo dose the night before.
So with TSH below 1, I don’t think it’s worth even asking the GP for a dose increase, yet my FT4 is only just above the mid-point of the range, rather than being in the upper part of the range as generally advised on here.
It seems to me the possible next steps are:
1. Source additional thyroid hormone by other routes (more levo? NDT?) to top up the 50mcg I get on prescription. Do I need to get my FT3 tested before going down this route? Would more levo be the right thing to try, or NDT, or something else?
2. Check how my vits and mins are doing. Is it too soon to re-test, given I’ve only been supplementing properly since last October? (Money is tight so need to use it wisely on private tests.)
3. Think about my adrenals. I did a cortisol saliva test as I find mornings crushingly difficult but am wide awake late at night, and the results were:
Waking*3.090 nmol/L (6.00 - 21.00)
12noon4.490 nmol/L (1.50 - 7.60)
4pm 1.850 nmol/L (0.00 - 5.49)
Before bed<1.5 nmol/L (0.00 - 1.99)
The Medichecks comments were: “Your waking salivary cortisol is decreased and is at a level that raises concerns about an underlying disease affecting your cortisol levels, such as Addison's disease. I recommend repeating your salivary cortisol test within the month to assess this further. Cortisol can be quite variable so it's best to confirm things with a second reading.” This got me worried of course! Should I be worried? Is it worth taking something to help my adrenals (I’ve heard of Nutri Adrenal and Adrenavive) or should I be talking to my GP about Addison’s?
4.Think about whether it’s the menopause. That was the GP’s view when she didn’t want to increase my levo, but my test results are inconclusive on that with FSH being very low (below range). Readers of my other posts may remember I was debating about whether to go on HRT or not; I’m still undecided on that and think that at the very least I need to ask to have my FSH and LH bloods repeated before going down that route.
5.Think about diet. I know there are stricter exclusion diets I could try. I’m not sure that at the moment I have the willpower for that though – that might sound a bit feeble but it’s how it feels! (I think there’s some research that suggests our willpower is finite, so if we’re using a lot in certain tasks (eg getting through the day!) we have less left for others (eg restricting diet more).)
(By the way, there's only one GP practice in town, so no scope to go elsewhere.)
Anyway, sorry for the length of this! Would really appreciate any advice, especially on 1, 2 and 3 above. Thank you!