Latest results - advice please

[Bagster2]

I was diagnosed with sub-clinical hypothyroidism 2 years ago. Since then I have been steadily increasing my dose of levo and I’m currently taking 112mcg. To be honest I haven’t experienced much change in symptoms. I still have very dry skin, low pulse and some breathlessness from time to time. But otherwise I am well. These are my latest results. I’ve noticed a drop in antibodies (TGAb), but FT3 stays doggedly around 4.5. That hasn’t really changed since I started taking levo. I’m concerned that my GP will ask me to reduce my dose because TSH is below range. My question is should I stay with my current dose or try a small increase? I’m not taking any supplements at the moment. Just a couple of Brazil nuts a day for selenium. Thanks in advance for any advice.

[Marz]

Your Ferritin is over range - this is stored iron - and could indicate an infection like a cold or something - otherwise possible inflammation in the body.

VitD could do with a boost - so taking 5000IU's daily and then reduce after testing if over 100. Also take Magnesium and VitK2-MK7 as important co-factors for VitD.

i would take a GOOD B complex to keep all the B's in balance - and to give you some B12 and folic Acid/Folate

Brazil nuts will only give you Selenium if they were grown in selenium rich soil - so check the packet. I would take Selenium from time to time ....

I will let others comment on your dose - maybe a small increase - but when nutrients are optimal maybe they will improve.

[Bagster2 in reply to Marz]

Thanks very much for your response Marz. I’m not too worried about the Ferritin. It’s always been slightly over range and there isn’t any infection as far as I know. I only take Brazil Nuts which specifically say ‘high in selenium’, but I will try supplements as you suggest. Also the vit D combo and B complex is an excellent idea. I’ve slipped with all the supplements. I used to be quite diligent but got fed up with all the pill popping. Many thanks again for your help x

[Marz in reply to Bagster2]

I agree it is a bore - but for many of us it does make a difference popping all those tabs to keep us on the up Maybe make them up for the week in a Pill Sorter Box - ( I don't have one ) then you only have to do it once !!

[Bagster2 in reply to Marz]

Oh I do have a plastic pill box. It just houses my Levo at the mo. I’ll be putting it to better use with all these supps x

[SeasideSusie Remembering]

Bagster

Actually, you are a bit undermedicated. The aim of a treated hypo patient generally is for TSH to be 1 or below or wherever it needs to be for FT4 and FT3 to be in the upper part of their respective reference ranges when on Levo, if that is where you feel well. So, with those ranges, you might feel better with your FT4 around 19.5 and FT3 around 5.9

You could try a small increase, maybe 12.5mcg to start with, and see how you feel. If your GP is reluctant, use the information in Dr Toft's article in Pulse magazine to support your request for the increase

thyroiduk.org/tuk/about_the...

"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)."

Dr Toft is past president of the British Thyroid Association and leading endocrinologist.

You can obtain a copy of the article by emailing Dionne at [e-mail] print it and highlight question 6 to show your doctor.

You can tell your GP that you have taken advice from NHS Choices recommended source of information regarding thyroid disorders, which is Thyroid UK. Best not to mention the internet or forum as they don't like that.

Your conversion is good, your FT4:FT3 ratio is 17.9 divided by 4.56 = 3.9:1 and good conversion takes place when the ratio is between 3:1 and 4:1

As you have Hashi's, confirmed by over range antibodies in previous post TGAb 361. (0 - 115), are you strictly gluten free and supplementing with selenium l-selenomethionine 200mcg daily?

Be aware that there is no guarantee that Brazil nuts contain any selenium unless grown in selenium rich soil, and it has to state this on the packaging to know that. Best areas for high selenium content are Eastern Amazon and Central Brazil honey-guide.com/2012/11/19/...

Your nutrient levels are not optimal., they need to be optimal for thyroid hormone to work properly.

Folate should be at least half way through it's range so a good B Complex such as Thorne Basic B or Igennus Super B will help raise your level.

Your Vit D is too low, the Vit D Council recommends a level of 100-150nmol/L, so you should take some D3 oral spray with K2-MK7, plus some magnesium.

[Bagster2 in reply to SeasideSusie]

That’s really very helpful. Thank you so much. I’ll up my dose, as you suggest, and see if that helps. The Brazil nuts I use are organic from Waitrose and do say ‘high in selenium’ on the bag but, of course, that’s no guarantee. I’ll get back on the B complex and Vit D. I was quite diligent about vitamins in the past but have been a bit negligent in recent months. I try my best to avoid gluten, not always successfully. And I know it has to be 100%, but my antibodies have reduced a bit in spite of the odd lapse. The TSH worries me because it is very suppressed, I.e. lower than even Dr Toft’s suggested range. And of course that is all my doctor looks at. But I really appreciate your excellent advice, many thanks

[SeasideSusie Remembering in reply to Bagster2]

‘high in selenium’

That can be a bit of a red herring. It should say "Grown in selenium rich soil" to be sure that it contains some selenium, and then knowing exactly where they come from tells you how much is likely to be in them, as that link shows.

The TSH worries me because it is very suppressed, I.e. lower than even Dr Toft’s suggested range.

Dr Toft does say in that article that "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." I've been hypo over 40 years and have kept a spreadsheet of my results since 1995, during all that time my TSH has been suppressed with just a couple of exceptions. I make sure my FT3 stays in range, that's the important result.

I've had the "suppressed TSH" conversation with a couple of doctors. I've recently had to see the Advanced Nurse Practioner at the surgery about something else and he made the same comment about my TSH. I pointed out my FT4 and FT3 levels were well within range and talked about TSH not being a thyroid hormone but a signal from the pituitary to tell the thyroid to make hormone, and if I'm taking Levo then there's no need for the pituitary to send the signal because it detects the replacement hormone. He ended up agreeing with me and thanking me for a "conversation with someone sensible". He didn't alter my dose, and I did say that if he had suggested it he knew what my answer would have been! I haven't had a doctor with such an open mind though (but of course, a doctor is always right and god forbid the patient should know more!).

[Bagster2 in reply to SeasideSusie]

That’s v reassuring. Thanks. I’ll go armed with your response when I see my GP. Though to be honest I avoid seeing her as much as I can. She has a response for everything even when it contradicts what she’s already said. I really am so grateful for your sensible advice. It’s v much appreciated.

[shaws Administrator in reply to Bagster2]

Before blood tests and levothyroxine were introduced we were given natural dessicated thyroid hormones.

Doctors diagnosed us upon clinical symptoms and increased dose gradually until we were symptom-free and felt well.

One of those doctors (deceased) said that nowadays hypo patients either remained undiagosed despite clear symptoms or given too low a dose to make them well and many, nowadays, were put in a parlous situation by doctors only taking notice of the TSH and not relieving clinical symptoms.