New here. Wifey has been diagnosed with Hashimoto's TPO 6 x Normal maximum at 243. B12 524 ng/l (130-1100). Folate 16.3 (12.7-15) Serum free triiodothyronine 4.1 (3.8-6) TSH 0.04 (0.35-3.5) Free T4 15pmol/l (8-21) TPO 243.4 Ku/L (0-34) WCC 2.8 (4-10) RBC 3.96 (3.8-4.8)Haemoglobin Conc 119 (120-150) Haematocrit 0.354 (0.36-0.46) MCV 89 (83-101) Neutrophil 1.1 2-7) Weak positive ANCA atypical pattern. 43GY Autoimmune profile completely normal. ESR 5. CRP 2 WNL. Protein 64 (63-82) Albumin 37 (35-50). Alkaline Phosphatase absolute top of normal 126. Ferritin 179 (23-300). We've seen Consultant privately who has prescribed 3 week course of steroids 30mg,10,5, to reduce inflammation . He says it will burn out and may be responsible for low bloods. She's taking Ferrous Sulfate, Tegretol (which may affect neutrophils). Also Calcium and Vitamins D tabs OTC and Ubiquinol Q10. We've tried 225 which makes no difference, The ANCA may be due to the Hashi's.
Any ideas?
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helenshubby
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Your wife’s TSH is very low, FT3 under half way through range, FT4 just over half way through range, TPO massively elevated.
Low haematocrit may suggest a destruction of red blood cells seen in the prelude to low iron levels which is evidenced by haemoglobin result. Also, may need to raise Vit B12 levels.
Thyroid antibodies can be managed and encouraged to reduce without the use of steroids. May burn out but return numerous times until the thyroid gland is totally destroyed. What is 225 ? ?
TSH is usually high with low thyroid hormone. Has your wife started medicating thyroid hormone replacement ? If so, which one, how much, and for how long ?
Why is she taking calcium? That's really not a very good thing to take. As she's taking vit D anyway, that will raise her absorption of calcium from food, so extra calcium is more than likely not necessary.
Also, she should be taking vit K2 - MK7 to make sure the extra calcium goes into the bones and teeth, and doesn't build up in the soft tissues and arteries, which can cause all sorts of problems. And, she should be taking magnesium with vit D, too.
Answering your q’s she is on 200 mcg T4 hence suppression of the TSH. Been on T4 3-4 years. She is anaemic & on ferrous sulfate. 225 is T4. She’s on T4 and increase From 200 to 225 made little difference to how well she felt. Was titrated up from 25 mcg to 200 over that time. Note slightly high folate. Due to Ferrous Sulfate? (2 x 200 mg day). So Radd, how do we get her Haematocrit/Haemoglobin up together with the B12n? How can we get the antibodies down w/o steroids? Grey goose if wife is given steroids that’s a calcium depleter and currently calcium is normal so there may be benefit there anyway short term. note calcium & Vit D were low too. Why do you suggest vit K2 and magnesium? She is also on paroxetene 27 years for OCD and Tegretol for 2x 2 absence attacks both of which happened at work near flickering lights at least once. 2nd absence attack occurred a few hours after each of the first. Ie 2 in 1 day. Lights on but talking gibberish. She doesn’t drive and is giving up work soon (Morrisons’s). She takes her T4 on getting up and showers then has bowl of crunchy bran about 20-30 mins later. Not sure if good combo. Also Tegretol, ferrous sulfate, paroxetene interact to make things worse. Just to add to the mix the COQ10 is high dose! I’ve tried keeping the Tegretol/T4/Ferrous Sulfate/calcium/paroxetene separate. T4 paroxetene am calcium 4 hrs later, then Tegretol, Ferrous sulfate & Tegretol last thing. Somehow we have to fit in the Ferrous sulfate twice 200mg each time.
All our cookware is stainless steel tin or glass. Next set of ideas please!
I’m inclined to try to wean off the Tegretol, stop the Q10, but spread the rest. Why the comment re gluten? Also her mum is supposed to have it but not seen overt symptoms at all. Your thoughts please.
You replied to my comments, so radd probably won't see your reply to her. I've notified her.
Why are you trying to get her antibodies down? Even if you got them down to zero, she would still have Hashi's. There is no cure for Hashi's, it can continue very well without the antibodies, because the antibodies are not the disease. It is not TPO/Tg antibodies that attack the thyroid, they just clean up the debris left in the blood after the attack. So, is it even desirable to reduce them?
When you take vit D, it raises your absorption of calcium from food, as I explained above. So, you take vit K2 to make sure the calcium gets into the teeth and bones and doesn't build up in the tissues, which is dangerous. It can cause a heart attack. Also, vit D and magnesium work together, and vit d depletes magnesium - and she's probably low on magnesium, anyway. Therefore, it's best to take a magnesium supplement. Magnesium is also necessary for good conversion.
She takes her T4 on getting up and showers then has bowl of crunchy bran about 20-30 mins later.
No, that is not good. Presumably she has milk with it? The milk will bind with the thyroid hormone and affect absorption. Also, a bowl of bran will probably be too much roughage. Too much roughage means that the hormone is rushed through the gut and out before it has time to be absorbed - the hormone that isn't bound to the calcium in the milk, that is. So, it's highly likely that she isn't absorbing much at all. And, no matter what she has for breakfast, she should leave at least one hour from the time she takes her levo until she eats.
Ferrous Fumerate should be taken strictly on its own - apart from vit C. Four hours away from thyroid hormone, and two hours away froe EVERYTHING else - except the vit C. Does she take vit C with it? It would be a good idea, because that increases absorption of iron, and will also help with her constipation - I imagine she is constipated, what with the hypo and the iron supplements - and that's why she's having bran for breakfast, no?
Calcium and vit D should also be taken four hours away from thyroid hormone. So, if she hasn't been leaving that gap, then that will reduce her absorption of levo even further. And it should most definitely be taken two hours away from iron, because iron and calcium will bind together, and she won't be able to absorb either or them.
Magnesium citrate will also help with constipation. But, should be taken four hours away from thyroid hormone. It's best taken at night, because it can make you sleepy. Vit D and vit K2 should be taken with some form of fat for absorption, so taken with food.
All the rest of her medication and supplements should be taken at least two hours away from thyroid hormone. So, you've got your work cut out, there, to create a programme! What a lot of people do is take their levo in the middle of the night, if they have to get up to go to the loo. Does your wife have to get up in the night? If so, that's an ideal time to take levo, well away from everything else.
I see you've also replied to MaisieGray and Hidden , all together in the one post. I'm afraid you cannot do that on here, because unless your click on the blue 'reply' button underneath their comments, they will not be notified that you have replied. I've notified them for you.
On the contrary constipation is not an issue. Can go 3 x before leaving for work! I think we will have to rethink brekkie big time and cut down the Tegretol for starters. She’s on 400 mg day which for 2 x absence attacks which just may have been caused by a low epileptic threshold to flickering lights may be overkill. Also she had these years ago and was getting up at stupid hours.
Then why the bran? I can't imagine anyone eating that for pleasure! lol Sorry, that's none of my business. But it certainly doesn't sound like a good idea in any way.
And, it doesn't sound as if she has epilepsy. But, doctors just love prescribing horrible drugs! Has she had any tests to diagnose it? If not, perhaps you should insist that your doctor does some tests, rather than keep giving her a drug she does not need.
re the antibodies not trying to get down.. Steroids to reduce the inflammation not the antibodies. Radd had said antibodies can be managed & reduced w/o steroids is I was asking her how.
Yes, but the question still is: why do you want to reduce antibodies? They're just doing their job. And there's no proof that one feels better without them. They fluctuate, so they're not always high. They're high just after an immune system attack, when they clean up the blood, and then go down again. And that's why a lot of people believe they've reduced them. But, they'll come back again when needed.
In a way, yes. As I said, they clean up the mess after the attack, the TPO that has leaked into the blood, where it shouldn't be. But, they do not do any attacking. One can have Hashi's without ever developing high levels of antibodies.
Yep, low ESR and CRP. O our Gp is Finnish and has Scandinavian outlook on medicine. We can communicate by email so I’m going to raise the points raised here with him for his opinion. Good doctor.
"I’m inclined to try to ....... stop the Q10" - just to clarify, I wasn't suggesting that your wife do that; only pointing out that contrary to what one might expect or assume, she may not need to supplement to the same degree as others might require. If she's not experiencing any of the possible side effects of excessive dosing, there would seem to be no need to change it.
It has just occurred to me that you wrote "On the contrary constipation is not an issue. Can go 3 X before leaving for work." I'd consider that to be perhaps indicative of the stomach upset / diarrhoea listed as possible side-effects of over-supplementation.
Well we can reduce the COQ10 next time we need some. I'm wondering if the breakfast of crunchy bran and milk within an hour may be a major culprit. ODing on 400mcg made a huge difference for a day.....
I think if someone doubles up on a usual 200 mcg dose, to 400 mcg, and feels great in the immediate term, I'd guess that's pretty much a stand alone effect, independent of breakfast tbh. It's not like say, just a 25 mcg dose being doubled up to 50 mcg. Any possible inhibitory effect of the cereal and/or milk would likely have been pretty much immaterial at that point. For the first 30 years of my being hypothyroid, which pre-dated patients presuming to be informed by the internet, so I didn't know otherwise, I downed my Levo always with coffee, and generally with food too, or took it whenever I remembered to, and never felt better. I'm not recommending that, just saying that presumably my optimal dosing was arrived at in response to my need for it, and my need presumably included ameliorating the effects of the food/coffee. There's no single perspective on managing hypothyroidism,
I only read the first part of your reply but have now read it all. I must admit We so wonder about the "flushing away of sufficient T4. We also just did the The Gluten Society test and and tights suggesting a possible intolerance. Will be discussing with GP. Unfortunately I have an op Friday and GP is hard to nail down. Likely to have to wait til end January and I've partially recovered (6 week job).
In various studies, CoQ10 levels in hyperthyroid patients were found to be amongst the lowest detected in human diseases; but contrary-wise, CoQ10 is actually elevated in both those with overt hypothyroidism, and those who are subclinical - to the degree that it may be a useful indicator to differentiate metabolic status between the different thyroid disorders. Add that to it's tendency to reduce blood pressure in some, and whilst it's generally well-tolerated in higher doses (stomach upset, loss of appetite, nausea, vomiting, diarrhea & skin rashes can be side-effects) your wife might want to avoid over-supplementation.
A little warning.......when I went gluten free, my absorption of my t4 greatly improved and I had to reduce my 200mg to 100mg. It was a hard lesson, it took me awhile to realise.....which meant I was over medicating myself and was hyper.....it was pretty bad. So look for signs when going gluten free!
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