Newly diagnosed: thoughts please?

[Laura71]

Hi, I've never posted before, but I'd be really grateful for any thoughts on my blood results and what to do...

Serum free T4: 11.9 pmol/L [12.0 - 22.0] L

Serum TSH: 5.10 mIU/L [0.3 - 5.0] H

Ferritin: 8 ng/ml [15 - 350] L

Serum B12: 385 ng/l [200 - 960]

Vit D was approx 35 nm/l, but I am taking a supplement now.

Antibodies (2013):

Antithyroglobulin antibodies: 159 IU/ml [<115] H

Antithyroid peroxidase antibodies: 11 IU/ml [<35]

Have had symptoms for years, but only got abnormal T4/TSH in 2017. GP prescribed 25 mg levo/day. I saw a private doctor (from the list) who prescribed 75 mg levo plus supplements. Never took the Levo as, after reading a bit more here, I asked for NDT. She prescribed Throid, but my pharmacy says there is a supply problem with the 30 mg tablets. I thought I would check on here for most readily available NDT before contacting my doctor again.

My ferritin is always between 8 and 30. I can't tolerate iron supplements, have tried fumerate, bisglycinate, haem (proferrin), all cause such GI issues that I give up. I had an infusion (venofer) in 2013 in Australia. The private doctor did say she could refer me for one here.

Have had negative coeliac test but suspect I should cut out gluten anyway. Am also perimenopausal, but not taking HRT yet.

Many thanks.

[SlowDragon Administrator]

Your TSH is too high

FT4 too low

There's no FT3

Ferritin obviously dire. Can you eat liver once a week (hide in casserole, sheep pie etc if don't like it)

B12 looks low

You need folate testing

Vitamin D obviously much too low

How much are you supplementing?

Yes gluten free diet helps many of us, even if test negative for coeliac

Private tests are available for FT3 if GP can't/won't test

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

[Clutter]

Laura71,

You are overtly hypothyroid to have TSH over range and FT4 below range.

It's a pity you didn't accept the 75mcg Levothyroxine the doctor prescribed. Most people do well on Levothyroxine once they are optimally dosed and not everyone does well on NDT. 30mg NDT would be equivalent to 37.5mcg Levothyroxine so your doctor's prescribing is a bit odd.

If by Throid you mean NatureThroid then RLC have been shipping 30mg, 60mg and 90mg for some time and your pharmacist should be able to source it via IDIS or another wholesale importer of specialist medicines. See thyroiduk.org.uk/tuk/treatm...

Your GP has prescribed a very conservative 25mcg. Go back in 4 weeks for a thyroid blood test as you will almost certainly need a dose increase. Arrange an early morning and fasting (water only) blood draw when TSH is highest, and take Levothyroxine after your blood draw.

The goal of Levothyroxine is to restore the patient to euthyroid status. For most patients that will be when TSH is 0.2 - 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.

Thyroglobulin 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. 100-200mcg selenium may also help support your thyroid.

chriskresser.com/the-gluten...

thyroiduk.org.uk/tuk/about_...

For maximum absorption Levothyroxine should be taken with water 1 hour before, or 2 hours after, food and drink, 2 hours away from other medication and supplements, and 4 hours away from calcium, iron, vitamin D supplements, magnesium and oestrogen.

It takes 7-10 days for Levothyroxine to be absorbed before it starts working and it will take up to six weeks to feel the full impact of the dose. Symptoms may lag behind good biochemistry by several months.

thyroiduk.org.uk/tuk/about_...

If you can't tolerate iron and you are iron deficient your NHS GP should refer you for an iron infusion. In the meantime, try cooking with the Cambodian Iron Fish healthunlocked.com/thyroidu....

How much vitD are you supplementing? Be sure to take vitD 4 hours away from thyroid meds.

B12 385 is unlikely to be deficient but if you have symptoms in b12deficiency.info/signs-an... go to healthunlocked.com/pasoc for advice as they're the experts on B12 and folate.

[Laura71 in reply to Clutter]

Thank you for such a comprehensive reply.

Is it best to try to get my iron up a bit before starting levo or NDT, or just start? (I still have the levo px). I am just wondering if the reason why some people don’t benefit as much as hopes from levo/NDT is due to their nutritional status, and am aware mine is poor.

Many thanks.

[Clutter in reply to Laura71]

Laura71,

You can start Levothyroxine or NDT and supplement to improve nutritional deficiences at the same time as long as you take the supplements away from Levothyroxine or NDT as advised above.

[Laura71 in reply to Clutter]

Thanks.

[Laura71]

Thank you both.

I still have the private px for 75mg levo so could go ahead with that.

I am taking 3 x 2500iu vit D (Cytoplan). And have bought selenium which I will start.

I am still confused about levo vs NDT though. Would getting a T3 blood test help to decide this?

Having read quite a few people on here find levo unhelpful I thought I’d go straight to NDT as I am pretty desperate. But may be I’m wrong?

[Laura71]

Hi, I am posting new test results as am seeing a ThyroidUK list endo tomorrow.

These bloods seem better than those posted years ago above. I would really appreciate any comments. Not sure what I’m hoping for now?

I have never taken any thyroid hormone and am not currently taking any supplements.

I have neglected dealing with this health issue due to ongoing depression/anxiety (which I realise is counterproductive!)

Many thanks

Blood results