November 2018 test results

[sy28]

I have Hashimoto's. In August my GP and Endocrinologist opposed me running TSH suppressed, at 0.04. My Levothyroxine dose was reduced from 150mcgms to 125mcgms. By October I was reporting renewed exhaustion, weight gain, insomnia, daily fatigue and hair loss. I self-medicated, raising my dose to 150mcgms.

My November Medichecks test results reported as follows:

The draw was 9.00am on empty stomach with 24hr break from medication. I stopped supplements 3 weeks, prior.

Your views would be really helpful.

TSH 0.223 <0.27-4.20>

Free Thyroxine 25.700 <12.00-22.00>

Free T3 5.55 <3.10-22.00>

Reverse T3 29 <10.00-24.00>

rT3 Ratio 12.46 <15.01-75.00>

Thyroglobulin antibodies 1185.000 <0.00-115.00>

Thyroid Peroxidase antibodies <9.0

<0.00-34.00>

Active Vitamin B12 143.000 <37.50-188.00>

Folate Serum 5.81 <3.89-26.80>

25 OH Vitamin D 59 <50.00-200.00>

Inflammation Marker 1.36 <0.00-5.00>

Iron Status

Ferratin 108 <13.00-150.00>

November Regenerus Laboratories Ltd

Result:

Deiodinase, iodothyronine, type II

DIO2 (T92A) rs225014

Heterozygous variant genotype TA

Consequences of the detected genotype:

- decreased ability of the enzyme to generate the active T3 hormone

Previous, August, Medichecks test result confirmed I might not be converting T4 to T3.

These test results are gathered in advance of a December NHS Consultant appointment.

I welcome comments. Thank you for reading.

[SeasideSusie Remembering]

sy28

In a previous post, you were talking about taking T3. Are you on Levo only?

Your FT4 and FT3 results appear to show poor conversion. You are taking a little too much Levo which has taken your FT4 over range. Your rT3 is over range and it could be the excess T4 making rT3 instead of FT3 (no guarantee of that because the test can show high rT3 but can't tell you why it's high).

Your Regenerus test confirms your decreased ability to convert T4 to T3, which would appear to confirm what your thyroid test results show.

If your consultant is willing to accept the DIO2 test results, then he should prescribe T3. I believe this is how SlowDragon managed to get T3 prescribed on the NHS.

Active Vitamin B12 143.000 <37.50-188.00>

This is good.

Folate Serum 5.81 <3.89-26.80>

This is low and folate should be at least half way through range (15.5+ with that range). Folate rich foods, and a good B Complex will help (Thorne Basic B or Igennus Super B are good B Complex supplements).

25 OH Vitamin D 59 <50.00-200.00>

This is low. The Vit D Council recommends a level of 125nmol/L and the Vit D Society recommends a level of 100-150nmol/L. To reach that level from your current level the Vit D Council recommends taking 3,700iu D3 daily (you'd need to take 4,000iu). As you have Hashimoto's then for best absorption an oral spray is recommended, eg BetterYou.

Retest in 3 months and when you have reached the recommended level then 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/

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 (some of which can be obtained from food).

BetterYou do a combined D3/K2 spray which you could consider.

Inflammation Marker 1.36 <0.00-5.00>

This is fine.

Iron Status

Ferratin 108 <13.00-150.00>

This is fine.

As you have Hashi's, are you gluten free and supplementing with selenium?

[sy28 in reply to SeasideSusie]

yes, gluten and dairy free. I stopped supplementing before the Medichecks Thyroid test (I was therefore pleased with B12 result, increased from August. Similarly pleased with Vitamin D, increased from August's 49 to 58 - my GP said this was fine! Though I realise this needs raising further - totally agree with your comments about raising Vit D). My supplements include Selenium and I notice an overall improvement in symptoms when I'm on the regime.

I'm taking these results with me to a referred, second opinion, Consultant Physician appointment in December. The DIO2 finding becomes vital. Many thanks for replying so quickly - it's especially helpful during a period of intense evidence gathering.

[SeasideSusie Remembering in reply to sy28]

Good luck with getting T3 prescribed on the NHS, I hope you're successful

[sy28 in reply to SeasideSusie]

I appreciate that - in recent experience, NHS appointments seem to be conducted by an inadequate pool of ill informed doctors. It is discourteous and detrimental to patient quality of life.

[sy28 in reply to SeasideSusie]

Thank you, I'll let you know. Without this forum, I doubt I'd have got this far so quickly.

[SlowDragon Administrator in reply to sy28]

Suggest you emphasise that you are gluten and lactose intolerant therefore gut is significantly affected

See the new guidelines on getting T3 here

New NHS England Liothyronine guidelines November 2018

sps.nhs.uk/wp-content/uploa...

Professor Toft recent article saying, T3 may be necessary for many

rcpe.ac.uk/sites/default/fi...

DIO2 gene test article

thyroiduk.org.uk/tuk/testin...

The endocrinologists are still unsure why DIO2 gene variation affects some, but not others

I got my T3 trial initiated before I tested DIO2. I think the test result may have helped persuade that I keep my prescription after 3 months. But the vast physical improvements also were clear to see. Could barely walk before, and could walk 2 miles or more after T3 added

Might find something useful in here

Dossier presented to Lord O'Shaughnessy November 26th

drive.google.com/file/d/1c2...

[sy28 in reply to SlowDragon]

Thank you Slowdragon, excellent reminder about gluten and lactose impact on gut health. I don't know if there's a connection, but since eliminating gluten and dairy, inflammation marker has reduced. Reaction to my November test results from members on this forum have been helpful and much appreciated - I was just slightly concerned by increasing my Levo from 125mcgms to 150mcgms the results showed I could be flipping from hypo to hyper. Overall, I did this to feel better, and to provide Endocrinologist with evidence of conversion issue. I emailed my CCG today regarding their compliance with November 2018 Guidance - Prescribing of Liothyronine|Regional Medicines Optimisations Committee (RMOC), which reiterates NHS England current guidelines regarding 'Exceptions and Further Recommendations'.

[sy28 in reply to sy28]

Also meant to add, I've taken copies of all you recommended. Thank you

[SlowDragon Administrator in reply to sy28]

Professor Toft suggests that first step is to increase Levo dose, even above top of range of FT4, to see if that improves FT3

He emphasised this again at the excellent talk last week in London

If this doesn’t help, then adding T3 is next step

[sy28 in reply to SlowDragon]

I attended Dr Toft's talk and flagged that in my notebook - which I was pouring over yesterday, as well as replaying the talk and taking further notes. I think I'm at the next step ...

[SlowDragon Administrator in reply to sy28]

I was there too. Thought it extremely interesting.

Yes I agree you are at next step.

Like you I tried increasing Levo, but it wasn't effective

[sy28 in reply to SlowDragon]

I wish I'd known you were there ... I used to be a music journalist, listening to Dr Toft was the equivalent of interviewing Freddie Mercury and being front of stage at Bob Marley concert, Finsbury Park ... but then I do need T3!

[SlowDragon Administrator in reply to sy28]

Which CCG area are you in?

Some are more helpful than others

[sy28 in reply to SlowDragon]

Dorset

[SlowDragon Administrator in reply to sy28]

Have you seen this ?

dorsetccg.nhs.uk/Downloads/...

dorsetccg.nhs.uk/Downloads/...

[sy28 in reply to SlowDragon]

Yes, I've seen these, that's why I wrote to them today.

[sy28 in reply to sy28]

Thanks!

[SlowDragon Administrator in reply to sy28]

One of the more difficult CCG's. Perhaps not quite as bad as Somerset or Brighton

[sy28 in reply to SlowDragon]

thanks

[sy28]

Hello Seaside Susie, no, I'm not taking T3. I'm on Levo only