I’m just wondering whether you could advise whether you think it’s worth me testing cortisol, testosterone and DHEA levels. I don’t want to spend money if these things could never be responsible for my symptoms.
I have lethargy and fatigue to the point where if I go for a 2 minute walk I start to feel weak and my heart pounds whilst palpitating. I have developed sinusitis and tinnitus. Have muscle and joint aches 24/7 and my bones crack everywhere constantly. Other less painful symptoms are things like blood shot eyes and thinning of hair (it also is fading in colour and taking an age to grow). There is also dizziness and a feeling of poor balance when I’m at my worst.
Thank you
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Curtis90
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Then you have autoimmune thyroid disease aka Hashimoto's as confirmed by your over range Thyroid Peroxidase antibodies. You have over range TSH as well and your GP should really start you on Levothyroxine.
The 'UK Guidelines for the Use of Thyroid Function Tests' state that, "There is no evidence to support the benefit of routine early treatment with thyroxine in non-pregnant patients with a serum TSH above the reference range but <10mU/L (II,B). Physicians may wish to consider the suitability of a therapeutic trial of thyroxine on an individual patient basis." If your TSH is above the range but less than 10, discuss a therapeutic trial of thyroxine with your doctor.
Subclinical hypothyroidism (where there are elevated TSH levels, but normal FT4 levels, possibly with symptoms) has been found in approximately 4% to 8% of the general population but in approximately 15% to 18% of women over 60 years of age.
Subclinical hypothyroidism can progress to overt hypothyroidism (full hypothyroidism with symptoms) especially if there are thyroid antibodies present.
If thyroid antibodies are found, then you may have Hashimoto's disease. If there are thyroid antibodies but the other thyroid tests are normal, there is evidence that treatment will stop full blown hypothyroidism from occurring.
Dr A Toft, consultant physician and endocrinologist at the Royal Infirmary of Edinburgh, has recently written in Pulse Magazine, "The combination of a normal serum T4 and raised serum TSH is known as subclinical hypothyroidism. If measured, serum T3 will also be normal. Repeat the thyroid function tests in two or three months in case the abnormality represents a resolving thyroiditis. But if it persists then antibodies to thyroid peroxidase should be measured.
If these are positive – indicative of underlying autoimmune thyroid disease – the patient should be considered to have the mildest form of hypothyroidism.
In the absence of symptoms some would simply recommend annual thyroid function tests until serum TSH is over 10mU/l or symptoms such as tiredness and weight gain develop. But a more pragmatic approach is to recognise that the thyroid failure is likely to become worse and try to nip things in the bud rather than risk loss to follow-up."
Dr Toft is past president of the British Thyroid Association and leading endocrinologist. You can obtain a copy of the article in Pulse magazine by emailing Dionne at tukadmin@thyroiduk.org and I believe it is Question 2 where you will find the above information which you can show your GP.
Personally, as hormone testing is expensive to do privately, I would pursue the Hashimoto's diagnosis initially (doctors call it autoimmune thyroiditis). You may need a referral to an endocrinologist, in which case when you email Dionne, ask for the list of thyroid friendly endos then ask for feedback from members of the forum for any in your area. You don't want to waste your time seeing a diabetes specialist, which most endos are.
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As for these results
Vit D - 80.6 nmol/L
This is on the low side. The Vit D Council recommends a level of 100-150nmol/L. You could supplement with D3 to raise your level. As you have Hashi's then an oral spray will be best for absorption as it bypasses the stomach - BetterYou do one. I would use their 3000iu dose spray for 2-3 months then retest and when you have reached the recommended level you'll need to find your maintenance dose, which may be 2000iu daily, maybe more, maybe less, it's trial and error.
There are important cofactors needed when taking D3
D3 aids absorption of calcium from food and K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems.
D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds.
Magnesium helps D3 to work and comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds
BetterYou do a combined D3/K2-MK7 spray which might be a good idea for you.
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B12 - 580 ng/L 211-912
Folate - 8.9 ng/L 3.0-14.4
These work together and seem fine. However, an extract from the book, "Could it be B12?" by Sally M. Pacholok:
"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".
"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."
If you want to raise your B12 level then taking sublingual methylcobalamin 1000iu a few times a week will do that, and you'll need a good B Complex as well to balance all the B vitamins. Or you could just try a B Complex on it's own as they contain B12. Don't go for a B Complex with high levels, such as B50 or B100, they aren't particularly well balanced. Make sure your B Complex contains Methylfolate and Methylcobalamin and not Folic Acid and Cyanocobalamin.
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Ferritin - 155 ug/L 22-322
This is very good. Do you supplement? Ferritin is good half way through range.
Antibodies are positive, they are over range. Only one interpretation of that. You have autoimmune thyroid disease aka Hashimoto's.
I have quoted from Dr Toft's article above where he says
"But if it persists then antibodies to thyroid peroxidase should be measured.
If these are positive – indicative of underlying autoimmune thyroid disease – the patient should be considered to have the mildest form of hypothyroidism."
There you have, from the UK's leading endocrinologist, confirmation that you have autoimmune thyroid disease.
Did your GP say why he is doing the anti-streptolysin blood test? That will be looking for current streptococcal infection or indicate a past exposure to streptococci.
I’m totally in agreement but my GP was adamant. Having retests of my TSH and anti-tpo was the best I could get.
We’ve tested my kidney and it seems to be fine but my urine tends to be really dark even though I drink lots of water. My stool also hasn’t been great and certain foods aren’t being processed etc. So I think that’s why he’s testing that
At the end of the day, it doesn't really matter what causes hypothyroidism, autoimmune is only one cause (although the most common), because the treatment is the same - Levothyroxine. The trouble with Hashi's is that it gradually destroys your thyroid so your TSH may climb very slowly to the magic number but you can be very unwell during all that time.
At this stage you can help yourself by addressing the Hashi's and trying to reduce the antibodies and hopefully slow down the destruction of your thyroid.
You can help reduce the antibodies by adopting a strict gluten free diet which has helped many members here. Gluten contains gliadin (a protein) which is thought to trigger autoimmune attacks so eliminating gluten can help reduce these attacks. You don't need to be gluten sensitive or have Coeliac disease for a gluten free diet to help.
Supplementing with selenium l-selenomethionine 200mcg daily can also help reduce the antibodies, as can keeping TSH suppressed.
Something else you can do is see a different doctor, one whose mind is not so closed and is willing to accept the suggestions of an expert in the field (Dr Toft).
Selenium ordered, thank you. I will start a gluten free diet tomorrow too!
I’m really hoping my TSH has gone up slightly since my last test just so it can trigger a maybe thought in my Dr’s head. Find out tomorrow afternoon or early Thursday.
My results from yesterday were TSH 3.4 and Thyroid Peroxidase Antibodies 611 mUI/ml. Dr said I will more than likely develop hypothyroidism in the next 12-24 months but my symptoms currently are not due to my thyroid.
I think he's as ignorant of Hashi's as the majority of doctors. Shame they aren't bothered about their patients, it seems to be something most GPs suffer from - couldn't-care-about-the-patient-itis. All the GPs at my surgery suffer from it. I never, ever expect anything from them and I am never, ever disappointed!
That's a big rise in your TPO antibodies, but that's the nature of Hashi's, they will continue fluctuating until your thyroid is destroyed and you have full blown hypothyroidism.
It looks like you're on your own then as far as this doctor is concerned. Personally, I'd find another one and push the autoimmune side and Dr Toft's article, show your fluctuations in test results and push for starting Levo.
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Cortisol Test? - Autoimmune Thyroiditis
Cortisol and very low DHEA
DHEA/Cortisol Ratio is Low
cortisol test
