First time posting here. Possible Hypothyroid issue? Advice welcome :)

[RadleyBradley]

Hey all! I decided to check on my thyroid in October (results attached) as I'd read that TSH could increase after smoking cessation (and that being a smoker can mask hypothyroidism)...and my results showed that it had, my TSH prior to quitting were usually of the 0.something variety. I should note that I was treated with Levothyroxine many years ago, as I had very low T4 but 'normal' TSH and the doctor couldn't figure out why I felt so tired all the time etc. Anyway, the 'experimental' treatment didn't work and I quit taking it... but over the years since, it's come to light that I've had iron, b12 and Vit D deficiencies...and I'm starting to feel so much better now that I'm on treatment for all three at the same time. It seems to me, after researching and reading forums and such, that my thyroid level results are questionable. Should I continue to monitor them, say, every 6 months... or am I being over-cautious?

[Cooper27]

Your thyroid is on the brink of hypothyroidism, so I think you do need to keep an eye on it. Your T4 and T3 ideally should be in the upper third of the ranges, and I'd expect TSH to be around 1 in a healthy person. If you were on medication, we'd recommend a dose increase, but you're not at a point where a doctor is likely to start medication.

[RadleyBradley in reply to Cooper27]

There's so much information out there and it clashes with what we're told by our GP'S and what 'normal ranges' are, it's eye-opening tbh. The doctor's comments that came along with these results obviously said they were 'normal' but I figured I'd get advice from forums etc...as that's really how I managed to get the nutritional deficiencies sorted out as my results in those areas had been below normal and I'd still been told that I'm 'fine'. Thanks for your response!

[radd]

RadleyBradley,

Welcome to our forum,

Glad you have given up smoking. Given the enormous effects smoking has on the thyroid gland and function, it might be prudent to assume these effects could be long lasting.

However, smokers usually have a lower serum TSH together with higher FT4 & FT3 levels but yours are quite low. Particularly T3 which is the active hormone bringing well being so you might benefit from replacement meds.

How long did you medicate Levothyroxine before and what dose ? A low dose can reduce thyroid hormone output further and recovering from long term low thyroid hormone levels can take months & months, even after good biochemistry.

Nutient/iron deficiencies are common in people with low thyroid hormone due to low levels of stomach acid & absorption problems.

[RadleyBradley in reply to radd]

Hi, thanks for your msg I can't remember the dosage of Levothyroxine I was taking and it's going back about 7 years ago. I was probs only on them for 6 months or so. Though I may not have felt any improvement because the nutrient deficiencies weren't being treated. The ferritin/iron issue is persistent and been ongoing for years. Without treatment it quickly bounces back to below the lower limit...and was overlooked so many times. I even saw a gastro doc that was rude and dismissed me by saying that heavy periods was the cause...despite telling him they were perfectly normal. He also told me my B12 was fine...even though I'd already had loading doses at my gp surgery at this point. B12 was only picked up when they'd dropped the treatment lower limit to below 200ng/L in my area...and my GP remembered that my last B12 bloods were already below this limit anyway. I was intrinsic factor negative but since my Paternal Grandmother had pernicious anaemia her whole adult life...AND a neurologist had agreed that B12 deficiency was the cause of many of my symptoms (such as peripheral neuropathy and loss of sensation in my right hand) that it would be best to give me 3 monthly jabs.

Folate is only just in range and I was told this was fine but it's the next thing on my list to start supplementing. My GP decided to check my Vit D levels on a whim because I'd mentioned it in the past...it wasn't the lowest result (34nmol/L) but she said that given I have all these issues it would be silly to not treat that as well. Although the doc did prescribe me pills that were pretty low concentration...so I use a Vit D spray instead.

I'm pretty sure my paternal half-sister also has some sort of thyroid issue but I'm not sure what kind. There's some kind of Autoimmune connection on both sides...as my mother has MS and the same ferritin issue that I have. Her B12 and folate are much higher than mine and I'm not sure they bothered checking her Vit D.

[greygoose]

Could be that you have Central Hypo, where the problem lies with the pituitary (Secondary Hypo) or the hypothalamus (Tertiary Hypo), rather than the thyroid itself (Primary Hypo). With such low Frees, you would expect the TSH to be higher, but if the pituitary and/or the hypothalamus aren't working properly, the TSH will stay low no matter what the level of the Frees. Might be a good idea to research that, and take the evidence to your doctor, because doctors know absolutely nothing about Central Hypo.

[RadleyBradley in reply to greygoose]

Thanks for your msg...yes, I've looked into those conditions briefly but the symptoms of pituitary issues don't seem to match my own. It's all very confusing but I'll definitely keep an eye on my levels and keep this in mind.

Gp's seem to struggle with anything that isn't 'textbook' or nutritional based. It's taken me years to get this far :/

[greygoose in reply to RadleyBradley]

Well, symptoms can often be misleading. But, what are the symptoms of pituitary issues? If the problem is just that your pituitary isn't producing enough TSH, but all the other hormones are good, then you would just have hypo symptoms due to the low FT3.

GPs are incapable of thinking 'outside the box', nor are they ever encouraged to do so by the medical fraternity. And their education in all things thyroid/hormonal/nutritional is pathetic. Which is why we all have to learn to look out for ourselves.

[RadleyBradley in reply to greygoose]

Indeed! Agree with every word you've said 👍🏻🙌🏻

[SlowDragon Administrator]

Next time you retest, would suggest you also include vitamin testing to check these are all optimal

You don't mention folate levels. Have these been tested?

Often folate is also low, especially if B12 was low too

Supplementing a good quality daily vitamin B complex, one with folate in not folic acid may be beneficial.

B vitamins best taken in the morning after breakfast

Recommended brands on here are Igennus Super B complex. (Often only need one tablet per day, not two). Or Jarrow B-right

If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 3-5 days before any blood tests, as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and fasting. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven tests include vitamin testing.

Quitting Smoking can apparently increase risk of hypothyroidism for 2 years after

verywellhealth.com/cigarett...

ncbi.nlm.nih.gov/pmc/articl...

[RadleyBradley in reply to SlowDragon]

Thanks for your msg...yeah, I'm 'on it' with the nutritional deficiencies. Folate is the one I'll be dealing with next because it was only just in range, despite being told that's normal...I figured that it should at least be brought up a bit. Methyl folate seems to be the go-to kind...but I'll look more into it. I'm on iron tablets indefinitely and I have B12 jabs 3 monthly.

[SlowDragon Administrator in reply to RadleyBradley]

All of which suggest gut is affected by something. Often low stomach acid due to hypothyroidism, or gluten intolerance or coeliac disease

[RadleyBradley in reply to SlowDragon]

Didn't get anywhere with the gastroenterologist...dismissed me completely. Fortunately I have a decent GP and I've had a fair few tests done, including a celiac screen which was negative. I'm currently cutting out carbs and that has pretty much excluded gluten from my diet, so I'll see how I get on with it 👍🏻

[SlowDragon Administrator in reply to RadleyBradley]

Majority of us with Hashimoto's test negative for coeliac, but many find strictly gluten free diet helps or is essential