Thryoid blood results

[Michaela_l]

Hi, I posted yesterday after an endocrinology consultant told me to go on antidepressants.

My bloods as from the 16th may 2018 are;

TSH 8.1

Ft3 4.99

Ft4 20.6

Is that ft3 considered low?....I didn't really think so.

Thanks

[Michaela_l]

While on 25mcg levo..

[SeasideSusie Remembering]

Michaela_L

We can tell how low your FT3 is as you haven't in lauded the reference range. Ranges vary from lab to lab so we need your lab's ranges to interpret your results.

Your TSH is very high considering your free T results. Have you had thyroid antibodies tested? I very much doubt you need anti-depressant.

[Michaela_l in reply to SeasideSusie]

Yes, they are high....trying to get a print out seems to be an issue!!!!

[SeasideSusie Remembering in reply to Michaela_l]

Not sure if you've seen these

thyroiduk.org.uk/tuk/NHS_In...

nhs.uk/chq/pages/1309.aspx?...

And as from this Friday, 25th May, they cannot make a charge, it's a new EU ruling.

[Michaela_l in reply to SeasideSusie]

Ye they said they'd have to charge me..

[SeasideSusie Remembering in reply to Michaela_l]

Then wait until Friday and they can't.

pulsetoday.co.uk/home/finan...

I don't have a link to the actual eugdpr.org page, the one I had isn't working now eugdpr.org/

[Michaela_l in reply to SeasideSusie]

Thanks

[Nanaedake]

Why did Endo say you needed anti-d's? The can contribute to osteoporosis according to NICE guidelines.

[Michaela_l in reply to Nanaedake]

They said I may have some background anxiety.. because he said I have nothing wrong with me...I'd rather not take them either, I've read a fair amount of research suggesting all the ways they negatively impact on your future health.

[Nanaedake]

Well don't take them then. Anxiety more likely due to poorly treated thyroid condition and or low nutrients. Increase calcium consumption in foods and check vitamin D, B12, folate and ferritin levels.

[Michaela_l in reply to Nanaedake]

Ye I'm not taking them. Thanks

[Gillybabe in reply to Nanaedake]

I agree. I would not take them. Underactive thyroid can make you low so can B12 deficiency. A very low B12 made my daughter feel abyssmal.

[Michaela_l in reply to Gillybabe]

Having looked at my results, they look some what low. Thanks for your help

[SlowDragon Administrator]

Suggest you find a different endocrinologist. This one likely a Diabetes specialist

If on Levothyroxine, it's recommended by NHS that TSH is under 2. (Many need it under 1)

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...

25mcg is only half the standard starter dose of 50mcg. (Unless frail, elderly or heart condition)

For full Thyroid evaluation you need TSH, FT4, TT4, FT3 plus TPO and TG thyroid antibodies. Plus extremely important to test vitamin D, folate, ferritin and B12.

Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies

thyroiduk.org.uk/tuk/testin...

Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have money off offers.

All thyroid tests should ideally be done as early as possible in morning and fasting. If on Levothyroxine, don't take in the 24 hours prior to test, delay and take straight after. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, GP will be unaware)

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

About 90% of all hypothyroidism in Uk is due to Hashimoto's. Low vitamins are especially common with Hashimoto's. Food intolerances too, especially gluten. So it's important to get tested.

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 also request the list of recommended thyroid specialists.

NICE guidelines on How to introduce and increase dose. Note most patients eventually need somewhere between 100mcg and 200mcg. Blood tests should be 6-8 weeks after each dose increase. Not 4 weeks as stated in here

cks.nice.org.uk/hypothyroid...

[Michaela_l in reply to SlowDragon]

Thank you, I'm taking it all in

[Michaela_l]

So 16th april;

B12 was 324 (197-771)

Folate 2.5 (2-18.7)

Ferritin 13.6 (20-130)

Ft3 5.72 (3.1-6.8)

Ft4 18.2 (11-23)

TSH 26 (0.27-4.5)

Serum thyroid peroxidase antibody concentration 147IU/ml (<34)

19th April

Ft3 4.74

Ft4 18.9

TSH 10

STARTED TAKING 25MCG LEVO

11th May

Ft4 21.8

TSH 8.9

16th May

FT3 4.99

Ft4 20.6

TSH 8.1

[greygoose in reply to Michaela_l]

OK, so you have Hashi's, and you have a conversion problem. A lot of Hashi's people do. But, that endo shouldn't be practicing because you are hypo, and your FT3 is too low because you can't convert the levo (T4) to T3. But he obviously knows nothing about that. What you need, is T3, with just a touch of levo - maybe even 25 mcg is too much, but you won't know until you start the T3. But, where you will find an endo to prescribe T3, I don't know.

Also, your ferritin, folate and B12 are too low. Which might be why you're a poor converter, but might not be the whole story. You need to supplement them, anyway.

[Michaela_l in reply to greygoose]

Thank you for your help! Really! Thank you whenever I mentioned myself possibly not converting he just dismissed it...again and again

[greygoose in reply to Michaela_l]

Because he doesn't know anything about it, not because you don't have a problem. He's not the type, by the sound of it, to admit he doesn't know.

[Michaela_l in reply to greygoose]

I sounded crazy explaining to my boss that I don't agree with a consultant! Though he said good on me for not giving in and going on antidepressants. I was never going to..and I'm continuing on my levothyroxin... despite my consultants advice. I am going to see what the new consultant says next Thursday and will be speaking to PALS regarding my misdiagnosis. I even have started getting pain around my neck...it doesn't bother me but...I know it's my thyroid! I know it was! So for him to shoot me down...grrrr!! Sorry for all the questions, but I don't know much about NDT; can you get T3 in this form? Thanks

[greygoose in reply to Michaela_l]

Well, what a nice boss! They aren't all that understanding.

NDT is made from pig thyroid and therefore called Natural Dessicated Thyroid. Although the tablets still contain fillers, so it's not that natural. One grain contains about 38 mcg T4 and only 9 mcg T3. So, that might be too much T4 for you, and not enough T3. You might be better off adding synthetic T3 to your levo.

[Michaela_l in reply to greygoose]

I know I've apologised for being somewhat of a liability at the minute. Last question, sorry! Can I get hold of synthetic T3?..since I may struggle to get a Dr to prescribe me some. Thank you so much

[greygoose in reply to Michaela_l]

You should write a new question, asking just that in the title, and asking people to PM you their trusted on-line sources of T3.

[Michaela_l in reply to greygoose]

Thanks, I've just found the page on thyroid UK regarding this. I'm going to read up on the two types (it seems) of T3 hormone. I like to ask questions, as well as read literature; I know what subjects to read up on then, as well as reading about the thyroid as a whole. Thank you so much!

[greygoose in reply to Michaela_l]

You're welcome. But what two types of T3?

[Michaela_l in reply to greygoose]

Liothyronine / Triiodothyronine... I know triiodothyronine is T3..but unsure of the other..so I'll be having a read

[greygoose in reply to Michaela_l]

Liothyronine is synthetic T3.

[Michaela_l in reply to greygoose]

As soon as I posted that, I wondered if it was just that thank you

[greygoose in reply to Michaela_l]

[Nanaedake in reply to Michaela_l]

You still need your vitamin D testing, it's very often low in people with Hashimotos. You have low ferritin and need to discuss with GP. GP should run a full iron panel. B12 and folate are both low. You could increase levels with a good B complex with the methylated forms of B's. I take Thorne Basic B which was suggested on this forum.

[Michaela_l in reply to Nanaedake]

Hi, I was put on iron tablets that it. I know my vitamin D will be low, just being in the UK and working indoors. I'm getting a call back tomorrow from gp for referral to private consultant, and will be asking for a range of blood tests thanks

[Nanaedake]

I would have expected ferritin to be higher if taking supplements but maybe you've not taken them for long? Look into SlowDragon's links on gluten and Hashimotos. YOu might benefit from going gluten free as it's possible that you are not absorbing nutrients effectively as a result of gut dysfunction, common among people with thyroid disease.

[Michaela_l in reply to Nanaedake]

I had a bowel resection as a baby; ilium taken away. I've considered going gluten free, but I've done a test (bought online) and it suggested I wasn't coeliac, unless I've got a type of antibody deficiency, so couldn't detect them. I'm currently reading a book..one of many...called 'The adrenal thyroid revolution' which goes into the root causes of hypothyroidism..including gluten.

Thanks

[Nanaedake in reply to Michaela_l]

You don't have to be coeliac to have a problem with gluten. I don't know much about it but it's not harmful to go gluten free so it's worth a try. I don't eat gluten now although I'm not coeliac. I don't think the antibodies test is conclusive although I could be wrong.

[Michaela_l in reply to Nanaedake]

Do you find it hard..going completely gluten free?

[Nanaedake in reply to Michaela_l]

Surprisingly easy!! I just eat plain food, lots and lots of veg, meat, fish, dairy, and fruit. I use a steamer to cook lots of veg at the start of the week and put it in the fridge to use during the week. I take left overs for lunch at work and often just sprinkle cheese on the top and reheat. I take nuts, cheese, carrot sticks for snacks.

I rarely buy anything that is manufactured gluten free. I've found lots of restaurants now have a gluten free menu if you ask, even places you don't expect.

I try to eat as wide a variety of fruit and veg as possible and vary it through the year. It really hasn't been a problem. I'm low carb too so I don't eat white potatoes, bread or pasta. I eat a very small amount of brown rice occasionally.

I eat plenty of good oils like olive, avocado, coconut and butter which I use to flavour the food and for cooking. I use yoghurt to make sauces and for deserts.

I do use a small amount of gluten free Japanese soy sauce to make my own sauces. Some people say not to eat any soy but I figure if it's fermented it's fine. I make my own kefir and take 200mls daily to boost calcium intake and other nutrients.

[Michaela_l in reply to Nanaedake]

I think I'll find it hard..when I'm back at work anyways. My diet isn't too bad at home, but when I'm on call and standby ('sleep' at the hospital, with bleep) I just eat anything to keep me going.

I've got a lot to think about. Thank you for your help, I'm going to put my phone down for tonight. I've got a lot to process!

[SlowDragon Administrator]

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 test vitamin D as well as folate, ferritin and B12.

Vitamindtest.org.uk £29 if GP won't test....but they should

hypothyroidmom.com/92-of-ha...

holtorfmed.com/vitamin-d-au...

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.

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, along with vitamin D test and Pernicious Anaemia test

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...

But don't be surprised that GP or endo never mention gut, gluten or low vitamins. Hashimoto's is very poorly understood

your B12 and folate are too low. Ask GP to test for Pernicious Anaemia. If they won't agree to testing and/or B12 injections then supplementing a good vitamin B complex , one with folate in should help.

If you start 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...

Your ferritin is very low. What was full iron panel result. They could offer an iron infusion to bring levels up much quicker

Only make one change at a time and wait at least 10-14 days to see reactions before changing anything else

[Michaela_l in reply to SlowDragon]

Thank you...it's going to take so much time. I'm kind of angry they haven't looked into this before. My thryoid stimulating hormone was raised a few years ago..and never was mentioned again..

[SlowDragon Administrator in reply to Michaela_l]

If you read daily posts on here you will see it often takes years for diagnosis or recognition of problem for many many people

[SlowDragon Administrator]

Testing negative for coeliac does not rule out gluten intolerance, especially with Hashimoto's. I found that out the hard way. More on my profile

[Michaela_l in reply to SlowDragon]

I am unable to follow you...I think I'm going to try gluten free.