Any views on my results please?

[Dancing-Queen]

Here there I was diagnosed with Hashimotos Thyroiditis a couple of years ago & have been trying to balance my medication. I still feel unwell but my GP said my results are ok.

Serum TSH level 1.3 mu/L

Serum free T4 15.2 pmo/L

Serum T4 (XaERr) 15.1 pmol/L

Serum 3 triiodothyronine 3.9 pmol/L

Vitamin D 115.2 nmol/L

Vitamin B12 345 ng/L

Serum ferritin 69 ug/L

Serum follicle stimulating hormone level 44.1u/L

Thank you so much

Dancing Queen

[thyroidorwhat]

Vitamin B12 345 ng/L

Serum ferritin 69 ug/L

Could be improved. Did you have folate tested too?

[greygoose in reply to thyroidorwhat]

Depends if it's a serum test or an active test, and we don't know without the ranges.

[thyroidorwhat in reply to greygoose]

Oh yes that's true, I assumed it was serum! Please post the range. For Active B12 that would probably be ok.

[Dancing-Queen in reply to thyroidorwhat]

Thank you

B12 ranges 10-307

They did not test for folate. Since my results I have been taking a Vit B complex tablet & feel better in my mood & energy levels. Not sure if it’s placebo!!!

TSH ranges 0.27-4.2

T4 ranges 12-22

Thank you

[SlowDragon Administrator in reply to Dancing-Queen]

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)

Is this how you did the test?

What's the FT3 range?

FT4 probably too low at 15. Should be nearer 18-20

FT3 looks low

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]

[Dancing-Queen in reply to SlowDragon]

Thank you. Yes I had an early appointment & took levothyroxine after.

T3 range 3.1-6.8

How would I achieve a higher T4 result please?

Cheers

[greygoose in reply to Dancing-Queen]

It's not the FT4 the most important. It's the FT3. That is much too low. Levo (T4), converts into T3, but your FT4 is also too low. So, you need an increase in dose.

With Hashi's, your TSH would be better at zero.

[Dancing-Queen in reply to greygoose]

Thank you so much. So fed up with my GP saying ‘no further action required’ Should I say I need a higher dose based on what you have suggested?

Cheers

[greygoose in reply to Dancing-Queen]

You can try. But they don't always appreciate patients knowing more about it than they do! He's just not looking at the right numbers.

[SlowDragon Administrator in reply to Dancing-Queen]

FT3 should be at least above 5, yours is very low

To increase FT4 and FT3 you need increase in Levothyroxine. Dose is increased in 25mcg steps and retesting after 6-8 weeks (or waiting longer, but not sooner)

Ask GP for 25mcg dose increase, as a "trial" if necessary

Going absolutely strictly gluten free diet is likely to help. Try for at least 3-6 months

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...

First step is to get FT4 towards top of range after increase in dose, gluten free, then if FT3 remains low then looking at adding small dose of T3 may be necessary

Thyroid UK has list of recommended thyroid specialists.

[Dancing-Queen in reply to SlowDragon]

Thank you that was so useful. I will get on the case now & sort it out.

🙏

[SlowDragon Administrator]

Also as you have Hashimoto's are you on strictly gluten free diet?

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

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...

[Dancing-Queen]

I am not on a gluten free diet but am willing to give it a go if it helps.

Thank you

[SlowDragon Administrator in reply to Dancing-Queen]

Many find it essential. You don't need to have any gut symptoms at all