Thyroid UK
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Could a kind person explain my results please.

I am on 150 mgs Levothyrixine and had my blood tested last week. First time in 3 years.

I have Hashimotos and my last antibodies test (which also was years ago) was 1000>

The results from last week are

Serum Free T4 19.4 l.pmol/L

Serum TSH level 5 miu/L

I would be most grateful if someone could explain it to me.

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Can you please add the reference ranges for your tests, as they vary from lab to lab we need your own lab's ranges to interpret your results.

EG

TSH: 2.5 (0.2-4.2)

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Sorry.

It says

Serum free T4 level 19.4 pmol/L (11-23

Suggests borderline adequate replacement/compliance with tbyroxine

Serum TSH level 5 miu/L (0.27 - 4.5)

Outside reference range

Reply

OK, so

TSH level 5 miu/L (0.27 - 4.5)

Your TSH is over range. The aim of a treated hypo patient generally is for TSH to be 1 or below or wherever it needs to be for FT4 and FT3 to be in the upper part of their respective reference ranges when on Levo.

free T4 level 19.4 pmol/L (11-23)

Your FT4 is actually pretty good considering your over range TSH.

How do you feel? If you feel symptomatic your TSH shows that you could do with an increase in dose of Levo.

Was Free T3 tested? Always important to see if you are converting T4 to T3 well enough, but rarely done.

Are you addressing the Hashi's by being strictly gluten free and supplementing with selenium l-selenomethionine 200mcg daily to help reduce the antibodies? Keeping TSH suppressed can also help reduce antibodies.

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I have not had any of that advice.

I had a telephone consultation with my GP (never met her) on Monday. She said my results are all fine. I asked about testing Vit D as previous GP had found it needed a boost and that was in summer. GO said you must have had a nice GP and I'm not nice!

I have taken earlier advice and am waiting on results from Medicheck.

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It would appear that the medical professionals know little about how to treat patients who are hypothyroid escept to get their TSH 'in range' even the top which is around 5 seems to be fine to them whilst they don't know one single symptom of hypo.

Reply

A correctly treated hypothyroid patient should have a TSH of 1.0 or below

Free t4 if around 19 but much more important is free T3 which should also be near top of its range

You are clearly undermedicated but also likely not converting the t4 in levo into the vital T3

Tests for

ferritin

Folate

B12

Vitd3

Must be done as all 4 must be halfway in their ranges

Reply

Make an urgent appointment to see a different GP

You are very under medicated to have TSH so high

Print this out to take in for a start

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

(Many of us find we need TSH nearer 0.2 than 2.0 as well)

See box

Thyroxine replacement in primary hypothyroidism

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

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

tukadmin@thyroiduk.org

Also ask for list of recommended thyroid specialists, sounds like you might need to see someone else

Your 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

Essential to test vitamin D, folate, ferritin and B12.

Always get actual results and ranges. Post results when you have them, members can advise

Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels

Low vitamin levels affect Thyroid hormone working

You say vitamin D was low. Are you still supplementing? Likely to always need a maintenance dose with Hashimoto's. Aim is to increase to around 100nmol

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 gut and gluten connection is very poorly understood

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

Ideally ask GP for coeliac blood test first and vitamins

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...

You need 25mcg dose increase in Levo and retesting in 6-8 weeks

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

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Thank you all for your advice. I am waiting for Medichecks results tomorrow.

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