Does fatigue, weight gain, con...

[masa2333]

Does fatigue, weight gain, constant tiredness, no desire to do anything, sleeping a lot etc. go away once you are well-medicated?

[SeasideSusie Remembering]

As long as all problems are dealt with then you should get back fairly close to normal. So you need to consider

Thyroid - are you optimally medicated

Nutrient levels - any deficiencies or low levels of vitamins/minerals mean that thyroid hormone can't work properly

Adrenals - part of the endocrine system so a problem with adrenals can mean your thyroid can't function properly

Sex hormones - again these could be involved.

It's quite a jigsaw really, so if it's a simple case of thyroid is out of whack and replacement hormone at optimal doses sorts it out, fine. But if that doesn't solve the problem, start looking at other possible areas that might need addressing.

[masa2333 in reply to SeasideSusie]

Thank you very much on your reply. My TSH was 0.96 (0.38-3.6) and FT4 was 14.1 (7.9-20.3) so the doctor said to stay on Levothyroxine 150mcg.

I found that I am deficient in Vitamin D and ferritin and I am now taking those in supplements. My prolactin was high at 620 (109-557) and total Calcium was slightly elevated at 2.56 (2.10-2.55) I also take Selenium+Zinc twice a week and Magnesium before bed.

But I feel no desire to do anything, constant tiredness, I sleep all day long, can’t sleep at night, have no energy, headaches, brain fog, anxiety... when I went to the hospital they reffered me to the psychiatrist and put me on antidepressants and concluded that I have panic disorder. I just don’t know anymore what to believe.

[SeasideSusie Remembering in reply to masa2333]

masa2333

A couple of things here.

My TSH was 0.96 (0.38-3.6) and FT4 was 14.1 (7.9-20.3) so the doctor said to stay on Levothyroxine 150mcg.

But I feel no desire to do anything, constant tiredness, I sleep all day long, can’t sleep at night, have no energy, headaches, brain fog, anxiety...

Your FT4 is just 50% through it's range. The aim of a treated hypo patient generally is for TSH to be 1 or lower with FT4 and FT3 in the upper part of their ranges if that is where you feel well. You are undermedicated and still have symptoms of hypothyroidism. You could do with an increase in dose of Levo, 25mcg now and retest in 6 weeks. You may feel better with FT4 around 17+

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (the magazine for doctors)

"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance.

But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l).*"

*He recently confirmed, during a public meeting, that this applies to Free T3 as well as Total T3.

You can obtain a copy of the article by emailing Dionne at [e-mail] print it and highlight question 6 to show your doctor.

What's also missing is testing your FT3. T4 is a storage hormone which converts to T3 which is the active hormone which every cell in our bodies need. So testing FT3 at the same time as FT4 tells us whether that conversion is good. If conversion is poor then we need to address that. Unfortunately, doctors don't see the importance of this.

What were your Vit D and ferritin levels, and what are you taking for them?

Vit D has important cofactors, magnesium you are taking, but are you taking Vit K2-MK7 as well? This is needed because 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. As your calcium is already high, you need to ensure it goes where it's meant to go.

Were B12 and folate tested?

If you are optimally medicated, with a good level of FT3, then I imagine you wouldn't need anti-depressants and you probably don't have a panic disorder, so really it is very unfair to label patients with this, and stick them on anti-depressants, unless all other avenues have been investigated.

[masa2333 in reply to SeasideSusie]

Thank you once again for taking time to help me figure this out, I really appreciate it.

My last thyroid test that was done on summer was TSH 0.34 and FT4 at around 11, with same refernce ranges, so the both have gone up a little. Also, I did gain about 8-10 kilos between two tests and was on same Levothyroxine dose at 150mcg.

My doctor didn’t want me to increase Levo, she said that this dosage is okay. Do you think it is safe to self-increase it? She also never ordered me to do FT3, as she says only TSH and FT4 are important.

My Vit D level was 43 (>50 optimal) and ferritin was 10 (15-260). I am taking oral sprat solDevit (D3) with 400IU of vitamin D(200% RDI) for vitamin D and capsules FerriMore (iron+vitaminC) for low ferritin. I might need to adress that my endo told me to have FerriMore only during my period, but I am taking it every day because I think it is too low to only take it 4 days a month. Folic acid was 16.9 (2.27-54.4) Serum Fe was 18.9 (8-30). Serum B12 was 355.5 (127-512)

I am not taking vitamins K2 and MK7, my endo never mentioned them to me and told me that Vitamin D does that? (Bonds calcium in bones and teeth)

Thank you for the article information!

They think as I am only 21 I am too young to have all the symptoms, but I really don’t feel well. They say I am too young to have back pain, brain fog, heart palpitations ect. and that it must be due to anxiety and panic issues so they always reffer me to either pshycologist or psychiatrist.

[SeasideSusie Remembering in reply to masa2333]

masa2333

Are you in the UK? I don't recognise that Vit D supplement and can't find anything about it on Google.

Do you take on 400iu D3 daily or do you take more?

What is the unit of measurement for your Vit D result, is it nmol/L or ng/ml?

ferritin was 10 (15-260).

This level of ferritin can suggest iron deficiency anaemia, in which case taking an iron supplement only during your period would not address this. Did you have an iron panel and full blood count carried out to see if you have any sort of anaemia?

Folic acid was 16.9 (2.27-54.4)

This is a bit low, folate should be at least half way through range, so that would be 28+ with that range.

Serum B12 was 355.5 (127-512)

What's the unit of measurement for this - pmol/L or ng/L or pg/ml

Serum Fe was 18.9 (8-30).

I don't know what this is, is it not Ferritin?

I am not taking vitamins K2 and MK7, my endo never mentioned them to me and told me that Vitamin D does that? (Bonds calcium in bones and teeth)

Don't expect doctors to know much about vitamins and minerals and cofactors needed, and optimal levels, etc. They don't do this in medical school.

As I said before, D3 increases uptake of calcium from food. Unless that calcium is directed appropriately - to bones and teeth - then it can end up in arteries and soft tissues causing calcification of arteries, kidney stones, etc. This is why we need K2, to direct the calcium to the appropriate places.

My doctor didn’t want me to increase Levo, she said that this dosage is okay. Do you think it is safe to self-increase it? She also never ordered me to do FT3, as she says only TSH and FT4 are important.

I have given you the information about where levels need to be according to the UK's leading endocrinologist. Most doctors don't understand what optimal thyroid levels are, and they don't know much about T3. If you have enough Levo then you could increase by 25mcg and retest in 6 weeks to check your levels, but it is very important to get FT4 and FT3 tested at the same time. We need FT3 to stay in range. If your doctor can't get FT3 tested, then can you get a private thyroid test to include TSH/FT4/FT3?

By the way, antidepressants aren't a good idea, they can affect thyroid hormones

ncbi.nlm.nih.gov/pubmed/957...

If you haven't already started taking them, then I wouldn't bother. Sort out optimal medication, vitamins and minerals.

If you have started taking them then you can't suddenly stop.

[masa2333 in reply to SeasideSusie]

I am not from the UK, I am from Serbia. I just tried searching it on google and results only showed in serbian language so it must be the reason why you could not find it, it is probably only available or produced here. I take 400iu D3 daily. Vit D result is nmol/L.

Fe is complete iron (as I understood from doctor) which was okay but ferritin was low so that’s the reason she wanted me to take supplements. I did have complete blood count and my hemoglobin was okay although a bit on the lower edge of the reference range, but doctor said I haven’t had anaemia.

I am sorry if I bother with questions, but doctors don’t seem to help me, how do I increase folate?

B12 was pmol/L

I will buy some K2 supplements, do I take them at the sime time as vitamin D?

I can do private lab test for all thyroid hormones, I just always relied on doctor’s knowledge, it was only when I joined this community that I started to doubt it. I don’t know much about Hashimoto’s yet, but I am trying to learn by reading articles recommended here and some of which I find online. In my country you can buy Levothyroxine without prescription for a really low price so it’s not a problem to get more if it will make me feel better.

I did start taking antidepressants 3 weeks ago when they convinced me that it is all in my head and medication will help with it all. Well, I can say that I still feel very much tired, anxious, sleepy, hungry, gaining weight, not having desire to do anything, back pain, headaches and everything that comes with it. But I planned on visiting therapist to discuss this medication, as I made sure that she knows that I have Hashimoto’s and am taking Levothyroxine for it, and she said it is completely fine to take antidepressants as long as it is 2 hours away from thyroid meds. Thank you for the link, I will give it a read now.

[SeasideSusie Remembering in reply to masa2333]

masa

I take 400iu D3 daily. Vit D result is nmol/L.

My Vit D level was 43 (>50 optimal)

So this is low and your 400iu D3 isn't enough to raise it. It's not even enough for a maintenance dose for someone with a decent level already.

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]. For your current level of 43nmol/L (17.32ng/ml) the Vit D Council recommends taking 4,900iu D3 daily (nearest equivalent is 5,000iu).

vitamindcouncil.org/i-teste...

This is probably something your doctor wont know about or acknowledge, as I said, they aren't taught about vitamins and minerals.

If you decide to increase your Vit D supplement then 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.

Fe is complete iron (as I understood from doctor) which was okay but ferritin was low so that’s the reason she wanted me to take supplements. I did have complete blood count and my hemoglobin was okay although a bit on the lower edge of the reference range, but doctor said I haven’t had anaemia.

Thank you for that. It's just called "Serum Iron" here in the UK so I hadn't seen Fe before. MCV and MCH in the full blood count need to be in range to discount iron deficiency anaemia.

Iron is complicated and we have to be careful with iron tablets as they can raise serum iron as well as ferritin and that may be why your doctor said to take it only for the days of your period. However, your ferritin is below range and an iron infusion would be best to raise your level, I understand an iron infusion can raise ferritin without raising serum iron, so it's something you might want to ask about.

Your ferritin level and your Vit D level will both be causing problems. You will find information about Vit D on the Vit D Council's website I linked to, and here is an article about low ferritin

restartmed.com/low-ferritin/

B12 was pmol/L

Serum B12 was 355.5 (127-512)

So 355.5pmol/L = 481.7pg/ml

According to 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."

So you might want to consider trying to raise your B12.

how do I increase folate?

For your B12 and folate, I think a good B Complex would be enough to increase both, one containing methylcobalamin and methylfolate (the active forms). Depending on what is available where you live, good brands are Thorne Basic B and Igennus Super B.

I will buy some K2 supplements, do I take them at the sime time as vitamin D?

That depends on what form your supplements take. Both Vit D and Vit K2 are fat soluble, so they need fat to be absorbed. This could be the fattiest meal of the day, in which case taking both Vit D and K2 at the same time means they will compete for the fat and may not be absorbed well enough. Both Vit D and K2 supplements can be bought in softgel form which contains olive oil, so there is already some fat within the supplement and you could then take them at the same time. I use a K2 liquid supplement which is oil based and just need 3 drops daily.

I have Hashimoto’s

Ah, then there's the likely reason your vitamins and minerals are so poor.

So I've just looked at your profile and see that SlowDragon gave you some advice about possible poor gut function/testing for coeliac, etc. here

healthunlocked.com/thyroidu...

This is something you should look into.

Don't worry about asking questions, it's the only way we can learn

[masa2333 in reply to SeasideSusie]

Thank you for the information about Vit D intake. I guess I should increase my dose then... I just always get confused when the package says ‘do not exceed recommended daily intake’ (and RDI is one drop of spray per day) so I get scared of overdoing it and causing more harm than good. But I guess people like us who have deficiency can’t reach toxic level that easy right?

I will ask my GP about iron infusion, if I could get it to raise my levels, thanks on that information! I was just reffered to adult’s endo recently, and I got these levels tested for the first time two months ago, as my pediatric doctor haven’t ordered these tests ever.

My endo did arrange my blood to be taken for 3 months again, to see how the levels are going, so I will be testing it again on April the 1st.

Oh, no problem, sorry, didn’t know that about serum Iron in UK. I guess we can all learn something new! Both my MCV and MCH were in the middle of reference range, that’s why the doctor told me anaemia wasn’t a problem.

I really appreciate you taking time to share those articles with me and advices about vitamins and minerals and all the other info. I will have a good read today!

Sorry for not adressing that I have Hashimoto’s earlier, I always forget that someone can be hypothyroid and take Levothyroxine without having Hashimoto’s. I’ve had it since I was 9 years old so it also became a habit of mine to only say ‘thyroid issues’ because people my age rarely understand what Hashimoto’s is and always look at me like a freak when I mention it. Yes, SlowDragon and greygoose did help me indeed a couple of times with good feedback and articles! I cut out gluten as advised by them (and all the other succesfull stories of course) a couple days ago and I’m working on cutting dairy, eggs, soy milk (I always made smoothies with it not knowing it affects thyroid) and nuts, and then re-introducing them to see my body’s reaction. I will also insist on my antibodies to be tested alongside thyroid hormones, and if they don’t want to do it, I will do it privately. I never knew the importance of all the parameters untill now.

[SeasideSusie Remembering in reply to masa2333]

But I guess people like us who have deficiency can’t reach toxic level that easy right?

Oh yes, I think we can. Which is why we should take guidance where possible, and in this case I don't think we can go wrong with the Vit D Council, and of course check our level regularly which I mentioned.

There's no real need to repeat antibody tests. You know you have Hashi's, so all it will tell you is the level of the antibodies on the day of the test, and as they fluctuate there's possibly not much to be gained from that information.

[masa2333 in reply to SeasideSusie]

Oh okay, I understand now. I will study it further and make sure to test my blood levels at appropriate times not to over-do anything.

Thanks again for everything, hope you have a good day!

[SilverAvocado]

Hi masa2333, I spotted you in another thread saying you had mental health problems and wondering how they relate to thyroid. I clicked through to see if I could find your results.

You have had awesome advice from SeasideSusie, she is extremely knowledgeable. I just wanted to add an extra voice saying these thyroid hormone levels look very low. Most people on Levothyroxine will need their freeT3 right at the top to feel well, and yours is far below that. It looks like you have some very low vitamins, too.

Fixing these will have a big impact on your health and hopefully mental health, too. Unfortunately doctors will often keep us ill and we need to do the hard work ourselves