Advice please. Newly diagnosed Hashimoto

[pipshaw]

Looking for advice please. Was taking 50mcg Levo for 4 weeks after discovering tsh was 15. I’ve recently moved to Spain, after arriving I had another blood test which showed Hashimoto.

Thyroid Antibody 343.20. Normal Range <9,0

Thyroglobulin 24.70. Normal Range <4.0

TSH 10.52. Range 0.3-4.20

T4 11.70. Range 4.6-10.5

Vit B12 158.4. Range 206-678

The gp has said reduce Levo to 50mcg one day and 25mcg next day alternating for the next 2 months then go for another blood test. Also prescribed B12 supplement 500mcg daily for one month.

I’m confused why he would reduce the Levo while TSH is still quite high. I have the usual symptoms weight gain, dry skin, fatigue etc but I have also developed a bad chest recently, shortness of breath and wheezing which I am using an inhaler to help.

Should I be on a higher dose of Levo?

Opinions much appreciated. Age 55.

Thank you

[SeasideSusie Remembering]

pipshaw

I’m confused why he would reduce the Levo while TSH is still quite high.

Yes so am I. You should have had an increase in dose to reduce your TSH.

Vit B12 158.4. Range 206-678 prescribed B12 supplement 500mcg daily for one month.

With a below range B12 I would have thought the most sensible thing would be further testing for B12 deficiency/pernicious anaemia. 500mcg B12 wont help much and if you continue to take it then it will skew further testing. I personally would stop supplementing and ask for further tests.

Maybe you should see a different doctor, I'm not sure this one knows what they're doing.

As for the Hashi's,

You can help reduce the antibodies by adopting a strict gluten free diet which has helped many members here. Gluten contains gliadin (a protein) which is thought to trigger autoimmune attacks so eliminating gluten can help reduce these attacks. You don't need to be gluten sensitive or have Coeliac disease for a gluten free diet to help.

Supplementing with selenium l-selenomethionine 200mcg daily can also help reduce the antibodies, as can keeping TSH suppressed.

Gluten/thyroid connection: chriskresser.com/the-gluten...

stopthethyroidmadness.com/h...

stopthethyroidmadness.com/h...

hypothyroidmom.com/hashimot...

thyroiduk.org.uk/tuk/about_...

[RedApple]

Welcome to the forum pipshaw.

Although your TSH is 10.52, your FT4 is showing as being over range. I suspect that has confused the GP and prompted the suggestion of lowering your dose.

Did you take any thyroxine before this blood draw, and if yes, what was the time gap between ingesting the tablets and having the blood drawn?

[pipshaw]

Thanks for advice. It was 24 hours between taking my last Levo to having the blood test

[SlowDragon Administrator in reply to pipshaw]

Would suspect you need to get all vitamin levels optimal first before you can tolerate higher dose of Levothyroxine

B12 is obviously very low. You really need full testing for Pernicious Anaemia before starting B12 injections, or if no injections from GP then usually the dose recommended is 1000mcg sublingual B12 daily

Folate, vitamin D and ferritin need testing too

Hashimoto's affects the gut and leads to low stomach acid and then low vitamin level. 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...

[RedApple in reply to pipshaw]

Just want to double check that you've reported the numbers correctly, so copying and pasting from your text above:

TSH 10.52. Range 0.3-4.20

T4 11.70. Range 4.6-10.5

Something isn't right here. TSH is high, implying an increase is needed, but FT4 being high implies overmedication.

If you had taken your levo just before the test, these numbers could possibly make some sense. But with a 24 hour gap, there's something very strange going on.

I suggest going back to your GP and discussing these numbers with him before changing your dose. Ask for another test to confirm this strange result, and make sure you leave the same length of time between taking levo and blood draw, plus get blood drawn at same time of day so that there is a direct comparison.

[pipshaw in reply to RedApple]

Thanks for your reply. I’ve double checked and those results are correct. There is also an Eosinophils result which is above normal with a reading of 7.0. Normal range 0.0-5.0 whatever that means.

My new life in Spain is turning into a bit of a nightmare as all bloods and medication has to be paid for although Levo is cheap. Is it worth asking to have T3 tested? Thanks. Phil

[RedApple in reply to pipshaw]

Yes, I would definitely have FT3 tested too, as this may help to shed some light on what's going on. Raised eosinophils can be caused by an infection or allergic reaction. Perhaps your bad chest is actually an infection, rather than caused by the hypothyroidism. Just speculating here, as I'm no doctor

[SeasideSusie Remembering in reply to RedApple]

Is that FT4? The range doesn't look right for FT4, it's usually around 10 points between top and bottom of range.

[RedApple in reply to SeasideSusie]

If this was in UK, I'd agree. But pipshaw is in Spain, so could be different there.

[SeasideSusie Remembering in reply to RedApple]

Ah OK, didn't realise that

Or should I say, it hadn't actually sunk in!

[pipshaw in reply to SeasideSusie]

Is there a difference in T4 with the ‘F’ in front. On the results it just says T4?

[SeasideSusie Remembering in reply to pipshaw]

Pipshaw

Yes. There is Total T4 and Free T4 and you need to know which one has been done.

Total T4 includes all T4, bound and unbound.

Free T4 just measures unbound and that's what's available to be used by our cells and is the most important of the T4 tests.

[pipshaw in reply to SeasideSusie]

Thanks Susie. So if I request a T3 test do I ask for it to be FT3?

[RedApple in reply to pipshaw]

Yes

I have assumed your T4 result to be FT4 as that's the most likely one for the lab to have done, plus numbers are usually very different again for TT4.

[SeasideSusie Remembering in reply to pipshaw]

Pipshaw

So if I request a T3 test do I ask for it to be FT3?

I don't know what it's called in Spain but it has to be their equivalent of Free T3, I doubt it will be known as FT3 there.

[Mouldyoledoll]

That FT4 ref range seems strange

[pipshaw]

Have been doing some research the T4 result must surely be total T4 and not FT4?