The report mentions the low TSH suggests I am being overtreated. Now what I don't understand is how can I be over treated AND still the conventional symptoms of under active thyroid?! I'm gaining weight, dry itchy skin and hair, fatigue/tiredness, sometimes slow motion both physical and mentally and the dreaded depression/anxiety.
My GP just fiddles with Levo up and down, I'm on 225mcg, brought up in Dec from 200mcg because I am feeling blarghhhh!
What else can I do? I have already started vit D and that does better it a tad wincy bit... I had a mirena coil inserted 5 years ago and that stopped mw being anaemic as my periods were far too heavy (and pms...)
The lab is suggesting you are overtreated because TSH is suppressed but FT4 and FT3 are within range so you are NOT overtreated. FT3 is less than halfway through range so you might feel better with some T3 added to Levothyroxine reduced to 200mcg to raise FT3. Your GP will probably need to refer you to endocrinology for a recommendation for T3 before GP can prescribe it.
Thyroid peroxidase 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.
VitD is replete >75 and optimal 100-150. I'd increase vitD to 125mcg (5,000iu) daily for 8 weeks then reduce to 5,000iu alternate days and retest in June. Take vitD 4 hours away from Levothyroxine.
So your high antibodies confirm you have Hashimoto's also called autoimmune thyroid disease.
About 90% of all primary 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
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 connection is very poorly understood
Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies
Vitamin D is too low. Do you supplement, if so how much?
Need to improve to around 100nmol. Better You vitamin D mouth spray is good as avoids poor gut function. Perhaps try 2 x 3000iu per day for 6 weeks, then reduce to once a day. Retesting in 3 months, can do via vitamindtest.org.uk - £28 if not doing a full retest
Likely to need ongoing maintenance dose, trial and error what each person needs. Possibly 1000iu or may be more, especially in winter. Test twice yearly
Ferritin is borderline, eating liver once a week should help improve. Should aim for level to be above 70
Improve by taking a good vitamin B complex daily that has folate in (not folic acid). Might also need sublingual B12 lozenge (1000mcg) daily
If you don't already supplement selenium it's recommended
Vitamin C also supports adrenals
Only start one supplement at a time and wait at least 10-14 days to assess if any noticeable changes, good or bad
Your FT4 is right at top of range, but your FT3 is low, so like many with Hashimoto's you are poor converter.
Once you have improved all vitamins and gone strictly gluten free, this may improve. Suggest retesting in 2-3 months . If FT3 remains low then look at adding small dose of T3.
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 request list of recommended thyroid specialists, some are T3 friendly
Professor Toft recent article saying, T3 may be necessary for many
Agree with SlowDragon. Getting vitamins etc optimal may mean you don't need to add in T3 I did this a few years ago now but it took me 5 months but that depends on how low you are and the doses you take to rectify it but it's well worth the effort.
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