Hi all
TT aug 18
Rai Oct 18
Got my bloods back today
TSH 1.1. 0.27-4.2
T423.7. 10-21
T3 4.8. 3.5-6.5
Current symptoms are
Tiredness
Anxiety cant control
Flank pain
Testicular pain
Sleep problems
Cold hands
Currently on levo 175 fri to sat and 200 mon to Thursday
Any advice
It looks as though you're not converting T4 to T3 very well. Your FT4 is over range and your FT3 is only 43% through range. They should be balanced.
Things that can affect conversion are poor nutrient levels so it would be worth checking those:
Vit D
B12
Folate
Ferritin
If these are all optimal then it might be worth considering less Levo and the addition of T3, but very difficult to get that on the NHS (if you are in the UK that is).
Optimal levels are:
Vit D - The Vit D Council recommends a level of 125nmol/L [50ng/ml] and the Vit D Society recommends a level between 100-150nmol/L [40-60ng/ml].
B12 - top of range
Folate - at least half way through range
Ferritin - half way through range
Thank you. I will post vit levels when I get home. I had them done last month
Vit d was 60.2 nmol/l
Ferritin 48 ug/l. 24 - 336
Folate 5.3 ug/l 3.1-19.9
B12 377ng/l 180 -914
Paul
Are you taking any supplements at all?
Vit d was 60.2 nmol/l (24.08ng/ml)
The Vit D Council recommends, to reach the recommended level from your current level, supplementing lwith 3,700iu D3 daily
vitamindcouncil.org/i-teste...
along with important cofactors magnesium and Vit K2-MK7
vitamindcouncil.org/about-v...
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.
naturalnews.com/046401_magn...
Check out the other cofactors too (some of which can be obtained from food).
Retest after 3 months.
When you've reached the recommended level 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 an NHS lab which offers this test to the general public:
Ferritin 48 ug/l. 24 - 336
Being closer to half way through range (180 with that range, although I've seen it say 150 is a good level for a male) is recommended. You can help raise your level by eating liver regularly, maximum 200g per week due to it's high Vit A content, also liver pate, black pudding, and including lots of iron rich foods in your diet
apjcn.nhri.org.tw/server/in...
Folate 5.3 ug/l 3.1-19.9
This is very low and should be at least half way through range - 11.5+ with that range.
Eating folate rich foods can help, plus supplementing with a good B Complex containing methylfolate (not folic acid). Thorne Basic B and Igennus Super B are good brands.
B12 377ng/l 180 -914 ng/L [is the same as pg/ml]
This is low. 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."
As long as you don't have any symptoms of B12 deficiency, you could supplement with sublingual methylcobalamin 1000mcg daily to raise your level.
You can check for signs of B12 deficiency here
b12deficiency.info/signs-an...
If you do have any signs then don't supplement B12 or B Complex, ask for further testing for B12 deficiency/Pernicious anaemia.
Optimising all these nutrient levels is a first step. Retest levels in about 4 months' time then if your nutrient levels are optimal and your FT4/FT3 are still as unbalanced as now then consider the addition of T3.
No. Thank you. I am now seeing a nutritionist
Can you clarify what sort of sleep problems. It could be that you are a bit hyper. I would reduce your levothyroxine maybe to 125 for a couple of months and then gradually work back up. This way you can assess how you respond. On a lower dose of levothyroxine your fT3 may be a bit higher.
This assumes your TT was not for thyroid cancer, if it was you need to take specialist advice on what TSH you need.
Hi. Jim
It was thyroid cancer. Have been told TSH should be under 0.1
Sleep is like 3-5 hours per night
If anxiety is bad. No sleep just toss and turn mind racing
I'm sorry you feel so unwell and anxious. I think it's quite common to get these problems after thyroidectomy. I'm not sure why but there are things that can help. If possible, cut yourself some slack, whether that's taking longer off work or just doing things more gently. Get all your vitamin levels optimal, your B12 could be higher, over 500 is said to be best and vitamin D is best around 100nmol. A suppressed TSH can make you feel anxious with a rapid heart rate. Any increase/decrease in levo might make you feel quite unwell. Just try to get onto an even keel and stay there. Try not to keep adjusting levo as stability is important. Really good healthy nutrition and gentle exercise might help too.
You will eventually feel better but your body has taken a big hit losing a very important part that controls metabolism and for some people it seems to take quite a while to readjust. Unfortunately, most people are not counseled about the potential long recovery period and surgeons just focus on the immediate healing time for the scar but not the hormonal impact on your body and seem to think you can bounce back after 3 weeks and straight back into work again. It's not the case for quite a few people and just because you can replace the missing hormone does not mean that your body is functioning exactly as it did before.
I'd discuss it with the surgeon or endocrinologist who is managing your care. 'No sleep just toss and turn mind racing' sounds like you are a bit hyper but of course you really want your TSH lower. I've no expertise in this area other than thyroid cancers can be classified and the degree and duration of TSH suppression adjusted according to how aggressive the cancer was. Maybe they can give you a beta blocker or something to calm your heart (if it is rapid) and this might help. You can also get quite cheap sports watches that are slim and comfortable to monitor your heart rate overnight (you need access to a recent iPad or mobile for the latest version of bluetooth to set them up).
You mean 'over-medicated', of course. You can't be hyper with no thyroid. 
Exhibiting hyper signs and symptoms. I tend to refer to hypo and hyper in terms of the patient experience. A large number of hypothyroid patients on this forum are not strictly hypo because their hormone levels are normal. You are correct in that hyper only refers to excess hormone release from the thyroid. If we apply the same strict definitions to hypothyroidism it gets very confusing because many patients with normal hormone levels are thyroid hormone under-active but we don’t know the cause and so it’s difficult to give a description other than hypothyroid. It would be correct to use the term thyrotoxic but this might convey a sense of intentional over treatment and appear to be a chastisement.
Why can't you just say 'over-medicated'? Because that's what it is. It's bad enough these stupid doctors refusing increases in dose because it will 'make you go hyper'. People that don't know much about thyroid need to know that levo does not make you 'go hyper', which is a totally other thing. If we start talking about people 'going hyper', I feel we are failing in our duty to enlighten.
In this case it is clear, but if a patient has e.g. thyroiditis it will not be clear if the hyper signs and symptoms are due to excess tablets or an autoimmune flare up. Hypo means under and hyper means over. I'm just describing the signs and symptoms. Too much hormone will make you hyper, wherever the hormone comes from. If we reserve the term hyper for excess thyroidal secretion we have to do the same with hypo.
Well, I 100% disagree with you. It sends the wrong message. But, we'll have to agree to disagree on that one. An autoimmune 'hyper' swing is not really hyper, either. And, I object to calling it a 'flare up', because that too sends the wrong message, because its not a 'flare up' in the way arthritis is, for example. It gives people the idea that if makes them more hypo, rather than less. Flare, if you must, but even that doesn't describe what really happens, but not 'flare up'.
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