I have Hashi's and am strict gf, df, with all the usual supplements (selenium, Vit D and K2, B complex, methylated folate, Magnesium and Vit C) and take low dose naltrexone to keep the auto-immunity in check. I started 25mcg levothyroxine, Teva brand, 6 weeks ago and just got my NHS and Medichecks results. My doc has said no change in prescription required but I still have all the symptoms plus a flare up of the two antibodies, and my results are still low/bottom ranges. What do you think?
Both taken at 9am, fasted and no meds, stopped all supplements too.
I had a note on the NHS results 'T3 is rarely useful in monitoring patients on thyroxine, why was it requested?'
Total T3 0.9 (0.9-2.5)
Well, that's a total T3 test so it isn't useful. It's Free T3 that is needed. But even so, it's at the very bottom of the range and goes to show that your T4 isn't converting to T3. The trouble is, doctors don't seem to understand about conversion!
Your TSH is far too high. The aim of a treated hypo patient generally is for TSH to be 1 or below or wherever it needs to be for FT4 and FT3 to be in the upper part of their respective reference ranges when on Levo if that is where you feel well.
Thyroxine Replacement Therapy in Primary Hypothyroidism
TSH Level ...... This Indicates
0.2 - 2.0 miu/L ...... Sufficient Replacement
> 2.0 miu/L ...... Likely under Replacement
So this shows you need your TSH less than 2.
Also see Dr Toft's article in Pulse magazine (the magazine for doctors) which states:
"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)."
Dr Toft is past president of the British Thyroid Association and leading endocrinologist.
You can obtain a copy of the article by emailing Dionne at
tukadmin@thyroiduk.org
print it and highlight question 6 to show your doctor.
Use all this information to support your request for an increase in your dose of Levo.
And doh! of course it's free T3 not just total T3. My friend works in our local NHS hospital lab and says that they don't do a free T3 which is why I got the Medichecks results at the same time. Having improved memory and brain function is something I am looking forward to if I can get my meds right!
Antibodies fluctuate, that's the nature of Hashi's. Even though you are gf/df and take selenium, they can help reduce the antibodies but there will still be some activity.
Thank you, I'm glad to have someone else to back this up, as it's easy when you're not feeling so great to get confused and be able to filter out what is and what is not important.
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