Would greatly appreciate thoughts on the following recent NHS blood test results please (locally GP surgery seriously understaffed and get no chance to discuss!).
I have Hashimotos - actually persuaded the GP to test for antibodies.
(took tests as recommended, prior to taking medication, first thing in the morning. Same time each time).
I've been taking levothyroxine for about 1.5 years. From about July 2018, my TSH has been quite low, but my FT4 has crept up from 11 to 18.9, then gone back down slightly to 17.2. Is there room for improvement?
I still feel quite tired, but I have no idea if that's my medication not quite optimal, or the usual full time working mum with a 4 year old and slightly stress full life symptom!
Thank you SO much in advance, you are amazing people on here!!
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AnnieOK
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Ideally your FT4 should be in the top third of the range, yours is below that so plenty of room for improvement so more medication. Sadly with no FT3 result we have no idea as to whether you are a.good converter of T4 to T3 so your FT3 could be too low and as it's the active hormone that's not the best place for that to be. You could ask your doctor to test Vit D, B12, folate and ferritin and post your results for advice. These 4 help your thyroid work better but they must be optimal, not just in range but they also help with conversion, can help with some of your symptoms plus being good for your general health. Many doctors don't realise how important nutrients are and many of us supplement for life. Medichecks so a test that is very popular which includes a full thyroid panel and vitamins and they do have special offers if ordering on a Thursday so worth looking at their site to see if that is an option for you. Blue Horizon also have offers but not as frequently. With vitamins it's best to supplement individually as things like multivits don't give you the levels of what is necessary if difficient and often contain things that don't help or negate other things in the mix.
For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also extremely important to test vitamin D, folate, ferritin and B12
Low vitamin levels are extremely common, especially if Thyroid antibodies are raised
Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and fasting. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)
Last Levothyroxine dose should be 24 hours prior to test, (taking delayed dose immediately after blood draw).
Is this how you do your tests?
Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies or all vitamins
Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have special offers, Medichecks usually have offers on Thursdays, Blue Horizon its more random
Medichecks currently have an offer on until end of May - 20% off
NHS guidelines on Levothyroxine including that most patients need somewhere between 100mcg and 200mcg Levothyroxine. Also what foods to avoid (note recommended to avoid calcium rich foods at least four hours away from Levo)
The aim of Levothyroxine is to increase the dose slowly in 25mcg steps upwards until TSH is under 2 (many need TSH under one) and FT4 in top third of range and FT3 at least half way in range
All four vitamins need to be regularly tested and frequently need supplementing to maintain optimal levels
Good article on why FT3 and FT4 are most important tests, not TSH
AnnieOK, Most people will need their TSH below range, some be quite a long way, to feel well. Unfortunately doctors are often quite ignorant about dosing thyroid hormone, so they may give you scare stories or refuse to allow a dose increase.
Most people taking Levothyroxine will need the freeT4 high in range to convert enough into T3. As others have said, without a freeT3 result, you can't tell how you're really doing. This is the number that most closely reflects symptoms.
Thanks to all that have commented. @SlowDragon that's great re: discount on medichecks, I think I'll order one today, spent too long pondering yesterday - and missed the opportunity.
Given the problem with the lack of NHS GPs and also their lack of knowledge on thyroid problems, I do find myself really worried about being looked after well. I console myself that in the whole scheme of things, given how poorly some people seem to be with thyroid problems, I seem to be relatively lucky and uncomplicated... but i worry for my future health.
I look at my 75 year old mum, who got diagnosed with hypothyroid about 15 years ago I think (nudged by her sister who had been diagnosed, and so did their mum - my gran - they've never been tested for hasmimoto's but fair assumption it is), with her osteoporosis - almost definitely caused by vitamin deficiency and I hope my health will be better!)
NHS can't/won't manage vitamins, other than to treat clear deficiencies
We have to be pro-active and maintain optimal levels ourselves. Great pity they don't explain that. Most GP's don't understand the gut connection at all
Come back with new post once you get results and ranges
If your antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease). It's likely considering the family members with hypothyroidism
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
Assuming test is negative you can immediately go on strictly gluten free diet
(If test is positive you will need to remain on high gluten diet until endoscopy, maximum 6 weeks wait officially)
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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