Help on test results please?

[Rock_chick1]

Just an update on my first post with recent private test results. I feel like I've hit rock bottom now. I crawl from sofa to bed everyday with my head in my hands. I feel so light headed, dizzy, extremely faint and weak, my vision and focus is awful, I cant think straight and I get various numbness and tingling in my body but not always.I am mostly breathless on little exertion and I get these bouts where my heart just pounds and races. I was on a paleo diet but for the past two weeks AIP (strictly) My stomach has really flared up and Im nauseous but still forcing myself to eat as I have low blood sugar. Im scared to put any vit pills down me. I also dont want to take Esomeprazole to help heal the stomach as I dont want to deplete my nutrients further. I have showed the GP these test results and she says she will keep an eye on the thyroid even though Ive had positive antibodies for 3 yrs now and my results are suboptimal. Im still unmedicated, she was reluctant about putting me on Levo because of my tendency to have a fast heart rate.She has put in for some more bloods to check cortisol, potassium etc and has given me some folic acid. She has also recommended me as a process of elimination to see a POTS specialist. I really do feel like Im running out of time. Please see test results enc. Many thanks

[SlowDragon Administrator]

Firstly your FT4 is clearly very low and TSH too high

Fast heart rate can be due to being very hypothyroid

Your GP should be prescribing a trial of Levothyroxine. Recommended starting dose is 50mcg Levothyroxine

SeasideSusie has a link about if patient has raised antibodies and symptoms, then trial of Levothyroxine should be started

Guidelines on initial doses

cks.nice.org.uk/hypothyroid...

The initial recommended dose is:

For most people: 50–100 micrograms once daily, preferably taken at least 30 minutes before breakfast, caffeine-containing liquids (such as coffee or tea), or other drugs.

* This should be adjusted in increments of 25–50 micrograms every 3–4 weeks according to response. The usual maintenance dose is 100–200 micrograms once daily.

Email Dionne at Thyroid Uk for list of recommended thyroid specialists. You may need to by pass GP to get treatment

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

chriskresser.com/folate-vs-...

B vitamins best taken in the morning after breakfast

Recommended brands on here are Igennus Super B complex. Igennus full dose is two tablets per day. But often only need one tablet per day, not two. Could even start with just a half a tablet

Or Jarrow B-right but this is a large capsule

If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before any blood tests, as biotin can falsely affect test results

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

endocrinenews.endocrine.org...

Ferritin is getting low. Eating liver or liver pate once a week should help improve

[Rock_chick1 in reply to SlowDragon]

Thank you Slow dragon, please see my reply to SeasideSusie for an update

[SeasideSusie Remembering]

Rock_chick1

Those results really should mean you get prescribed Levo.

Your TSH is over range - officially classed as Subclinical Hypothyroidism.

Your FT4/FT3 are "normal" although FT4 has barely scraped into range.

Now that your TSH is over range, because you have positive antibodies, maybe discuss Dr Toft's article with your GP:

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (the magazine for doctors), in answer to Question 2:

Question 2 asks:

I often see patients who have an elevated TSH but normal T4. How should I be managing them?

Answer:

The combination of a normal serum T4 and raised serum TSH is known as subclinical hypothyroidism. If measured, serum T3 will also be normal. Repeat thyroid function tests in 2 or 3 months in case the abnormality represents a resolving thyroiditis.

But if it persists then antibodies to thyroid peroxidase should be measured. If these are positive - indicative of underlying autoimmune thyroid disease - the patient should be considered to have the mildest form of hypothyroidism.

In the absence of symptoms, some would simply recommend annual thyroid function tests until serum TSH is over 10mU/l or symptoms such as tiredness and weight gain develop. But a more pragmatic approach is to recognise that the thyroid failure is likely to become worse and try to nip things in the bud rather than risk loss to follow up.

Treatment should be started with levothyroxine in a dose sufficient to restored serum TSH to the lower part of it's reference range. Levothyroxine in a dose of 75-100mcg daily will usually be enough.

You can obtain a copy of the article by emailing Dionne at:

[e-mail]

print it and highlight question 2 to show your doctor.

You could possibly start on a very low dose of Levo - say 12.5mcg - and increase very slowly. Improvement will take longer as normal starting dose is 50mcg, but it will ensure that your body gets used to it gradually.

Before you start the folic acid, I would check the following:

See if you have any signs and symptoms of B12 deficiency here b12deficiency.info/signs-an...

B12 and folate work together, you are folate deficient, I would check to see if you are B12 deficient. You can have decent Serum B12 levels but Active B12 level can be poor. I don't know if the NHS tests Active B12 but you can get it done with Medichecks fingerprick test for £39 less 10% discount by using code THYROIDUK. If Active B12 is below 70 then that suggests testing for B12 deficiency. If this was me, I would be doing that now, and delaying the start of folic acid because taking that will mask signs of B12 deficiency and skew results. I would use this as part of your doctor's "process of elimination".

[Rock_chick1 in reply to SeasideSusie]

Seaside Susie, thank you. I did as you recommended and send off for an active B12 test. this was high also. It is 210 and the range should be between 37.5 to 188. Ferratin has since dropped to 29 the range is 24 to 200 I cant tolerate any iron. I have started to take a folate supplement to boost my low folate Methyl Folate 5-MTHF Do you know if this one is suitable as I havent been tested for the MTHFR gene but thought this might be best for my poor intestinal absorption. Sorry for all the questions!. Please advise if I need to be starting a new thread

[SeasideSusie Remembering in reply to Rock_chick1]

You have a very good Active B12 compared with your Serum B12. Do you supplement with B12 or a B Complex?

The methylfolate supplement should be fine, it's the converted form of folic acid and fine for most people.

As for Ferritin, if you can't take iron supplements then it will have to be iron rich foods. Top of the list is liver, chicken or lamb will be fine, no more than 200g per week due to it's high Vit A content. Or liver pate or black pudding.

[shaws Administrator]

Have you been diagnosed with hypothyroidism? Or is your GP one of these doctors who ignore symptoms (they know none) and is concentrating on your TSH and waiting for it to rise to 10 before you're diagnosed?

When we are on too low a dose or undiagnosed we can have awful symptoms. I can relate with you about having no strength and your FT4 is too low and FT3 nearer 6. I had problems with levothyroxine and heart was always racing - night and day but our heart needs T3 in order for our whole body to function. We have millions of T3 receptor cells and they need T3. We just don't have any clue as to why this is happening and are surprised GP doesn't know either. The aim for TSH is 1 or lower with both Frees near the top of the ranges.

thyroiduk.org.uk/tuk/testin...

Most of us have to educate doctors as in these 'modern' times they haven't a clue about symptoms and that is how we used to be diagnosed and were given a trial of NDT (Natural Dessicated Thyroid Hormones).

I'd make an appointment or leave a note in the surgery with a copy of the above link along with the following:-

thyroiduk.org.uk/tuk/about_...

You may have low stomach acid which causes symptoms similar to high acid so doctor will prescribe something to reduce it, when we need stomach acid to dissolve food. Most on this forum use a supplement, either Betaine with pepsin tablets or Apple Cider vinegar mixed with juice /water.

Phone your doctor on Monday and ask for a prescription of 50mcg of levothyroxine. You take it on an empty stomach, usually when we get up with one full glass of water and wait an hour before eating. Food interferes with the uptake of levothyroxine.

The main hormones are T3 (Active) and T4 (inactive).

[Rock_chick1]

Thank you for that. Which one so you mean as I have checked it out and there are two groups with that name. I haven't taken any supplements for a while as my stomach is so raw and I'm concerned about upsetting it further. Only Epsom salts baths. But I know that glycinate is gentler on the stomach. Is there one you can recommend please