Hi i am new here. I have a family history of thyroid and autoimmune issues and I have low iron, folate and B12. So even though I had an ultrasound on my thyroid in November 2018 which showed a goitre and I had symptoms which I thought were thyroid related such as fatigue and feeling cold I was told my thyroid levels were ok and I was sent away with antidepressants. Any idea if I should be pressing for treatment please? Thankyou
Serum TSH level 5.2 (0.2 - 4.2 mIU/L)
Free T4 level 15.6 (12 - 22 pmol/L)
Free T3 level 4.1 (3.1 - 6.8 pmol/L)
Serum ferritin level 26 (30 - 400 ug/L)
Serum folate level 4.2 (4.6 - 18.7 ug/L)
Serum B12 level 227 (190 - 900 pg/L)
Total vitamin D 25.5
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Bailee93
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Well, you don't have to take the antidepressants. Why were they prescribed, and did you agree with the reason your GP prescribed them? Doctors often try and fob us off with antidepressants rather than look for the real problem.
Please post your thyroid results, including reference ranges, along with your vitamin and mineral results, and members will comment and try to help. If you don't have your results, pop along to your surgery and ask at the reception desk for a print out, don't accept verbal or hand written results, make sure it's a print out. We are legally entitled to our results here in the UK with no charge.
Thanks seasidesusie. I reported to the doctor my symptoms and she gave me a script for fluoxetine and said they will help me feel better and so I believed her.
Just throwing this in - GPs get funding points/incentives for diagnosing depression and prescribing antidepressants, nothing for diagnosing/prescribing for hypothyroidism!
Sorry, I've heard and read too much to be anything other than an old cynic where the treatment of hypothyroidism is concerned.
Anyway .....
As there is a family history of thyroid and autoimmune issues, it would have been sensible if your GP had tested thyroid antibodies, especially as you have a goitre, I would hazard a guess that your antibodies would be raised and confirm autoimmune thyroid disease aka Hashimoto's which is where the thyroid is gradually destroyed. I would ask for these:
Thyroid Peroxidase (TPO) and Thyroglobulin (TG) - both of these can be tested for Hashi's. If TPO come back negative, it doesn't mean you don't have Hashi's because TG could be positive.
Serum TSH level 5.2 (0.2 - 4.2 mIU/L)
Free T4 level 15.6 (12 - 22 pmol/L)
What you have here is actually subclinical hypothyroidism
◦Signs of hypothyroidism such as weight gain, coarse facies, hair loss, lethargy, bradycardia, diastolic hypertension, and delayed relaxation of deep tendon reflexes.
◦Goitre (thyroid enlargement that is palpable and may be visible) and/or thyroid nodules.
Blood tests for thyroid stimulating hormone (TSH) and free thyroxine (FT4):
◾Suspect subclinical hypothyroidism (SCH) if TSH is above the reference range and FT4 is within the reference range. In non-pregnant people repeat TSH and T4 (ideally at the same time of day) 3–6 months after the initial result to exclude transient causes of a raised TSH (such as intercurrent illness) and to confirm the diagnosis of SCH.
Refer or discuss with endocrinology (the urgency depending on clinical judgement) people with subclinical hypothyroidism (SCH) who:
◦Have a goitre, nodule, or structural change in the thyroid gland — if malignancy is suspected, refer using a suspected cancer pathway (for an appointment within 2 weeks). For more information, see the CKS topic on Neck lump.
If TSH is between 4 and 10 mU/L and FT4 is within the normal range
◾In people aged less than 65 years with symptoms suggestive of hypothyroidism, consider a trial of LT4 and assess response to treatment 3–4 months after TSH stabilises within the reference range — see the section on Prescribing information for further information on initiation and titration of LT4. If there is no improvement in symptoms, stop LT4.
So let's be kind and say your GP was unaware of all this, despite it being in the NICE Clinical Knowledge Summary which she could very easily look up. So I would make a note of these websites and pass the information on to your GP.
**
Your nutrient levels are very poor and again this suggests Hashi's may be present, there are very often gut/absorption problems where there is Hashi's which can lead to low nutrient levels or deficiencies.
Assuming nothing has been done about or prescribed for these levels, then
Serum ferritin level 26 (30 - 400 ug/L)
This is below range and needs pointing out to GP, with a request for an iron panel and full blood count to see if there is any iron deficiency anaemia and if there is ask the GP to follow the NICE Clinical Knowledge Summary for it's treatment.
Serum B12 level 227 (190 - 900 pg/L)
This is very low. Please check for signs of B12 deficiency here
If you have any then list them for your GP and ask for testing for B12 deficiency/Pernicious Anaemia. Do not take any supplements for B12, folic acid (including a B Complex) before further testing. Doctors should go by symptoms not numbers.
I have read (but not researched so don't have links) that BCSH, UKNEQAS and NICE guidelines recommend:
"In the presence of discordance between test results and strong clinical features of deficiency, treatment should not be delayed to avoid neurological impairment."
And 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."
Serum folate level 4.2 (4.6 - 18.7 ug/L)
This is below range so you are folate deficient. Again this needs pointing out to your GP and folic acid should be prescribed (but don't take it until after further testing of B12 is done as folic acid masks signs of B12 deficiency).
Total vitamin D 25.5
The unit of measurement is very likely nmol/L, in which case you are Vit D deficient and again point this out to your GP and mention the NICE Clinical Knowledge Summary
"Treat for Vitamin D deficiency if serum 25-hydroxyvitamin D (25[OH]D) levels are less than 30 nmol/L.
For the treatment of vitamin D deficiency, the recommended treatment is based on fixed loading doses of vitamin D (up to a total of about 300,000 international units [IU] given either as weekly or daily split doses, followed by lifelong maintenace treatment of about 800 IU a day. Higher doses of up to 2000IU a day, occasionally up to 4000 IU a day, may be used for certain groups of people, for example those with malabsorption disorders. Several treatment regims are available, including 50,000 IU once a week for 6 weeks (300,000 IU in total), 20,000 IU twice a week for 7 weeks (280,000 IU in total), or 4000 IU daily for 10 weeks (280,000 IU in total)."
Each Health Authority has their own guidelines but they will be very similar. Go and see your GP and ask that he treats you according to the local guidelines or this summary and prescribes the loading doses. Once these have been completed you will need a reduced amount (more than 800iu so post your new result at the time for members to suggest a dose) to bring your level up to what's recommended by the Vit D Council - which is 100-150nmol/L - and 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/
Your doctor wont know, because they are not taught nutrition, but there are important cofactors needed when taking D3 as recommended by the Vit D Council -
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 if taking tablets/capsules/softgels, no necessity if using an oral spray
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 if taking tablets/capsules, no necessity if using topical forms of magnesium.
Check out the other cofactors too (some of which can be obtained from food).
Please come back and say exactly what your GP is going to do, what is prescribed, etc.
I think your GP has been extremely negligent if nothing has been done about your nutrient levels, and if that is the case I would see a different GP, get things sorted, then make an official complaint about this one.
Oh, and I wouldn't take the antidepressants either. Depression is one of the signs/symptoms of hypothyroidism
Confirms Hashi's and probably the reason for your dire nutrient levels, as mentioned.
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 possibly 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.
Cue loads of diabetics on long term meds even though could be cured with lifestyle changes (doctors don't have the time to advise all of this and very reluctant to take you off meds once you're on them)
Easier to pop antidepressants - most people who don't understand thyroid issues would think the GP was taking their depression /anxiety seriously and be thankful!
And lots of b12 deficinies (and thyroid) being wrognly diagnosed as dementia /MS/Alzheimer's.
The pernicious anaemia society is full of them (!) Unsurprisingly
I've had 3 close calls with family members whose b12 defiicnecy was stopped because they had blood tests that were too high after supplementing (!) And went on to get lost on the way home from memory issues and another diagnosed with dementia. All.b12! And fine once restarted supplements
Im sure i read Fluoxetine can have a negative effect on thyroid levels so if you do decide to take anti depressants maybe ask for something different, but with your levels id be asking for trail of levo to see if helps improve your symptoms and addressing your vitamins and minerals. All the best .
That is the first thing that comes up if you google Fluoxetine and hypothyroid >>>
Prozac and thyroid disease
Fluoxetine has been reported to reduce T3 and T4 levels in otherwise euthyroid depressed patients. Similarly, sertraline and fluoxetine have been reported to reduce hypothalamic thyrotropin-releasing hormone secretion, which would reduce secretion of TSH from the pituitary gland and thyroid hormones from the thyroid.
From Drugs.com: "There were no interactions found in our database between bupropion and Synthroid - however, this does not necessarily mean no interactions exist. Always consult with your doctor or pharmacist."
This page (part of a 4-page article) describes the known side effects of various anti-depressants. I was first prescribed a tri-cyclic A-D and it made everything much, much worse. When I went back a week later and complained, the doctor told me that I had to stay on it for a full 6-weeks to tell if it would work for me. I went home and cried, then I got mad. Got on the phone and demanded an immediate appointment with a different doctor. She switched me to Prozac (fluoxetine) which was much better, but after a year or so, my depressive symptoms reappeared. Then she switched me to bupropioin, which I have been on ever since. I recently started on T3, and am hopeful that as my hypothyroid symptoms subside, I will be able to taper down and off the bupropion. webmd.com/depression/featur...
Your family history of thyroid and autoimmune issues points to a genetic condition known as Impaired Sensitivity to Thyroid Hormone, sometimes called Thyroid Hormone Resistance. It causes hypothyroid symptoms and requires very high Free T3 levels (often above the top of the normal range) in the body to overcome the resistance.
It causes low stomach acid, causing poor absorption of minerals and B12. It can also cause a goitre, which will shrink with adequate thyroid hormone medication.
With the condition some people have unusual thyroid hormone levels but others can be low, normal or high.
TSH is not a thyroid hormone. It is produced by the pituitary gland and travels in the blood to the thyroid gland where it signals to the thyroid gland to produce more thyroid hormones. Your TSH is over range and if above range could indicate hypothyroidism. This is however a secondary indicator - the Free T3 is the direct indicator.
Thyroxine (T4) is a thyroid hormone but is not an active hormone, it needs to be converted to T3 to become active. Your Free T4 is in the bottom part of the normal range but this needs to be interpreted in conjunction with the Free T3 value.
T3 is the active thyroid hormone which controls the metabolism and therefore the symptoms. You need to get a Free T3 result to get a better indication of your thyroid status.
Your Free T3 level 4.1 (3.1 - 6.8 pmol/L) would indicate that you are not hypothyroid and Free T3 is a much better indicator than TSH.
Many people on this forum however find that they do not feel well until the get their Free T3 above the mid point of the range and some need their Free T3 even higher. I suspect that many of them have thyroid hormone resistance!
As mentioned above doctors rely on thyroid hormone levels to determine if you need thyroid hormone treatment so based on your blood test results it is unlikely that doctors will prescribe thyroid hormones. If they do give you a trial it is likely to be a small amount of 25 or 50 mcg of thyroxine and you are not likely to see any improvement. They will want to do a further blood test before giving any increase and again the blood tests will be used as the reason for refusing the increase. Most doctors will blame your remaining symptoms on other causes such as depression, ME etc.
Sorry for being so negative but this is the reality people face.
You do and free T3 of only 4.1 is too low for most people to feel well. If it was the correct level for you, your TSH would be around 1.2 which is the mode for healthy people.
Thankyou I have been told I have and need a trial of thyroid hormone
..........
Any idea if I should be pressing for treatment please?
Why are you asking if you should be pressing for treatment? If you've been told you have "autoimmune hypothyroid" and need a trial of thyroid hormone surely you have your diagnosis and you have been prescribed Levothyroxine? If not then you need to ask the doctor who told you that you need thyroid hormone why he hasn't given you a prescription.
"Any idea if I should be pressing for treatment please? Thankyou"
Simple answer - yes.
And please follow through everything SeasideSusie has written. It's a lot to take in as a new member but she is one of our most exoerienced users and her advice is brilliant especially regarding vitamins.
All your vitamins are seriously low-and they hemselves will be causing any depression fatigue and other issues you have. Fluoxitine is not the answer ! ( At least not yet!) So angry your GP didn't even address your vitamins but gave you fluoxitine ??
Those vitamins Re also crucial for.gpod thyroid conversion so.you may see your thyroid return to. More normal levels once they are optomised.
You will certainly feel a hundred times better.
As you have autoimmune thyroidism.in.family do the antibodies testing. It will also predict how likely you are to become.hypothyroid in future.
But definitely step one is vitamin deficiencies. My levels were almost exactly the same as yours and I felt like death. Apart from vit D (which was less than 20!) they didn't even mention the other deficinies and it took me scouring over my previous copies and narrowing it down to finally correct it. I now feel brilliant even though my T3 is still quite poor in comparison
First of all, before prescribing anti-d's (maybe because you keep complaining with symptoms and she along with most other doctors, don't know any symptoms at all) and she has not tested your Free T4 and Free T3. If both are low you wont feel well. Both have to be towards the upper part of the ranges. T3 can be prescribed for people who are depressed who are not hypothyroid, so why - if we have hypothyroidism and both Ts low, why not prescribe T3, the only Active Thyroid Hormone and it is needed in all our millions of T3 receptor cells.
See GP and politely insist that vitamin deficiencies are treated
Getting vitamins optimal is absolutely essential
Also request coeliac blood test as possible cause of vitamin deficiencies
Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels. Low vitamin levels affect Thyroid hormone working
Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten.
According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps, sometimes significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)
Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies
This sounds horribly familiar. I had a lump in my throat and was told it was a goiter. I was sent for blood tests. I called the Doctor to ask for blood test results. She said they were OK. I told her I didn't feel well. She sent me to the hospital. After 12 hours of tests, I was diagnosed with Acute Papillary Carcinoma of the Thyroid. I had an 8-centimeter Tumour in my neck and another around my left ear. They are so sloppy. You need to go and ask for proper tests, scans etc. That was 7 years ago. After 2 surgeries and 4 years of feeling terrible, I have taken my treatment to my own hands. No pharmaceuticals, just natural products, good diet, and exercise. I feel great and you can too.
I started reading about an alternative. Then I found a Doctor who prescribed NDT. Then I read about Vitamins and minerals. One thing I knew was that I had to change the way I thought about the world and myself. Through testing, I found the right dose of NDT. I take Magnesium, B12 and Vitamin C. I changed my diet. Lots of fruit and vegetables and very little red meat. Minimal alcohol and exercise every day.
I also meditate every morning. The focus of the meditation is gratitude and wellness.
I get blood tests every 6 months. They are always within the desirable range. I see an endocrinologist. He is amazed at how well I am. He is not that happy with my alternative approach. However, he is a good guy and see's the benefits
I think keeping it simple and focussing on wellness is the key to maintaining any health condition. The Thyroid is a very complication organism. The signals you give your brain are important. Being fearful and anxious about your health will leave you fearful and anxious.
You need to take your health into your own hands. Do not trust Doctors. Sadly the medical system only cares about drugs and money. Having a healthy disrespect will keep you well and alive. Trusting them won't.
This might sound overly simplistic. However, even with discussions with alternative practitioners, they complicate it too.
Finally, the first thing I do every morning is breathing. It alkalizes the body and creates a feeling of wellbeing for the day. Life is good.
Can I help you? Maybe if I post a video in the next few days. Start with just doing breathing exercises. That will change the mindset, state, and alkalinity.
Hi, I'm no expert here but unless you feel you have depression be very careful with antidepressants as they can cause other issues years after taking them. Read up on this beforehand.
Mine was 150 and I can’t finctuon without monthly injections
I would try to get your doctor to prescribe b12 and then get the strong Vit D pump from Holland and Barrett and see how you feel in a month.
Hi Baylee93
Write to the practice manager and threaten legal action if you are not given the treatment you need!
That was my first reaction, and is only partly a joke. But of course you have to try other avenues first.
The way they have treated you is disgusting. Either that or your doctor
Hi Baillee and welcome
sezzy said "Fluoxetine has been reported to reduce T3 and T4 levels in otherwise euthyroid depressed patients. Similarly, sertraline and fluoxetine have been reported to reduce hypothalamic thyrotropin-releasing hormone secretion, which would reduce secretion of TSH from the pituitary gland and thyroid hormones from the thyroid."
So not only is your doctor refusing to treat your obvious hypothyroidism, he is giving you something to make your condition worse!!!
I am only partly joking to say that my first reaction is you should write to the practice manager and threaten to take them to court for abuse (neglect is technically a form of abuse, and they also prescribed you a harmful substance instead of the hormone that you need).
I was "Subclinical" too, but that only means that the reference ranges are set too high for anyone with thyroid problems. For someone with Hashimoto's the upper limit should probably be a TSH of 1 or under.
Thanks to advice from this forum I asked for a clinical trial of Levothyroxine, and to my relief was given it. Things got a bit hairy when my TSH went down to just under 3 and I still had troublesome symptoms. Miraculously, the nurse who saw me to discuss blood results was very sympathetic and somewhat enlightened about the thyroid, and after a chat with the practice pharmacist, prescribed an increase. I gave the nurse a summary of the most troubling symptoms and how they were affecting my life and she scanned it into my notes.
The pharmacist even said that I might need another increase at the next blood test in January - here's hoping...
TSH is too high. FT3 is too low, should be ~75% up in range. Your doctor did not run the other 3 tests of a full thyroid panel: rT3, TPO antibodies, TG antibodies. (Hashi's is the most common cause of low thyroid; it can be diagnosed via antibody tests.) Ferritin, folate, and B12 should all be up close to the top of their ranges. Also, you could have insufficiency of other important nutrients such as iodine and selenium. Vitamin D should be higher, say around 40. Take it from someone who was pushed down the psych drug path by a Moron MD: you will NEVER feel truly well on BigPharma drugs such as antidepressants. These drugs cannot make you feel 'natural' wellness, that sort of effortless feeling you probably had when you were a child, because these drugs are foreign to human biochemistry.
Your B12 is VEylow. You need injections to bring up your levels and you may have Pernicious Anemia. B12 shots help so much with anxiety and depression!
There are soooo many causes for fatigue and depression. The more I read the more I see it with low Thyroid hormones being inly one of them. Low folate, low D, certain gut microbes, low B12, and more...
Also, folic acid is synthetic! Methyfolate is the real B9. Have you checked to see if you have any MTHFR genetic mutations? A possible reason for low folate levels. If you do, you absolutely want to avoid folic acid and should learn more about how the B vitamins work together. Google Dr Ben Lynch if you want to know more about MTHFR and folate and B12.
Following on from JoyCA advice : Dr Ben Lynch supplements brand is 'Seeking Health' I have obtained in the UK at website amrita.co.uk . Supplement Folate not folic acid. Folic acid is made in a lab and not natural (see Chris Kressers article folate v folic acid (folic acid can be dangerous for some/possibly everyone)
Folate aka veg and fruit (foliage) eat plenty infact eat lots and lots
Also following on from Trigger88's brilliant advice
I am using a redlight/near infrared light and shining on my neck/ thyroid area for 5 mins once or twice per day. So much research going on re specific wavelengths of red light and health.
See the websight redlightman.co.uk click on the tab across the top - Light info and read the benefits /health info re hypothyroidism in the list.
Basically our cells and how well they function dictate our health
We are our cells and the accumulated cells of other beneficial organisms (our microbiomes most noteably our gut/intestinal microbiome)
So stands to reason that our cells need to function optimally
To improve the function of our cells we need to provide the nutrients they need, through our diet, water and air. Poor diet you build poor cells OR poor absorption of nutrients/poor cells
However
Our cells respond to light (obviously evidenced by vit D production)
There are 100's / 1000's of mitochondria in most cells dependant on the function of the organ so 1000's of mitochondria in heart cells for instance re the energy heart cells need to provide. Mitochondria in the cell provide the energy (called ATP)
Mitochondria require feeding, so nutrients
It is now discovered that mitochondria also feed on light, so to speak
Specific red light wavelengths feed/enhance/influence mitochondrial health
helping them produce more energy and reproduce. Get below a certain level of mitochondria and energy produced and you are dead. So mitochondria are pretty vital
The basics are when you are ill, feel bad then your cells sometimes specific cells are obviously not functioning normally.
Red Light helps the cell to function normally (hopefully despite the crapness of our modern environment)
Which is why I am shining red /near infrared light on my thyroid with the hope that my thyroid gland will stand a chance of functioning more normally or even optimally
I haven't had any blood tests for over a year . GP appointments and all that entails depress me! So I cannot say whether my TSH etc levels have improved (has been climbing steadily over the last few yrs/lots of symptoms and ignored by GP)
I will soon face and request blood tests (I am autoimmune too)
Yes so I do not know whether using light therapy has had an effect but I have a positive mindset about as can see the science behind.
Ensuring a nutritious diet and exclude processed food, suplementing where necessary (esp quality natural B vits/B12, vit D3 once blood tested) and Redlight therapy cannot be used on its own.
We have to change what got us in this mess in the first place and stop crating a toxic environment in our body
So clean up the food and water we eat and exclude all chemical toxins (insectisides, herbicides, glyphosate) by eating only organic food and filter water. Chlorine is death to the thyroid and we absorb far more chlorine in a shower than when drinking, so get a shower filter too
Fluoride is also anti thyroid, brain health so get fluoride out of your toothpaste/mouth wash/life
So time to clean up all toiletries including deodorants and makeup.
Plastics are a biggie - cut them out - buy water/drinks in glass bottles not plastic. Save a glass bottle and then refill with your filtered water. Tin cans are lined with plastic all these xenoestrogens affect our thyroid and hormonal system. Google lists to see if your shampoo etc contain nano plastics - most do (order natural toiletries - little Cornish company - Purenuffstuff.co.uk)
Also be aware of chemicals in cleaning products and fire retardants on new furniture/carpets. And Dry cleaning chemicals all seriously affect the thyroid and not only the thyroid, your health across the board
We can only do what we can, one step at a time but put in place all suggestions and the see how you feel.
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