Newbie, first post. Help understanding results please

[Nathalie88]

Diagnosis in Dec 2012

TSH 45 (0.2 – 4.2)

FT4 10.3 (12 – 22)

On 75mcg Levo Mar 2013

TSH 4 (0.2 – 4.2)

On 100mcg Levo Aug 2013

TSH 4.4 (0.2 – 4.2)

FT4 15.4 (12 – 22)

On 125mcg Levo Nov 2013

TSH 4.7 (0.2 – 4.2)

FT4 15.7 (12 – 22)

On 125mcg Levo Jan 2014 – still had symptoms of hypothyroid

TSH 2.8 (0.2 – 4.2)

On 125mcg Levo Mar 2014 – still had symptoms of hypothyroid

TSH 3.6 (0.2 – 4.2)

On 125mcg Levo May 2014 – still had symptoms of hypothyroid

TSH 6.02 (0.2 – 4.2)

FT4 18.3 (12 – 22)

On 125mcg Levo Jul 2014 – still had symptoms of hypothyroid

TSH 0.02 (0.2 – 4.2)

FT4 23.8 (12 – 22)

FT3 6.1 (3.1 – 6.8)

TPO ANTIBODY 148 (<34)

On no Levo Sep 2014 – still had symptoms of hypothyroid

TSH 2.55 (0.2 – 4.2)

FT4 15.7 (12 – 22)

FT3 4.1 (3.1 – 6.8)

On 100mcg Levo Nov 2014

TSH 6.80 (0.2 – 4.2)

FT4 13.7 (12 – 22)

FT3 4.0 (3.1 – 6.8)

On 125mcg Levo Jan 2015

TSH 3.87 (0.2 – 4.2)

FT4 13.3 (12 – 22)

FT3 4.2 (3.1 – 6.8)

On 150mcg Levo Mar 2015

TSH 2.96 (0.2 – 4.2)

FT4 14.1 (12 – 22)

FT3 4.1 (3.1 – 6.8)

On 175mcg Levo Mar 2015

TSH 5.22 (0.2 – 4.2)

FT4 25.8 (12 – 22)

FT3 5.2 (3.1 – 6.8)

TPO ANTIBODY 485 (<34)

TG ANTIBODY 266.3 (<115)

On 175mcg Levo Aug 2015

TSH 1.30 (0.2 – 4.2)

FT4 19.2 (12 – 22)

FT3 4.0 (3.1 – 6.8)

On 175mcg Levo Jan 2016

TSH 0.08 (0.2 – 4.2)

FT4 22.4 (12 – 22)

FT3 4.3 (3.1 – 6.8)

On 25mcg Levo Mar 2016

TSH 6.3 (0.2 – 4.2)

FT4 12.9 (12 – 22)

FT3 4.1 (3.1 – 6.8)

On 75mcg Levo May 2016

TSH 3.84 (0.2 – 4.2)

FT4 13.8 (12 – 22)

FT3 4.3 (3.1 – 6.8)

On 100mcg Levo Jul 2016

TSH 3.65 (0.2 – 4.2)

FT4 18.3 (12 – 22)

FT3 4.5 (3.1 – 6.8)

On 125mcg Levo Nov 2016

TSH 2.90 (0.2 – 4.2)

FT4 17.2 (12 – 22)

FT3 5.0 (3.1 – 6.8)

On 150mcg Levo Jan 2017

TSH 1.77 (0.2 – 4.2)

FT4 16.1 (12 – 22)

FT3 4.3 (3.1 – 6.8)

On 175mcg Levo Aug 2017

TSH 0.03 (0.2 – 4.2)

FT4 21.1 (12 – 22)

FT3 3.8 (3.1 – 6.8)

On 150mcg Levo Nov 2017

TSH 5.60 (0.2 – 4.2)

FT4 13.8 (12 – 22)

FT3 4.1 (3.1 – 6.8)

On 175mcg Levo Dec 2017

TSH 0.02 (0.2 -4.2)

FT4 25.7 (12 – 22)

FT3 4.0 (3.1 – 6.8)

TPO ANTIBODY 349 (<34)

TG ANTIBODY 548.3 (<115)

Feb 2018 on 25mcg Levo

TSH 5.7 (0.2 – 4.2)

FT4 14.7 (12 – 22)

FT3 3.6 (3.1 – 6.8)

Symptoms – leg shakiness, dry skin, tiredness, fatigue, muscle cramps, weight gain, sugar cravings, puffy eyes, feeling cold all the time, splitting nails, depression, memory loss, sweating, tremor.

Thanks

[diogenes Remembering]

Why on earth was the T4 you take lowered so drastically from 175 to 25 ug? This is absolutely unacceptable - T4 dosage should never be changed as drastically as that - only in 25ug steps if needed wih plenty of time on the new dose before testing again. This has caused a great shock to your body. Comparing your December and February results, it's clear that, first, you are a poor converter of T4 to T3. This is because on going from 175 to 25 ug T4, your FT3 was lowered only slightly compared to the drastic change in T4 therapy level of FT4. On both occasions however the FT3 was at the bottom of the scale regardless of how much T4 you took - this again shows the limits of conversion your body is capable of. TSH in December was suppressed because of the excess T4. In February it was high and is another clear indication of gross underdosing. This huge alteration in dose should never have been done - you have been on T4 for 6 years and your body will have got used to the dose. You need urgently a) to raise the T4 dose to at least 125, and b) strongly consider adding T3 to your regimen to help your poor T4-T3 conversion.

[Nathalie88 in reply to diogenes]

I have spoken to my GP about T3, he says I need it. A previous endo recommended T3 as well and was going to prescribe it to me but she left and I was transferred to someone else who said there was no clinical benefit of being on it

[SlowDragon Administrator]

Presumably you know that high thyroid antibodies is Hashimoto's

Who keeps changing your dose? You, GP or endo ?

You are currently very under medicated, dose needs increasing in 25mcg steps (retesting 6-8 weeks after each dose increase) until TSH is around one and FT4 towards top of range and FT3 at least half way in range

Low vitamins due to Hashimoto's are extremely common

Essential to test vitamin D, folate, ferritin and B12.

Always get actual results and ranges. Post results when you have them, members can advise

Hashimoto's affects the gut and 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. Dairy is second most common.

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)

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, at same time as request vitamin tests

amymyersmd.com/2017/02/3-im...

chriskresser.com/the-gluten...

thyroidpharmacist.com/artic...

scdlifestyle.com/2014/08/th...

drknews.com/changing-your-d...

thyroidpharmacist.com/artic...

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, 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 articles from Thyroid UK email print it and highlight question 6 to show your doctor

 please email Dionne at

[e-mail]

Suggest you ask for list of recommended thyroid specialists too

Getting TSH down, vitamins optimal (not just in range) and very likely to need to be absolutely strictly gluten free diet

Optimal vitamin D around 100nmol

B12 and folate towards top of range

Ferritin at least half way in range

Most with Hashimoto's need to supplement significantly to achieve this

If FT3 remains low after all these steps, then, like many with Hashimoto's you may need addition of small dose of T3

FT3 needs to be at least above 5

Professor Toft recent article saying, T3 may be necessary for many, otherwise we need high FT4 and suppressed TSH in order to have high enough FT3

rcpe.ac.uk/sites/default/fi...

Only EVER change dose of Levo by 25mcg at a time (up or down)

[Nathalie88 in reply to SlowDragon]

I have spoken to my GP about T3, he says I need it. A previous endo recommended T3 as well and was going to prescribe it to me but she left and I was transferred to someone else who said there was no clinical benefit of being on it

Other GPs, other consultants and endo changing dose between them

[SlowDragon Administrator in reply to Nathalie88]

You will need to do ALL the other steps first

Email Thyroid UK for list of recommended thyroid specialists

[Nathalie88]

I supplement vit D and folate, haven't noticed a change in symptoms or levels

[SlowDragon Administrator in reply to Nathalie88]

You will need them optimal, not just in range

It takes months of correct vitamins and strictly gluten free diet to help heal gut

Bone broth, probiotics, fermented foods like kefir all help too

TSH around one, with FT4 towards top of range

Read as much as possible about leaky gut, gluten and Hashimoto's