Newbie feeling better -- questions on TSH levels and TG ab

[Ninajado1988]

Thanks for all the great advice I received when I posted my newbie questions five months ago -- I have followed the advice and feel better than I have in 4 years.

I am hoping that I can get some insight from this group on if my TSH is now too low. I have an appointment with my GP tomorrow and am concerned that she may lower my meds due to my TSH being at .297 on my last labs. I feel really great and am hoping that we can maintain everything as is.

Also, I convinced my GP to test for Thyroid Antibodies -- and it appears that the TG ab is abnormal -- what does this mean?

Here are my meds and test results:

*My GP changed my meds from generic Levothyroxine to Synthroid and upped my dosage from 50 mcg to 75 mcg in September (on generic Levo from March to Sept).

*I began taking Vit K, B Complex, magnesium, selenium (brazil nuts) and a probiotic in June 2018.

*Still taking the Vit D 50,000 ui weekly and B12 - 4,000 mcg sublingual Daily since March 2018.

Below are my labs since last Feb when I started on Levo:

Dec-18 ReferenceUnits

TSH 0.297 ----- Ref 0.45 - 4.5uIU/mL

T4, Free(Direct) 1.5 ----- Ref 0.82 - 1.77ng/mL

Thyroid Peroxidase (TPO) Ab 13.0 ----- Ref 0 - 34IU/mL

Thyroglobulin Antibody (TG) Ab 2.7 ----- Ref 0 - 0.9IU/mL

Vitamin D, 25-Hydroxy 49.5 ----- Ref 30 - 100ng/mL

Vitamin B12 1,525 ----- Ref 232 - 1245pg/dL

Folate (Folic Acid), Serum >20 ----- Ref >20ng/mL

Aug-18 ReferenceUnits

TSH 3.2----- Ref 0.45 - 4.5uIU/mL

T4, Free(Direct) 1.4----- Ref 0.82 - 1.77ng/mL

Vitamin D, 25-Hydroxy 56.7----- Ref 30 - 100ng/mL

Vitamin B12 1,449----- Ref 232 - 1245pg/dL

Folate (Folic Acid), Serum >20----- Ref >20ng/mL

May-18 ReferenceUnits

TSH 1.4----- Ref 0.45 - 4.5uIU/mL

T4, Free(Direct) 1.3----- Ref 0.82 - 1.77ng/mL

Vitamin D, 25-Hydroxy 33.9----- Ref 30 - 100ng/mL

Vitamin B12 580----- Ref 232 - 1245pg/dL

Feb-18 ReferenceUnits

TSH 4.620 ----- Ref 0.45 - 4.5uIU/mL

Triodothyronine T3 159.0 ----- Ref 71 - 180ng/mL

Vitamin D, 25-Hydroxy 7.8 ----- Ref 30 - 100ng/mL

Vitamin B12 298 ----- Ref 232 - 1245pg/dL

Folate (Folic Acid), Serum >20 ----- Ref >20ng/mL

Thanks so much for your help!!

[MissGrace]

I posted this a couple of times the other day in reply to someone else, but thought some of it might be relevant to your situation - especially as your TSH is low and you appear to have hashimotos from the antibodies I think? I see an endo privately which I know isn’t an option for everyone. Here was my response to an the similar posts.

I went to see my endo this week - my TSH is now plunging into the nether regions, my T4 and T3 are about 50-55% of the way through the range and I still feel like cr*p, though not as cr*p as the cr*ppest I’ve felt. He is happy for me to continue to increase. What he said was interesting - he said most Doctors understand underactive thyroid as that is relatively straightforward, but they don’t understand hashimotos, so they just treat it in the same way but it isn’t the same. He said that the TSH does strange things with hashimotos as the pituitary doesn’t know WTF is happening as the thyroxine from the thyroid waxes and wanes. So basically it loses the plot and tends to go low. He also acknowledged what I have always thought that despite doctors saying synthetic thyroxine is just the same as our own, it isn’t and many struggle to convert it. This means the TSH responds to the level of T4 and goes low, but we actually struggle to manufacture T3, so need more of the synthetic stuff than we would of our own - even more than the normal range for some people to make adequate active energy and therefore to feel well. The combination of hashimotos and synthetic T4 creates a perfect storm. Therefore other than T3, patients should not be assumed to be well just because they fall within the ranges and a low TSH is fine if there are no signs of being over medicated e.g. high FT3, heart racing, tremor etc.

[Ninajado1988 in reply to MissGrace]

Miss Grace,

Thanks so much for your timely reply.

The information in your response makes perfect sense and I am grateful. My T3 has not been tested since I started meds and I can now see that it's really important. This is exactly the information I need for my appointment - I don't have any of the signs you mentioned of being over-medicated.

Thanks again!

[SlowDragon Administrator]

High TG antibodies is most likely due to Hashimoto's

healthline.com/health/antit...

Are you on strictly gluten free diet?

If not ask for coeliac blood test before trying strictly gluten free diet for 2-3 months minimum

amymyersmd.com/2017/02/3-im...

chriskresser.com/the-gluten...

thyroidpharmacist.com/artic...

scdlifestyle.com/2014/08/th...

drknews.com/changing-your-d...

thyroidpharmacist.com/artic...

Have you had ferritin tested?

If not ask GP to do so

Also absolutely essential to test FT3 alongside FT4 and TSH

Often FT3 is low in Hashimoto's

[Ninajado1988 in reply to SlowDragon]

Slow Dragon,

I will ask for the coeliac blood test ( not following a gluten-free diet), FT3 and ferritin to be tested when I see my GP tomorrow. She is very easy to work with and will test whatever I request -- and right now, my health insurance is co-operating and paying for the tests.

Thanks so much for your reply and I appreciate the links to more information I can delve into.

[SlowDragon Administrator in reply to Ninajado1988]

Assuming you are in USA

Often total T3 seems to be tested in USA

Here in UK we prefer Free T3 test (if you can get it)

[Miserable1970]

My endocrinologist never really cared too much about my tsh, he says that reading my t4 and t3 and my symptoms are more important, as the pituitary may not function properly to produce tsh, but if your t4 getting too high they will reduce your meds. Your tsh is probably low because your t4 is almost at the upper level and your pituitary doesn't need to produce tsh as your taking meds. Your b12 is very high, I would omit it for a couple of weeks and maybe take 1 a week for a while, too much b12 can be toxic

[MaisieGray in reply to Miserable1970]

Are you sure it can be toxic? The NHS says only that there's not enough evidence to show what the effects may be of taking high doses of vitamin B12 supplements each day. The US Linus Pauling Institute's Micronutrient Information Center, which is a source for scientifically accurate information on the functions and health effects of all micro & other nutrients says "No toxic or adverse effects have been associated with large intakes of vitamin B12 from food or supplements in healthy people. Doses as high as 2 mg (2,000 μg) daily by mouth or 1 mg monthly by intramuscular (IM) injection have been used to treat pernicious anemia without significant side effects. When high doses of vitamin B12 are given orally, only a small percentage can be absorbed, which may explain the low toxicity. Because of the low toxicity of vitamin B12, no tolerable upper intake level (UL) has been set by the US Food and Nutrition Board".