Blue Horizon results

[Peregrine]

Can I please have advice on my results? I’ve been on 50mg Levothyroxine for approx 18 months after being diagnosed hypothyroid and with antibodies. Last NHS blood test December 2017. I fall asleep most nights on the sofa, just zonk out, and have hip twinges most days.

[SeasideSusie Remembering]

mead18

After your diagnosis and starting Levo, your GP should have checked your levels every 6 weeks and increased your dose until your symptoms were alleviated. 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.

So with your TSH over range at 4.30 that would indicate that a dose increase is necessary.

However, your FT4 is 71% through range which is pretty good. Increasing Levo will take it higher, maybe even over range.

Did you do your test as we always advise on here, ie

* Do test at the earliest possible time of the morning, no later than 9am.

* Fast overnight (eat normal evening meal the day before test, then delay breakfast until after blood draw), with water only until after the test.

* Leave off Levo for 24 hours.

* If you take a B Complex containing Biotin or Biotin alone or in another supplement then leave this off for 3-5 days before the test.

If not, what time did you do your test, when was your last dose of Levo before the test?

**

Your raised TPO antibodies confirm autoimmune thyroid disease aka Hashimoto's which is where antibodies attack the thyroid and gradually destroy it. The antibody attacks cause fluctuations in symptoms and test results.

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. You need to read, learn, understand and help yourself where Hashi's is concerned.

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.

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

stopthethyroidmadness.com/h...

stopthethyroidmadness.com/h...

hypothyroidmom.com/hashimot...

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

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

**

Ferritin is almost top of range. Do you supplement?

**

Vit D at 79nmol/L is a little low. The Vit D Council, the Vit D Society and Grassroots Health all recommend a level of 100-150nmol/L. Do you supplement? If not you may wish to consider supplementing with D3 and the Vit D Counci suggests to bring your level up to the recommended level then the dose required is

To achieve 100nmol/L take 800 IU D3 daily

To achieve 125nmol/L take 2500 IU D3 daily

To achieve 150nmol/L take 4600 IU D3 daily

Retest after 3 months, then if you've reached the recommended level you'll need a maintenance dose which may be 2000iu daily, maybe more or less, maybe less in summer than winter, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. You can do this with a private fingerprick blood spot test with City Assays vitamindtest.org.uk/

As you have Hashi's then for best absorption an oral spray is recommended, eg Better You.

There are important cofactors needed when taking D3 as recommended by the Vit D Council -

vitamindcouncil.org/about-v...

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

naturalnews.com/046401_magn...

Check out the other cofactors too.

**

B12 at 294pmol/L is the same as 398pg/ml. An extract from the book, "Could it be B12?" by Sally M. Pacholok:

"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".

"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml." If you wish to supplement then consider a sublingual methylcobalamin lozenge, 1000mcg daily would be adequate. When supplementing with B12, we also need a good B Complex to balance all the B vitamins.

**

Folate: 12.80 (8.83-60.8) - this should be at least half way through range (35+ with that range). Folate rich foods can help, but a good B Complex containing 400mcg methylfolate will raise your folate level. Look at Thorne Basic B or Igennus Super B.

[Peregrine]

Thank you Susie for such a detailed reply.

I’m afraid I forgot about doing the test first thing with no levo that morning. I did it early afternoon, I’d had my 50mg levo at approx 7am and I’d had breakfast.

I don’t supplement ferritin. The only thing I take is a Vit D3 liquid as I had a slightly low vit D test a while ago.

[Jazzw in reply to Peregrine]

SeasideSusie wont have seen your replies as you need to hit the reply button on Susie’s response rather than the thread reply button. She should now see this.

It does look like your FT4 reading is higher than it would have been had you not taken your Levo that morning - that’s why we always advise fasting beforehand and not taking your Levo.

Do you have the laboratory reference range for that Vit D result?

[Peregrine in reply to Jazzw]

Thank you 😊

Vit d ref

Under 15 severe deficiency

15-30 deficiency

30.1- 50 insufficiency

over 50 adequate

[SeasideSusie Remembering in reply to Peregrine]

Mead18

As TSH is highest in the morning, then the fact that is is 4.3 in the afternoon when it is naturally lower, then under the advised testing conditions then your TSH would have been even higher.

Your FT4 result is likely to be slightly higher than the normal circulating amount due to taking Levo that morning.

You need an increase in Levo of 25mcg now, retest in 6 weeks, another increase of 25mcg, another retest 6 weeks later, etc., until your levels are where they need to be for you to feel well.

[Peregrine in reply to SeasideSusie]

Thank you Susie, at least now I have some evidence for my GP rather than telling him I feel lousy and being told there’s nothing to be found and do I want anti-depressants.

I will have a go at supplementing more too.

[Peregrine in reply to SeasideSusie]

Doc reluctantly gave me 12.5mcg increase with retest in 6-8 weeks. He said TSH of 4.3 only just over range and nothing to worry about. Think it’s time to find a new doctor, sigh.....

[SeasideSusie Remembering in reply to Peregrine]

So sorry you have the sort of doctor that thinks being just over range is OK. They wouldn't think that if it was their thyroid results. There is so little understanding of this condition, it makes you want to put a curse on all doctors who think it's OK to treat a number rather than the patient.

At least you got 12.5mcg which might make a bit of difference. See what happens after 6 weeks and for your test remember to make the earliest appointment of the day, leave off your Levo for 24 hours, and fast overnight from evening meal the night before - just drink water and delay breakfast until after the blood draw.

You can always pop your new results onto the forum for comment, but if you are still symptomatic then you can always refer to the article by Dr Toft (past president of the British Thyroid Association and leading endocrinologist) to support your request for a further increase. He says in Pulse magazine (the magazine for doctors):

"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 article by emailing Dionne at [e-mail] print it and highlight question 6 to show your doctor.

You can also point your GP in the direction of NHS Leeds Teaching Hospital

pathology.leedsth.nhs.uk/pa... where they show that a TSH of between 0.2 - 2.0 is the aim (scroll down for box with this information):

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

[Peregrine in reply to SeasideSusie]

Thank you so much Susie, your advice is invaluable.

[Peregrine]

Vit D was 48.8 nMol/l

[Peregrine]

I did have a 6 week follow up and doc did test for antibodies as well which were found. Last test he said TSH was 2 which was fine and levo was right, this surprised me as I was expecting an increase as I was already gathering info from this excellent site.