17 Year Old Daughter struggling with fatigue, advice most welcome

[KIRM]

Turned to Blue Horizon for latest bloods. (Hopefully attached). Gluten free for 11 months, with the odd slip. This has resulted in a reduction of her antibodies. Takes, B12, Vitd &K2, Seleniun, Magnesium, Ashwaganda, CoQ10, ProBio, B1, Omega 3, Vit C.

Was on 125mcg T4 when these bloods were taken (we upped it from 100mcg which has been her usual dose for the past 3 years as always thought she was struggling with her T3). Endo saw her suppressed TSH and was not surprised by response. Have dropped it back to 100mcg so will compare when we do more bloods in a couple of months. We buy her Euthyrox OTC so are free from restraints if we need to change her dose.

Endo was more concerned by her lethergy, appearance of a depressive state and dismissed the fact that she can have 10 hours sleep and still wake up tired. But related none of this to her thyroid. He did do the following bloods, taken around noon -

LH 8 IU /L, FSH 6 IU/L, Testosterone 1.1 nmol/L [0.5-2.6], Oestradiol 216 pmol/L - normal IGF-1 340 ng/ml, Prolactin 333 mU/L, Cortisol 249 nmol/L - normal

Electrolytes and full blood count - normal, Hb 132 g/L

tTG Iga Antibody 0.5 kU/L (0.0 - 14.9)

Any thoughts/advice most appreciated as she is in Y13 and predicted to do well in her exams - if fatugue, stress and brain fog doesn't get the better of her.

Thank you.

[Judithdalston]

Even on the higher 125 mcg dose of levothyroxin your daughter's active FT3 is low at 5.2, as 5.6 would only be halfway thru range. Yet she does seem to be converting T4 ok. Obviously what ever you do to improve her FT3 , whether adding more T4 or starting to add T3 , will upset her doctor as the TSH will go down even more! As adults many forum members might consider adding T3 to levothyroxin; shame her endo seems so cautious! One result from the bloods sticks out as low: ferritin, at her age she should be in 100-130 for good thyroid health, not 57...that might infact be contributing to tiredness etc. I don't know whether your Gp would agree to supplement her as technically she is still a child; I take iron supplements with vit C daily. Her Vit D is also lowish- better at 100-150, so up the supplementation perhaps especially as sunshine now diminishing. See SeasideSusie's previous replies to posts regarding supplementing for iron: doses, brands etc.

[KIRM in reply to Judithdalston]

Thank you for your advice. We have struggled to get her ferritin up since diagnosis 3 years ago. We eat liver once a week but no additional supplements. We have also struggle with her Vit D despite being on a daily dose of Cytoplans Vit D/K2. It has also taken 2 years to get her B12 to this level.

[Judithdalston in reply to KIRM]

Sorry don't recognise Cytoplans...is it a liquid form eg drops or spray...i find anything that bypasses gut by absorption in mouth/ under tongue works well ( can get sublingual B12 too). Have you asked doctor for injections, not a nice sounding option, but might push ferritin etc levels up enough to then be able to rely on pills etc? Has your daughter had full iron panel checked...as I suggested before as a child you would think your daughter might get better support than adult patients.

[KIRM in reply to Judithdalston]

Thank you again for your feedback. Her B12 is sublingual. Will check her last iron panel and change to a B complex as suggested by grey goose and see how she goes on her next bloods.

[greygoose]

Why is she taking Ashwagandha? That could be lowering her cortisol. She doesn't appear to have high cortisol.

Is she not taking a B complex with her B12, rather than just B1? Her folate is low so getting a B complex with at least 400 mcg methylfolate would probably do her more good.

She may have reduced her antibodies, but remember she will still have Hashi's.

[KIRM in reply to greygoose]

Her Naturopath suggested a trial of Ashwagandha to help with her stress levels, but if it interferes with her cortisol will stop supplementing. Will start on a B Complex and ditch the B1. Sadly I know she will always have Hashis.

Thank you for your support x

[greygoose in reply to KIRM]

Well, it would help with her stress levels, if her stress levels were caused by high cortisol, which is what they don't seem to understand. Does she feel it's done her any good?

[KIRM in reply to greygoose]

No! She feels no difference with anything that she is taking!!! Although I notice a difference with her being gluten free. Hair is better quality and acne is much improved but still there. Also her goitre is not as noticeable. It’s just her lethargy and lack of enthusiasm for anything other than sleep!

[greygoose in reply to KIRM]

That could be due to her low ferritin. And her low FT3, of course. It's not even mid-range. Most hypos need it up the top of the range to feel well.

[KIRM in reply to greygoose]

Thank you x

[greygoose in reply to KIRM]

You're welcome.