First post: Struggle to interpret blood test results and resolve symptoms

[Mediterranean]

I have been following this forum for a few months and I am really grateful that I discovered its existence. So thank you very much to all of you, who are contributing to the wealth of its information and advices!

After a first episode of strong fatigue in September 2016, I was quickly diagnosed with Hashimoto (TSH of 7 at the time, and TPO of 122, confirmed by scan). Started on 25 mgr dosis of Thyroxine, which was increased progressively to 75mgr. I felt fairly well most of the time until last June.

During summer, I struggled with fatigue, loss of drive and focus (classical Hashimoto symptoms). I tested TSH (2.16) and decided to increase my dosis to 100mgr from 75. The symptoms resolved.

However, starting from September 1st, I have been continuously experiencing a range of new symptoms, most of them appearing and then disappearing to reappear again:

- Brief aches in limbs

- Mild lower back pain

- Tingling, numbness and burning sensation in hands and feet (also previously in thighs)

- Discomfort in the right testicle

- Inner palpitation (since 3 days)

- Very brief pain in anus and inside ears

- Anxiety, driven by the thought that these new symptoms are not related to Hashimoto but to another undiagnosed neurological disorder

I am based in Switzerland and saw an endocrinologist in September, who said that the tingling in legs is unlikely to be related to Hashimoto. He did a scan of the thyroid and an extensive blood test on 25/9 incl. following results:

- TSH: 0.085 mIU/l (0.33 - 4.49)

- FT4: 23.6 pmol/l (11.6 - 22)

- T3: 2.2 nmol/l (1.2 - 3.2)

- Cortisol basal: 541 nmol/l (80 - 638)

- B12: 426 pmol/l

- Anti-tTransgluminase IgA <5 (<10)

- HbA1c: 5.3% (4.8 - 5.9)

- Iron: 19.5umol/l (11-33.8)

- Ferritin: 149ug/l (30-300)

Based on these results, the Dr. suggested to go back to 75mgr dosis, which I didn't do as I was afraid of getting back to fatigue. I only reduced to 88mgr. The Dr. said my TSH is very low and risky.

I re-did a test on 14/11:

- TSH: 0.36 mIU/l (0.3 - 3.6)

- FT4: 1.39 ng/dl (0.78 - 1.54)

- FT3: 5.72 pmol/l (3.5 - 6.5)

- Vitamin D (25-OH-D): 35 nmol/l (50-175)

Dr. said everything is fine but I need to supplement vitamin D. Which I am doing now.

A third blood test on 21/12 including all vitamins and minerals, incl:

- TSH: 1.56

- FT4: 24.11 pmol/l

- FT3: 4.43 pmol/l (4-8.3)

- TPO: 194 U/ml

- Anti-TG 103.6 U/ml

- CRP: 0.82

- Folate: 11.5 ng/ml (4-16)

- Calcium: 103.35 mg/l (84-102)

- Magnesium: 22 mg/l (14-30)

- Cholesterol: 2.11 g/l (1.5 - 2)

based on these results, I increased the dosis to 100mgr. However, 3 weeks after increase, I still have the same symptoms with some fatigue in the last 3-4 days.

I am struggling to understand why T4/T3 conversion ratio has significantly dropped from 14/11 to 21/12 although I hadn't changed anything.

Do I have a conversion issue? How can I resolve it? Do i need to try taking T3? Do I need to supplement anything else than vitamin D? Do you think my symptoms are related to hashimoto or could it be something different?

Sorry for the long post but any help would be very much appreciated!

Many thanks.

[magsyh]

There seems a few things at play here. Firstly having hashimotos will mean that your results may swing about a bit and to help that its best to keep your tsh as suppressed as possible. The 100mcg dose hadnt had time to level out in 3 weeks so reason why is you tested too early. Your vit d should be much higher, your b12 also too low. A gluten free diet may help reduce your antibodies. This needs a far more detailed reply hopefully someone else with more knowledge regarding hashimotos will see your post soon. I don't have it so no experience there.

[Mediterranean in reply to magsyh]

Many thanks Magshy! Much appreciated. What makes you think my B12 is too low? Also the Dr. said that based on my anti-tTransgluminase, no need to consider Gluten free.

[magsyh in reply to Mediterranean]

Your b12 should be minimum 500 even higher is better it could be what is causing your tingling legs. If you are taking vit d should be about 3000 - 5000iu a day with your levels being that low. Also you need to take it with vit k2 mk7 especially as hour calcium is high as hou need the calcium from your bloodstream put back into your bones this won't happen till your d levels reach about 80+ so you need to have the k2 to prevent damage from calcium in your soft tissues. Your magnesium may need looking at as the blood test only confirms whats in your blood which is about 5%. Your body makes sure it has that 5% in your bloodstream to prevent heart attacks so your cells could be running low. Your blood sugar test is on the high side magnesium will bring this down as magnesium is required to keep your blood sugar in check and your blood sugar down. Its complicated as everything works together in tandem to keep us balanced only one thing needed to make it all wrong and this is where doctors fail they have no idea of the whole picture. As i said your question needs a complicated answer. Selenium too will help with conversion and lower your antibodies

[magsyh in reply to magsyh]

You may be gluten sensitive as i am and many are no need to be celiac

[Mediterranean in reply to magsyh]

Did gluten free diet help in your case to bring down antibodies ?

[Mediterranean in reply to magsyh]

Many thanks! Very helpful.

A few points:

- How does a suppressed TSH help to reduce volatility?

- I think B12 result is using different units than the conventional ones. 21/12 test gives a value of 723.3 pg/ml (145-735). So I guess it is fine. Does it harm to supplement B12 even if it is high?

- I took 100000iU every 2 weeks 3 times and now moving to 2000 daily maintenance. Hope that will be sufficient to bring D level above 80. I’m not taking K2 though as Dr. said not necessary (He didn’t see calcium result at the time)

- Is there a way to know whether I’m magnesium deficient or not? Can I supplement without prior testing? Does it harm?

- I thought that my sugar level was fine as mid range. Do I need to work on that (I eat quite a lot of sugar in my diet - the only issue that I have with diet right now)

- I started eating 6-7 of Brazil nuts daily. Do you think it is sufficient or do I need to switch to classical supplement

Many thanks!

[magsyh in reply to Mediterranean]

Oh be careful of the brazil nuts you can give yourself selenium poisoning! No more than 2 a day. Drs dont acknowledge k2 please take it, its vital. If your tsh is suppressed means that your thyroid function is shut off and the antibodies will not attack the gland as before. B12, you can continue to suppliment as your kidneys will flush out whats not needed. I dont take mine every day. I dont have hashimotos. I have low antibodies so always tested negative. Gluten gives me ibs and maybe reason my antibodies are kept low? The more sugar you eat the more magnesium your body requires. 400+ mcg per day i use magnesium gel as pill form doesnt help the ibs!

[Mediterranean in reply to magsyh]

Thank you! IBS is Irritable Bowel Syndrome, correct? I’ve never experienced any issues with Gluten but I will give the gluten free diet a try.

Does Epsom salt help with magnesium? Is it safe to supplement without knowing the exact values?

[magsyh in reply to Mediterranean]

You need magnesium replenished every day. By oral route usually you can tell if the manesium is too much for you as hospital uses it as laxitive!

Epsom salts baths are good. Hope this all helps and you get things to work for you.

[Angel_of_the_North in reply to Mediterranean]

Epsom salts can cause diarrhea, but are a good addition to a bath. Better to use another form of magnesium orally (not oxide)

[humanbean]

Inner palpitation (since 3 days)

This sounds like what some people describe as "inner vibration". This may be a cortisol issue.

You had a serum (blood) cortisol test which looked fine. What that tests is the sum of all cortisol, both cortisol attached to proteins that carry it around the bloodstream (bound cortisol) and unbound cortisol which is not attached to carrier proteins. For the body to be able to use cortisol it needs to be unbound i.e. separated from its carrier proteins.

en.wikipedia.org/wiki/Trans...

So you can have a reasonable cortisol level in a serum test, but if you don't have enough unbound cortisol you could be in a low cortisol state. Alternatively, you could have levels of unbound cortisol which are too high, and high unbound cortisol is not a good thing to have either.

Saliva testing for cortisol measures unbound cortisol only. It is worth doing a saliva test for cortisol at four points during the day/evening - roughly when you wake up, late morning, late afternoon, and just before bedtime. (Doing more is not worth the extra cost unless you have information that tells you the optimal levels of cortisol at all the times you test.)

Optimal levels for the four-part test can be found here :

See Example 1 : rt3-adrenals.org/cortisol_t...

Also note these links :

stopthethyroidmadness.com/s...

rt3-adrenals.org/does_it_af...

[humanbean]

Iron: 19.5umol/l (11-33.8) 37% of the way through the range

Ferritin: 149ug/l (30-300) 44% of the way through the range

Optimal results for iron can be found here :

rt3-adrenals.org/Iron_test_...

On the basis of that link your iron is a bit too low. You would need to get it up to about 60 - 70% of the way through the range i.e. approx 25 - 27 (if I've got my arithmetic right). Your ferritin needs to be roughly mid-range or a little bit over i.e. 165 - 180 (approx).

Iron can be raised with supplements, but since your iron isn't too bad I would suggest eating liver once a week to raise your levels, rather than supplements.

[Mediterranean in reply to humanbean]

Many thanks for the detailed reply! Eating liver once a week is easy to do

[Mediterranean]

Thank you all for very valuable replies.

The only thing I’m not clear on is whether I do have a conversion issue. And if so, does it really help to continue raising Thyroxine dose as I feel T3 level is low.