Blood results back- would really appreciate your advice, please.

[Kipsy]

Hi. I’m on 125mcg of T4 and these are yesterday’s Medichecks results. I’d be so grateful for your thoughts. Apologies for the long post- I was hoping these results would give me a definitive answer as to whether I need to try T3 but I’m still confused!

*TSH 0.006 (0.27-4.20)

*Free thyroxine 24 (12.00- 22.00)

Total thyroxine (T4) 101.0 (59.00- 154.00)

Free T3 4.38 (3.10-6.80)

*Thyroglobulin antibodies 493 (0.00-115.00)

*Thyroid peroxidase antibodies >600 (0.00-34.00)

Vitamins

*Active B12 >300 (25.10- 165.00)

Folate serum 18.83 (2.91- 50.00)

25 OH Vitamin D 100 (50.00- 200.00)

CRP High sensitivity 0.88 (0.00-5.00)

Ferritin 106 (13.00-150.00)

I was diagnosed with Hashimoto’s in 2017 and am gluten, soy, dairy and refined sugar free. I supplement daily as follows:

D3 5000iU

K2 as MK-7 90mcg

B12 1000mcg

B complex

Selenium 200 mcg

Vitamin C 1000mcg

Also take 20mg of Solgar’s Gentle Iron about twice a week.

I’m pretty happy with the vitamin results, especially the D3 and ferritin. The T3 is disappointing as it’s not even halfway through the range (it’s 35% through the range if I’ve calculated that correctly). My T4 is over range so despite the optimal vitamins, I guess I’m not a great converter. Back in August 2017, when I was on 75mcg, my T4 was lower at 17.1 (12-22) but my T3 was only marginally worse than now at 4.08 (3.1- 6.8). My TSH then was 3.29. It seems the extra 50mcg of T4 that I’m now on has barely raised my T3 (it’s gone up less than 8%)

I feel much better in myself than a year ago at diagnosis, especially since cutting out refined sugar recently (what a difference!), although I can still get fatigued (although nothing like it was a year ago) and my tongue is scalloped. My hair is much better and my nails are actually growing beautifully. I really did expect the T3 result to be better. I’ve had difficulty sleeping through the night for the last couple of weeks (could this be because my T4 is too high?) I’ve also dropped a few pounds recently without trying and am almost at my ideal weight. Brain fog has pretty much gone, anxiety is minimal and low mood is now a medium mood and, on a sunny day like today, actually a good mood!

A few questions-

1. Is over range T4 a problem? I thought not if T3 was unequivocally in range (which mine is), according to the much cited Dr Toft article in Pulse magazine.

2. Could the excess T4 be turning into reverse T3 and stopping me converting efficiently? If I were to reduce T4 to, say, 117mcg might my T3 actually rise naturally or is it unlikely it would actually make it to halfway through the range?

3. If I’m advised by the wise people here to try to add some T3, do I see my GP and come clean? I haven’t had a blood test on the NHS since October 2017 or seen my GP despite a dose increase back then and despite her telling me she wanted me to retest in mid November. I’ve been using Medichecks as I thought she’d freak out at a suppressed TDh. I’m worried the GPs are going to catch up with me at some point...

Thank you if you’ve managed to read this far! I do appreciate your wisdom and any thoughts. Thank you.

Best,

Kipsy

[SeasideSusie Remembering]

Hi Kipsy

*TSH 0.006 (0.27-4.20)

*Free thyroxine 24 (12.00- 22.00)

Total thyroxine (T4) 101.0 (59.00- 154.00)

Free T3 4.38 (3.10-6.80)

Well, these results do confirm poor conversion. FT4 well over range with FT3 just 34% through range. Yes, your high FT4 could be making rT3 rather than T3, this is what happened to me. I don't think your FT3 will rise if you reduce your Levo dose, mine didn't (but of course that was my experience, it just made me more unwell).

As your nutrient levels are pretty good, if these were my results I would be wanting to add T3 to a reduced amount of Levo (despite what Dr Toft's article says).

Dr Toft's new article states that many patients benefit from the addition of T3 rcpe.ac.uk/sites/default/fi...

Whether you self source T3 and tell your GP is entirely up to you. The chances of getting it on the NHS are extremely slim, and finding an endo to prescribe it will be difficult.

I didn't have an NHS test for 3 years (kept dodging them) but I did keep an eye on my levels with private tests. When I did eventually have to have a test with my GP, I knew my TSH would suppressed (it has been for 20 years, even before taking T3) so I made sure my FT4 and FT3 were well within range. The GPs don't like the suppressed TSH but the Nurse Practioner I can discuss it with and he accepts that as the Frees are within range then it's fine.

By the way, I would drop off the B12 supplement for now, you don't appear to need it. As you are taking a B Complex I would continue with that as your Folate isn't half way through range, and the B Complex will contain some B12 anyway.

Of course, this is not medical advice as I am not medically trained, this is based on my own experience and reading

[Kipsy in reply to SeasideSusie]

Hi SeasideSusie - thank you so very much for your detailed reply. I’ve been mulling it over all evening. I will read the counterblast article in detail tomorrow as I haven’t looked at it properly since it was first published. Thank you for the reminder.

Do you think I need to immediately reduce my T4 to try to bring it into range? I have had difficulty sleeping through the night in the last few weeks and wondered if it might be due to being overmedicated? I’m currently on 125mcg...I could reduce to 117mcg?

One final question- do you think I should reduce my D3 now that Spring is here? I’ve been on 5000iU. Would perhaps 2000iU be a good maintenance dose until October?

I’ve read so many of your responses to people over the last 12 months about supplements and know that my vitamins are only optimal thanks to your brilliant advice. Thank you ever so much for all that you do for everyone on here. Truly, huge thanks.

[SeasideSusie Remembering in reply to Kipsy]

Kipsy

It would be a good idea to retest your Vit D now and that will tell you if you need to still supplement and what dose. When we supplement with D3 we should test twice a year to keep within the recommended range of 100-150nmol, and October/November and April/May are ideal.

I don't know if reducing your Levo will cause you symptoms. I think you need to decide about adding T3 then take it from there.

[Kipsy in reply to SeasideSusie]

Hi SeasideSusie - thank you for your swift reply. my D3 was tested yesterday and is 100. I'm fairskinned and don't sit in the sun much so not sure what to do. I will definitely retest in October but if you have any advice about a maintenance dose, I'd be very grateful to hear. I was thinking of reducing from 5000iU to 2000iU for 6 months.

Thank you for the advice re T4. I agree that a reduced dose could make me symptomatic. I think I will do a new post tomorrow asking for reliable sources of T3 and how much to reduce T4 by once the T3 (hopefully) arrives. My husband's not keen on my self-medicating but I'd like to try especially as I've worked so hard at dietary changes and supplements so far. It feels like I've done everything I could have, bar introducing T3, for the last 12 months..,it's exactly a year ago today that I went strictly gluten & soy free and then more recently I've stopped dairy and sugar.

Many thanks in advance for any D3 advice.

[SeasideSusie Remembering in reply to Kipsy]

With a level of 100 you are only just at the lower end of the recommended range.

Do you get out in the sun much, even walking is enough. To make D3 naturally we need some skin uncovered and without sunscreen and to be in the sun for about half an hour (depends on skin colour). I can't tolerate the sun, my skin feels like it's burning even through trousers. So to keep the level at around 150 I take 2000iu for 5 days a week in summer.

I think you may be OK to take 2000iu now, it's unlikely to take you too high as you're only at 100.

Are you taking magnesium as well as K2? Magnesium helps the body use D3.

[Kipsy in reply to SeasideSusie]

Hi SeasideSusie - thanks again. Oops, forgot to say I take 600mg of magnesium citrate. (I tried magnesium malate but it didn't suit me). I worry that the citrate doesn't absorb well but the laxative effect is necessary.

I walk the dog for an hour a day, five days a week, so that sounds like it will help. Will reduce to 2000iU until retesting in October.

Thank you very much once again! Much appreciated. X