Thyroid UK
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Blue Horizon Results

Hi all - I've had nothing but great advice from this forum so, after getting these results from BH I wonder if you can look at them for me please. Does the high antibodies always mean Hashimoto's? Should I be concerned about the high Ferritin? I was supplementing B12 which probably explains the high result. I am currently taking 125mcg Levothyroxine and 20mcg T3.

Vitamin B12 * 1107 pg/ml 197 - 771

Folate (serum) 7.6 ug/L > 2.9

FERRITIN * 164 ug/L 13 - 150 Optimum Ferritin level for females : >27 ug/L

C Reactive protein 0.7 mg/L <5.0

TOTAL THYROXINE(T4) 63 nmol/L 59 - 154

THYROID STIMULATING HORMONE * 0.06 mIU/L 0.27 - 4.2

FREE THYROXINE * 11.7 pmol/l 12.0 - 22.0

FREE T3 4.1 pmol/L 3.1 - 6.8

25 OH Vitamin D 80 nmol/L 50 - 200

Thyroglobulin Antibody * 410.0 IU/mL 0-115

Thyroid Peroxidase Antibodies * 42.6 IU/mL 0 - 34

REVERSE T3 13 ng/dL 10 - 24

Any advice would be great.

Thanks

Terri

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Ferritin can be due to inflammation and/or Hashimoto's

forefronthealth.com/hypothy...

Are you supplementing a good vitamin B complex with folate in? That would improve your folate. You could possibly reduce B12 supplement a bit.

Yes your antibodies confirm you have Hashimoto's, more commonly called autoimmune thyroid disease

Hashimoto's affects the gut and often 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 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

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...

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Thank you SlowDragon for all the fabulous links - much appreciated. That's my reading material for this evening :) xx

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Are you taking iron supplement? If not, get your transferrin saturation done.

If your transferrin saturation is high, you may have a mutant gene which permits too much iron to go into your bloodstream

If transferrin is normal, get liver enzyme testing done. If the liver is inflamed, ferritin will leak out into the bloodstream.

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That’s interesting, I didn’t know inflammation of the liver could cause other blood test results to change because of leakage into the blood stream. My full blood profile showed liver inflammation so I need to retest in a month, to see if it’s settled. I’m now gluten free and taking all recommended vitamin supplements including high dose D3 as this was very low

Do you have any links to further information on Hashimotos and the liver? Thanks

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You know yourself. I have no information from what you have posted as to whether, for example, if you have fatty liver, or metabolic syndrome. Non alcoholic and alcoholic liver disease will result in raised ferritin and raised liver enzymes.

Hashimoto's can cause problems with the liver if the hypothyroidism resulting is not adequately treated. Over treatment resulting in a hyperthyroid situation can also damage the liver.

You may need to modify your diet.

academic.oup.com/qjmed/arti...

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Thanks a lot of useful information there and especially the deoiodase (probably spelt it wrong) function as well. I don’t drink! However I took Roaccutane for 8 months an acne drug in 2016 and had to have regular liver tests as it can cause liver damage, they didn’t do any at the end of my course of treatment and now I’m worried it’s left some long term damage. My cholesterol levels are all excellent and always have been so that’s a relief

Many thanks for the link

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gabkad

WOW ! GREAT INFO ! THANK YOU !

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Hi Gabkad - many thanks for replying. I don't take iron supplements. That's interesting about the ferritin leaking into the blood stream and I will definitely request those blood tests. Thanks again

Terri xx

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Hi

You’d have to be v unlucky to have damaged your liver in that short a time frame. If you are concerned you could have a creatine test thro blue horizon it’s circa £35.

I’d definitely consider a stool analysis test to see what’s happening in your gut. It’s unusual not to have some issues with hashimotos. I was surprised how severe mine were but I’ve sorted them out and to be fair now I am absorbing food and vitamins etc better.

Your b12 is ok at that level providing all your other vitamin levels are optimal. If you self inject like me- I keep mine at that level.

Good luck

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Your thyroid panel is a little strange, and I hoped someone else would have commented on it. Clearly your freeT3 is pretty low, and you need an increase now, and probably a few more increases to get it into the top third.

Your freeT4 is below range. This isn't surprising as a large proportion of your hormone replacement is T3 (T3 is 3-5x more potent than T4, so just under half of your replacement is in T3).

What surprises me is that your TSH is quite surpressed. It's a good bit under range, even though your frees show a picture of being very under medicated.

Where you on this dose for 6 weeks or more before the blood test? Do you have results for any different doses to compare, it might give a clearer picture of if anything additional is going on. Although sounds like you've had even lower Vit D in the recent past, and maybe other vitamin issues, so that might explain things looking a bit strange.

You don't mention how you feel. Do you still have hypo symptoms? What's the rough history of treatment, was the diagnosis recent, or have you been on this dose for years?

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Hi SilverAvocado - many thanks for looking at these results. About 4 months ago I had a pre-op prior to knee arthroscopy - the results came back as TSH 0.02 (0.27-4.20) and my FT4 8.1 (11-25). T3 was not checked although it had been asked for. The anaesthetist refused to operate until my TSH was back in range so, Endo said stop taking T3 and just take 125mcg of T4. This I did and my results in February were TSH 3.14 (0.27-4.20)

Free T4 17.2 (11-25). Anaesthetist said great 'we will do your operation end of June' I however, felt that bad with a TSH so high and knew I couldn't carry on feeling worse until the end of June, (really bad joint pains, mood swings, weight gain - all the old symptoms really) so deferred operation til a later date (I know I'll have to go through the whole rigmarole again but....) Re-introduced the T3 mid February and had the BH tests done in March. I just wanted a clearer picture of my condition but now I'm more confused :)

Thank you so much for commenting.

Terri xx

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Thanks for all that history! So sounds like you had been on this dose for 4 weeks or less? And a lot of chopping and changing before that.

This makes a lot more sense. The rule of thumb is it takes 6 weeks for a new dose to settle down, and we can't rely on blood tests taken before that.

Sounds like a horrible situation! Can't believe they wanted to leave you hanging around till June!

With the older results it looked like you had a very low TSH then, too. Even though the freeT4 was even lower, and actually under range. I suppose we don't know what's happening without the freeT3. My guess looking at those two numbers would be that it was high. But looking at your recent results your freeT3 isn't high...

Hmm... Even that TSH of 3.14 looks a bit low - you'd had your dose cut in two, which is very stressful for the body, and I'd expect it to be screaming out! This is making me think there might be problems with TSH production. But on the other hand everyone is different!

It's clear you have Hashimoto's, so it's obvious what's causing thyroid problems.

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Thanks SilverA - I really am going to make a conscious effort to go gluten free. I will also ask GP to run LFT's as Gabkad has suggested.

Thank you once again for taking the time - much appreciated.

Terri xx

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It's true what SilverAvocado wrote about how the fT4 is low despite the dose you are taking. 100 mcg = below range and 125 mcg = 17. There should not be such a huge difference unless you didn't take T4 for a couple of days before the first test. Or if you took the 125 mcg the day of the blood draw.

Looks as if you are not absorbing the T4 or T3 well. But when you are on T4 only you are absorbing it better but who knows what the fT3 was at that time. Given your symptoms, it was probably very low.

My endo says that when someone has been on thyroid replacement for many years, the TSH does not respond well to changes in dose. Also the pituitary gland does it's own T4 to T3 conversion and it can be feeling fine when the rest of the body is suffering.

Something is going on for why your blood levels are not reflective of your dose. Also T4 is converted to T3 by the liver (most of it, not all). Normal absorption of T4 from the gut is about 80% of the dose. T3 is usually better absorbed than T4 and yet it doesn't seem to show on your blood test (although if you left 24+ hours between last T3 dose and blood test, then it can look a lot lower than it would normally be). Clutter has the calculation for this so if you left considerable time before the test, then there's a way to figure out what your highs and lows would be in a 24 hour period. You did not mention anything about how many hours after the last dose the blood draw happened.

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Hi Gabkad - I left roughly 36 hours before the blood test, then went straight back to 125mcg T4 and 20mcg T3. Because of this forum I am always mindful to leave 24 hours+ before any bloods. I'm not sure where to go with this - increase the T3?? Ha ha, I'm glad Clutter has a calculation because my brain hurts :)

Thanks again gabkad

Terri xx

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With T3, you should leave 12 hours. With T4, take it after you do the blood draw as early as possible in the morning, so approximately 24 hours after last dose.

Your fT3 results is skewed to abnormally low. You don't say how frequently you take it, if it's once a day or twice. Most likely under normal dosing circumstances your fT3 is above 5.0.

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Hi gabkad - I take T4 last thing at night and T3 immediately when I wake.

Terri xx

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I'm assuming you feel better with this? Or would it be better if you were on 125 mcg T4 plus the T3?

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Do you mean take all together? Worth a shot I suppose as nothing to lose.

Thanks

Terri xx

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