Thyroid UK
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Test Result Help, please

Hi,

I'm new here. I was diagnosed with subclinical hypothyroidism in December '17 by a private ENT who I was seeing for sinusitis. My antibodies were very high, TSH was just over 6 and my free T4 low - I don't have a print out of these. My Mum was also hypo as is my brother.

I was initially put on 25 micrograms of Levo which was increased 10 weeks later to 50 micrograms. TSH reduced to just over 4 from 6 but Free T4 had little change. I've just been back today and as I'm feeling a bit better the specialist was keen to keep me on 50 micrograms however I'm still getting tired, struggling with my weight and having problem periods so she reluctantly increased me to 75 micrograms. Also, she said there is no change in my TSH or Free T4 from last time. I suspect this might be because I did the latest test first thing in the morning fasting with no Levo but the others in the afternoon after food and Levo. These are the results I have from 2 weeks ago (I managed to get a print out this time):

Free T4 = 14.49 (12.0 - 22.0)

TSH = 4.670 (0.270 - 4.200)

Free T3 = 4.4 (3.1 - 6.8)

My ferritin has been stubbornly low at around 6 for over a year but I started a new liquid iron and b vitamin supplement which I feel is working much better and I'll get it tested again soon.

I've been taking liquid supplements of selenium, zinc, vit c, vit d, folic acid, a powder myo-insitol and a magnesium spray. I feel these have made a big difference to my health.

I've been tested for gluten and inflammatory bowel and all came back as clear. I eat very little processed / junk food. I've switched to eating more good quality protein which gives me a lot more energy. I was experiencing constipation and stomach aches but this is mostly cleared now thanks to magnesium and stopping the antibiotics I was taking for the sinusitis which has thankfully gone.

I've had my thyroid scanned and this showed it is slightly smaller than normal but I was told there was nothing to worry about.

I'm just wondering if I need to give it time or if I should switch to a private endo who will hopefully know a bit more? I am fortunate to have private health insurance from my employer.

Sorry for the essay. Thank you for reading if you've got this far!

6 Replies
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As your antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).

About 90% of all primary hypothyroidism in Uk is due to Hashimoto's

Essential to have good levels of vitamin D, folate, ferritin and B12.

Always test before supplementing and 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)

So even though you have tested negative for coeliac it's definitely worth trying a strictly gluten free diet for minimum of 3-6 months. Ideally testing antibodies before you start and after 6 months. Strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

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...

When on Levothyroxine TSH should be around one and FT4 towards top of range and FT3 at least half way in range. So you need a dose increase.

Dose should be increased in 25mcg steps, retesting blood 6-8 weeks after each dose increase

Your ferritin sounds dire. What is the range? What has GP done? You need full iron panel to test for Anaemia If very under range you should be referred to haematology for iron infusion l if low then prescribed ferrous fumerate supplements 2 or 3 times per day. Taking these with vitamin C improves absorption.

Thyroid hormones need ferritin half way in range

See Box 1. Towards end of article

Some possible causes of persistent symptoms in euthyroid patients on L-T4

You will see low vitamin D, folate, ferritin and B12 listed

onlinelibrary.wiley.com/doi...

Reply

Thanks SlowDragon. My GP has tried me on various iron supplements but all gave me terrible digestion problems. I'm now taking a liquid iron supplement, Floradix, and eating lots of iron rich foods as a last resort before a referral to haematology and an infusion. I don't have a reason for my low iron.

I'm going to switch from the ENT specialist to an Endo. I can't believe she was happy for me to stick with 50 micrograms despite having a TSH of 4.6 and knowing we'd like to try for a baby.

Thanks again.

Reply

When hypothyroid we tend to have low stomach acid making it very difficult to absorb nutrients. also leaky gut and often gluten intolerance too, especially with raised antibodies (Hashimoto's)

So your iron is low in part because you struggle to absorb. (Heavy periods are classic sign of being hypothyroid and make situation worse)

Changing to strictly gluten free diet can slowly help gut heal. Obviously also need to get Levothyroxine dose improved as well

TSH should be around one (definitely under 2) and FT4 towards top of range

Official NHS guidelines saying TSH should be between 0.2 and 2.0 when on Levothyroxine

(Many of us need TSH nearer 0.2 than 2.0 to feel well)

See box

Thyroxine replacement in primary hypothyroidism

pathology.leedsth.nhs.uk/pa...

It's catch 22 with low vitamins, they are low so can't improve Thyroid and low because of thyroid.

Supplementing is usually necessary too. Iron is notoriously difficult to find supplement you can tolerate. Have you tried ferrous fumerate?

Eating liver once a week should help improve (Or liver pate)

Essential to test vitamin D when supplementing Ideally twice yearly. Vitamin D is toxic in excess as is oil based so we need enough, but not too much.

Aiming for level around 100nmol. Better You vitamin D mouth spray is good as avoids poor gut function of Hashimoto's

Vitamindtest.org.uk £29

Also good idea testing B12 and folate, though as water soluble we can get rid of excess. But you want to know you are taking enough

A good vitamin B complex will support all B vitamins, not just B12 and folate.

If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 3-5 days before any blood tests, as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

Like you I was tested twice for coeliac, both negative. Like extremely high percentage of patients with Hashimoto's, I turned out to be severely gluten intolerant (absolutely no gut symptoms. Just couldn't walk!) more on my profile. I thought for years I had cast iron stomach...ha ha..

Reply

Yes, I've tried ferrous fumerate but didn't get on with it. I was trying different iron supplements whilst also taking several lots of antibiotics for a sinus infection that wouldn't budge which didn't help.

I know you're right regarding gluten and I have cut down. I'm looking into bread machines with a gluten free option!

I'm off to pick up my last test results from the GP done in January which included folate and B12 I think. They were apparently normal but I'm going to verify and re-book.

Thanks again.

Reply

Did you get your TSH down under 2.5 as recommended for anyone TTC

Essential to have good levels of folate, B12 especially for baby's development too, but your Thyroid also needs good ferritin and vitamin D as well

gp-update.co.uk/files/docs/...

thyroiduk.org.uk/tuk/guidel...

Reply

Hi, I have a blood test booked for 3 weeks time for thyroid and ferritin with my GP. My Levo dose was increased about 3 / 4 weeks ago. My B12 and folate were checked in January and they were both good. Thank you :-)

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