Thyroid blood test results.. advice needed

[karener]

Hi, I have been diagnosed hypothyroid 9 years ago and am currently on 100mg levothyroxine. I am feeling exhausted and body aches. I would really appreciate any feedback on my blood test results as don’t know where to go from here.. any advice is much appreciate.

[SeasideSusie Remembering]

Although your TSH is in a good place - when on Levo we normally need it to be 1 or below) - your FT4 and FT3 are quite low in range ie FT4 is 47% through range and FT3 just 28%.

According to the BMA's booklet, "Understanding Thyroid Disorders", many people do not feel well unless their levels are at the bottom of the TSH range or below and at the top of the FT4 range or a little above.

The booklet is written by Dr Anthony Toft, past president of the British Thyroid Association and leading endocrinologist. It's published by the British Medical Association for patients. Available on Amazon and from pharmacies for £4.95 and might be worth buying to highlight the appropriate part and show your doctor. However, I don't know if this is in the current edition as it has been reprinted a few times.

Also -

Dr Toft 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 article by emailing [e-mail] print it and highlight question 6 to show your doctor to see if you can get an increase in your Levo.

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Thyroid Antibodies are both in range but Thyroglobulin are rather high. It would be worth repeating at some stage as antibodies fluctuate and if they go over range at any time this indicates autoimmune thyroid disease.

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As for your vitamins and minerals, some improvements are needed:

Ferritin: 49.1 (13-150)

For thyroid hormone to work (that's our own as well as replacement hormone) ferritin needs to be at least 70, preferably half way through range. You can help raise your level by eating liver regularly, maximum 200g per week due to it's high Vit A content, and including lots of iron rich foods in your diet apjcn.nhri.org.tw/server/in...

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Vit D: 84.9nmol/L

The Vit D Council recommends a level of 100-150nmol/L so you might want to supplement with D3 to improve your level.

I would suggest you buy either some D3 softgels or a D3 oral spray and take 3000iu daily for 2 or 3 months then retest. When you've reached the recommended level then reduce to a maintenance dose to keep it there, which you will need to find by trial and error, possibly 2000iu daily, maybe more or less and maybe needs adjusting in summer.

There are important cofactors needed when taking D3

vitamindcouncil.org/about-v...

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

naturalnews.com/046401_magn...

Check out the other cofactors too.

You can get combined D3/K2-MK7 supplements. BetterYou do a combined oral spray.

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Active B12 of 130 is good.

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Folate: 3.15 (2.91-50)

This is very low and you might want to discuss with your GP to see if he will prescribe folic acid as it's not far off deficiency. If not then look at a good B Compex containing 400mcg methylfolate, eg Thorne Basic B. Also eat lots of leafy greens.

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CRP is raised which indicates inflammation or infection somewhere. It's a non-specific marker so if it continues to be raised maybe your GP will look to find the cause.

[karener in reply to SeasideSusie]

Thank you so much for your very helpful reply. Medichecks have said my tsh is too low and it puts me at risk to osteoporosis. I am wondering if I should try ndt as I’m not doing well in the levothyroxine at all

[SeasideSusie Remembering in reply to karener]

Medichecks doctors are the same as NHS, misinformed about low TSH. When on Levo, of course TSH will be low. TSH is a pituitary hormone, the pituitary checks to see if there is enough thyroid hormone, if not it sends a message to the thyroid to produce some. That message is TSH (Thyroid Stimulating Hormone). In this case TSH will be high. If there is enough hormone - and this happens if you take any replacement hormone - then there's no need for the pituitary to send the message to the thyroid so TSH remains low.

I just wish someone would inform doctors of this simple fact! Somewhere there is an article about low TSH and this scaremongering about osteoporosis and atrial fibrilation. Next time I see it I will bookmark it.

I don't think NDT is the solution at the moment. You really need to see if the appropriate dose of Levo works, and your dose is too low at the moment as borne out by your low FT4/FT3. If you get your free Ts to the upper part of the range that could be all that is needed.

NDT contains both T4 and T3. You may or may not need the T3 element. And NDT is getting harder to find and can be expensive. Branded ones from the US are very expensive, the Thai equivalents are cheaper, but both sorts mean that they can attract VAT plus a Royal Mail handling fee if picked up by Customs.

If you raise your Levo, your FT4 will rise and your natural conversion will mean that your FT3 will also rise. If your FT4 gets near the top of the range and your FT3 remains low then you need some T3 either in the form of NDT or synthetic T3 added to Levo. First step is to improve your FT4 and see what follows BUT .....

You have to improve your ferritin, Vit D and folate levels as outlined above. No thyroid hormone will work until ferritin is at least 70, and all nutrient levels really need to be optimal.

[karener in reply to SeasideSusie]

Thanks again for further reply but my tsh is lower than recommended by Dr Toft in the pulse article at only 0.084 and Dr a Toft states 0.2-0.5 and if my levothyroxine is increased it will lower further. Also I doubt my gp will increase it due to this.

[SeasideSusie Remembering in reply to karener]

Did you not read the bit further down where Dr Toft says

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.

[SlowDragon Administrator]

Although your antibodies appear to be low, you might consider trying strictly gluten free diet, once you have vitamins optimal if still not feeling 100%

[Nasasteve2]

Your RT3 is high and from what I’ve read it should be below 15 anything higher indicates Thyroid Resistance and/or poor T4 to T3 conversion