I wonder if anyone can help with an analysis of my results (below) v current medication? The GP says my TSH is normal but I am not sure - I have severe fatigue still. (the first column is the date, the second is the Serum TSH level (mU/L - range 0.35 - 5.5), the third is the Serum free T4 level (range 10.0 - 19.8) and the last column is the medication dose (Levothyroxin):
16.03.17 7.7713.725mg
21.06.17 4.8814.825mg
27.09.17 3.8915.0 25mg
09.01.18 10.7713.950mg
26.02.18 8.3111.150mg
09.04.18 5.2615.675mg
11.09.18 8.4515.775mg
22.10.18 8.2814.275mg
01.04.19 10.6712.9
Many thanks in advance
John
Written by
JFD1
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It's difficult to make sense of your results all squashed up like that.
Much easier to read when put it like this
Date
TSH: xx (range)
FT4: xx (range)
xxmcg Levo
So assuming your latest results are
TSH: 10.6 (0.35 - 5.5)
That alone says you're very undermedicated.
When on Levo only, 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.
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 tukadmin@thyroiduk.org print it and highlight question 6 to show your doctor.
So your results are worse witha higher TSH and lower FT4. You appear to have been undermedicated for a long time.
The Serum thyroid peroxidase antibody concentration tested in June 2017 was 81 iu/ml (range0.0 - 60.0).
Your raised antibodies mean that you are positive for autoimmune thyroid disease aka Hashimoto's which is where the thyroid is attacked and gradually destroyed. Did you already know that? Fluctuations in symptoms and test results is common with Hashi's.
Most doctors dismiss antibodies as being of no importance and know little or nothing about Hashi's and how it affects the patient, test results and symptoms. You need to read, learn, understand and help yourself where Hashi's is concerned.
You can possibly help reduce the antibodies by adopting a strict gluten free diet which has helped many members here, although there is no guarantee.
Gluten contains gliadin (a protein) which is thought to trigger autoimmune attacks so eliminating gluten can help reduce these attacks.
You don't need to be gluten sensitive or have Coeliac disease for a gluten free diet to help.
Supplementing with selenium l-selenomethionine 200mcg daily can also help reduce the antibodies, as can keeping TSH suppressed.
Hashi's and gut absorption problems tend to go hand in hand and can very often result in low nutrient levels or deficiencies. Do you have current levels of Vit D, B12, Folate, Ferritin?
Which brand of Levothyroxine are you currently taking?
Is it Teva?
Many many people react badly to Teva
Politely INSIST that vitamin D, folate, ferritin and B12 are tested too
Low vitamin levels are EXTREMELY common when under medicated
Your results show you are very hypothyroid
Gluten intolerance is very common with autoimmune thyroid disease (Hashimoto's)
Ask GP to do coeliac blood test just to rule this out before trying strictly gluten free diet
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
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