These are my son's latest results. Currently on 175mg levothyroxine. He is still extremely tired and feels rubbish. Any thoughts please. I suspect they will lower his meds.
T4 25.4 (10.30 - 24.50)
T3 5.8 (3.50 - 6.50)
TSH 0.03 (0.30 - 5.50)
Thank you
An obvious query is has he had ferritin, folate, vit D, b12 tested and found to be optimal in these at upper half of range? His results are a tad over range but generally ok, he dosn’t want to loose much FT3 if his levo. is reduced...what about other vits/ mins like selenium, zinc, magnesium levels?
Thanks Judith. Vit levels have not been done for a while. Will have to do privately. However, trying to get a young man to take vitamins/supplements is challenging The GP is somewhat dismissive of vitamins/supplements unfortunately.
From experience, but admittedly much older than your son, I know how for eg low iron ( but still well within range) can make you feel rubbish, while as you say dr.s not bothered unless really deficient. You might find that liquid supplements where possible might be easier for your 24 year old son, as not quite as problematic to take ( with water, time gaps etc); nor quite as bad as lots of pills like old people need! Also a regime where doses are taken alternate days might be better eg ferrous fumerate one day, selenium or B complex the next etc. Once he feels better, and he realises why, he might be more cooperative! Lots of sporty/ active young people take various supplements...find some articles that make them sound ‘sexy’!
as he has Hashimoto's low vitamin levels are extremely common
He needs to retest regularly and many of us need to supplement virtually continuously to maintain optimal levels
Testing vitamin D, folate, ferritin and B12
Is he on strictly gluten free diet?
Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels
Low vitamin levels affect Thyroid hormone working
Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common.
According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps, sometimes significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)
Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies
Ideally ask GP for coeliac blood test first or buy test online for under £20, just to rule it out first
Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse
chriskresser.com/the-gluten...
amymyersmd.com/2018/04/3-re...
thyroidpharmacist.com/artic...
scdlifestyle.com/2014/08/th...
drknews.com/changing-your-d...
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Thanks SlowDragon. Will order test for vitamins, etc.
Levothyroxine 'uses up' available zinc and selenium to aid thyroid conversion... at the moment conversion looks ok, but symptoms of low zinc are particularly troublesome for men as they need it to help make serotonin and testosterone - also b6 is important ... anger can be a problem if either zinc or b6 are low and b6 is vital for energy and it improves our uptake of b12. Low b12 is a real problem for hypos, so anything that helps is a bonus. Also, as the metabolism improves with Levo, magnesium gets used up and low magnesium can be responsible for muscle cramps, anxiety and poor sleep.
I recommend you do as Slow Dragon says, but also look into supplementing zinc, b6 as p5p (absorbable form) and magnesium.. Igennus, for example, do one called Neurobalance (contains all three) to support cognitive function, energy levels and sleep which they recommend taking spaced throughout the day... although it's not a very high dose compared to some other brands, it says that uptake is better this way. In fact, there are many US and other supplement companies doing a very similar blend aimed at men and athletes... so probably worth shopping around.
healthifybody.com/zinc-and-...
I would note caution in any supplement using Magnesium Oxide - it is pretty useless in this form.
Thanks HLAB, this is great info. Funnily enough, he does get a bit snappy at times! Will look at Igennus.
No problem. The last thing you need is a young man becoming like an older grumpy one! (It is typical for older men to get grumpy with age due to their reduced testosterone levels. Zinc, Magnesium and B6 really helps.)
Also, to bring the Levo dose down a smidge may help as Popoff suggests as he'll only begin to metabolise the excess t4 into rt3 which makes one very tired (not sure this is the same as being hyper to be honest as hyperthyroidism is usually when t3 is also very high).
I am not medically trained but I am a thyroid sufferer of more than 30 years. While it is a very good idea to test the various Vitamins outlined by other contributors here, I think it looks that your son is slightly over medicated. May be for 3/4 days he could take 175 mg levothyroxine and the other 4/3 days he could reduce the dosage to 150mg and see how it goes. I have had many similar episodes such as this, corrected with small changes to the dosage. Tiredness and feeling unwell is also one of the main symptoms of hyperthyroidism. It is worth pursuing this, especially given the very low TSH and very high T4! Try this approach for 2-3 weeks and adjust slightly again. Ideally TSH should be 0.30 or slightly above and T4 in the top part of the normal range, but not above the range, to feel well.
A very good way to monitor how things develop is of course looking at the symptoms but another easy and straight forward way to monitor thyroid functioning at home is to measure the body temperature upon waking up (while still in bed but before moving around or getting up; simply taking the temperature on open the eyes) and then do the same 1 hour after breakfast (again sit down for 10 minutes and then take the body temperature) and in the afternoon. If the waking temperature is below 36.0 and below the 1 hour after breakfast, then he is likely hypothyroid and thus do not reduce dosage, otherwise it could be hyper so could reduce the dosage and measure again for 3 days. If the waking up and 1 hour after breakfast temperatures are below 36.0, compare this with the afternoon measurement. if afternoon measurement is much higher than the 1 hour after breakfast again is hypo and thus do not reduce dosage but if 1 hour after breakfast is higher than afternoon and above 36.0 then likely hyper and thus could reduce dosage. It may sound complicated but it could be informative in adjusting levothyroxine dosage at the margin. I hope that this helps.
I disagree that excess t4 causes hyperthyroidism in many of us with Hashi's - it's far more likely to get converted to rt3 which gives you those symptoms you describe which are pretty unpleasant. Hyperthyroidism is almost always a consequence of high active thyroid levels i.e. t3. The body is pretty good at knowing its limits, so, unless you have Graves' antibodies as well, Levo will stop converting to t3 once the baseline level of t4 for proper thyroid functioning is reached. But your point, about exceeding the limit is completely valid as you're correct that it will cause symptoms.
I did not imply that excess T4 by itself causes hyperthyroidism but looking at the whole picture, namely, symptoms, reasonably high T3, very low TSH and excess T4 does seem to suggest hyperthyroidism. If T3 was low and T4 very high then this could suggest that rT3 is higher and thus still hypo despite high T4 levels in blood stream but in this case T3 is reasonably high so the likelihood that rT3 is high is rather low and thus hyper is a more reasonable outcome. One thing that I have learned over the last 30 years and having read many books and research studies on this topic and managing my symptoms, is that you can never rely on a single indicator or test to evaluate thyroid levels. We are also very different and thus a bit of trail and error is needed to correct unwanted and unpleasant symptoms.
Thank you Popoff. It may be worth a private blood test to check rt3. If is was high how do you deal with that.
Given that T3 is quite high, an rT3 testing is not really necessary. There are also some issues relating to the measurement of rT3 and the interpretation of the results, which are lab specific. Anyway, if you go ahead with the rT3 test, and if the results show that it is high and out of range, the solution is neither easy nor straight forward. In that case you will need to test various Vitamines to ensure that there is no Vit deficiency that prevents the conversion from T4 to T3. rT3 will be high if for some reason a person is not converting T4 which is in the blood stream to T3 which is what is needed to support energy at the cell level. Conversion issues could be due to the digestive system and/or metabolism. Vit deficiency will cause these problem, although solutions are not straight forward. I still think that a slight adjustment of the dosage will lead to a good result in this case. I hope that this helps.
Thank you. GP has agreed to test Vit B12, D and folate, ferritin.
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