Hi. Two years ago I went to my doc complaining of tiredness, constantly cold, aching muscles and difficulty losing weight. He did some blood tests and they came back with low vit D. No apparent prob with thyroid but don’t really know what all the results were until I went back the other day And the doctor I saw looked through my previous results - I noticed tsh was 1.0.
After that first visit I upped my vit D and guess there may have been mild improvement but time passes and things get worse. I went back to my doctor last week and explained the same symptoms are worse, I am forgetful and irritable and just plain miserable. She discusses mental health because I have had depression in the past but although it could account for some of the symptoms I’m not sure it isn’t another symptom itself rather than the cause. Doc wants me to have the same blood tests again but in the meantime I paid to have some. B12, ferritin, folate, vit d all good. Tsh 2.71, ft4 15.4, ft3 5.21, t4 83.5 - all within range but tpo 42 and tgab 225. So I have high antibodies, symptoms but other results within range what are the chances that my doctor will even consider treatment? I don’t think the tests she will order include antibodies so will she even accept the tests I had done? I also have had problems over the years with stomach pains and diarrhoea and based on my high antibodies it was suggested ( not by my gp)I was also test for coeliac disease. Any advice would be much appreciated. X
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If you can list your results with their reference ranges, we can interpret them accurately. Ranges vary from lab to lab so we need the ranges from the lab that did the test, eg.
TSH: 2.5 (0.2-4)
FT4: 19 (12-22)
TPO: 12 (<34)
Did you have vitamins and minerals done as well as the thyroid panel - Vit D, B12, Folate and Ferritin?
Your TSH at 2.71 shows your thyroid is struggling, your FT4 is quite low in range and your FT3 is showing that your body is making a good attempt to convert T4 to the active hormone T3 at the moment.
TPO: 42 (0-34)
TGAB: 225 (0-115)
These results confirm autoimmune thyroid disease aka Hashimoto's as shown by your high antibodies. Hashi's is where antibodies attack the thyroid and gradually destroy it. The antibody attacks cause fluctuations in symptoms and test results.
Your GP may or may not be prepared to accept your private results, some do, some don't. Your GP may be able to get TPO antibodies tested but wont be able to get TG antibodies tested, this is normally done by an endo. However, you can push this aspect - high antibodies - when you discuss things with your GP. Unfortunately most doctors dismiss antibodies as being of no importance and know little or nothing about Hashi's and how it affects the patient, test results and symptoms, so you can do something to help yourself here.
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.
What might be useful when seeing your GP is to take information from an article in Pulse magazine (the magazine for doctors) written by Dr Toft (leading endocrinologist and past president of the British Thyroid Association) where he says that if antibodies present then patients should be prescribed levothyroxine to nip things in the bud. Email Dionne at
tukadmin@thyroiduk.org
and ask for a copy which you can then show to your doctor. The information is in answer to question 2.
What time did you do your Medichecks test? You need to do it as early as possible, certainly no later than 9am. What you really need is for your TSH to be at least 4, because if it's between 4 and 10, with hypothyroid symptoms, then that's classed as Subclinical Hypothyroidism, and Dr Toft's article then becomes more relevant.
When booking thyroid tests, always book the very first appointment of the morning and fast overnight (water allowed) . This gives the highest possible TSH which is needed when looking for a diagnosis, an increase in dose or to avoid a reduction. TSH is highest early morning and lowers throughout the day. It can also lower after eating and coffee also affects TSH. Also, when on thyroid replacement, take your Levo after the blood draw because if you take it before then your FT4 will reflect this and show higher than what is normally circulating. We usually advise 24 hours between last dose of Levo and blood draw so if you take your Levo in the morning then delay until after the test, or if you take it at night then delay that dose until after the test. These are patient to patient tips which we don't discuss with doctors or phlebotomists.
and if you have any then list them for your GP and ask for further testing.
Folate: 10.2 (8.83-60.8)
This is very low in range. Recommended is for folate to be at least half way through range. Your GP may agree to prescribe folic acid, but as it's within range maybe not. But you can always buy your own methylfolate or B complex (as for suggestions here if buying your own) and that will raise your level. HOWEVER, don't supplement to raise your folate level until further testing of B12 has been carried out, as supplementing with folic acid/folate masks signs of B12 deficiency, and should only be started after B12 injections/supplementation has begun.
Ferritin: 85.2 (13-150)
This is fine, maybe a little higher will be best if still menstruating.
Vit D: 77.4 (50-200)
The Vit D Council, the Vit D Society and Grassroots Health all recommend a level of 100-150nmol/L.
With your current level, the Vit D Council recommends the following
To achieve 125nmol/L take 2500 IU D3 daily
To achieve 150nmol/L take 4600 IU D3 daily
As you have raised antibodies, for best absorption an oral spray is recommended. BetterYou do a 3000iu one.
There are important cofactors needed when taking D3 as recommended by the Vit D Council -
D3 aids absorption of calcium from food and K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems such as hardening of the arteries, kidney stones, etc.
D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds.
Magnesium helps D3 to work. We need Magnesium so that the body utilises D3, it's required to convert Vit D into it's active form. So it's important we ensure we take magnesium when supplementing with D3.
Magnesium comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds
Thank you for all that information! With so much out there I find it difficult to filter out what I need to know so this has helped a lot.
I took my sample at 7.30am but my gp’s bloods are due to be taken at midday so I will try to rearrange that appointment- though that was the first appointment I could get and it was two weeks after I saw my gp!
I have a question about lowering the antibodies by going gluten free - does this mean that it is possible in some cases to control the symptoms by diet only or would that depend on how much damage has already been caused to the thyroid?
Do try and change your appointment, doesn't matter how long you have to wait, you really need the highest possible TSH so just wait for an early appointment.
I don't have Hashi's nor am I gluten free so I have no experience to pass on, but I will ask our Hashi's expert SlowDragon to pop along and comment when she's around.
Going strictly gluten free may lower TPO antibodies slowly over many months
It can dramatically improve symptoms for some. Others notice a slow improvement. It can sometimes help vitamins stop dropping quite so fast
If no noticeable difference gluten free, after 3-6 then consider reintroducing gluten, ideally retesting antibodies first. If symptoms get worse then stop gluten again
Ideally ask GP for coeliac blood test first, just to rule it out
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