I recently had thyroid ultravit test with medi check, I was diagnosed with sub clinical hypothyroidism in 2012 after going back to the doctors several times over the next year I was put on levothyroxine in Sep 2013 my TSH was 7.4. It was later increased to 50mg and by June 2014 my TSH was 22.23 I was given 100mg. over the next few years it went up and down from 0.9 to 8.63 then down to 3.63 in March this year, as I have a lot of hypo symptoms I took the blood tests, my results are as follows
Ferritin 163 (13 -150)
Folate serum. 8.49. (0 - 3.89
Vitamin B12. Active. 115. (37.5 -188)
Vit D. 60.9. (50 - 175)I take Adcal prescribed by doctor
TSH. 5.52. (0.27 - 4.2). I am on 75mg of Levo
Free T3. 4.21. (3.1- 6.8)
Free Thyroxine. 17.8. (12 - 22)
Thyroglobulin antibodies. 54.8. (0 - 115)
Thyroid Peroxidase antibodies 121 (0 - 34)
CRP HS. 2.07. (0. -5)
I realise that most of these results are within the normal range but need help to understand the abnormal results and what to do about them
I would be grateful for any help as I am fed up with all the symptoms
Thank you
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over the next few years it went up and down from 0.9 to 8.63 then down to 3.63 in March this year
This is the reason for the variation in results:
Thyroid Peroxidase antibodies 121 (0 - 34)
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. Fluctuations in symptoms and test results are common with Hashi's.
When the attack happens, the dying cells release a lot of thyroid hormone into the blood and this can cause TSH to become suppressed and Free T4 and Free T3 to be very high or over range. These are called 'Hashi's swings'. You may get symptoms of being overmedicated (hyper type symptoms) to go along with these results that look as though you are overmedicated. The hyper swings are temporary, and eventually things go back to normal. Test results settle back down and hypo symptoms may return. Thyroid meds can be adjusted slightly at these times if necessary, but will need readjusting when hypo symptoms return.
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.
Some members have found that adopting a strict gluten free diet can help, 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.
TSH. 5.52. (0.27 - 4.2). I am on 75mg of Levo
Free T3. 4.21. (3.1- 6.8)
Free Thyroxine. 17.8. (12 - 22)
These results show undermedication with such a high TSH although your FT4 isn't dire at 58% through range but could be a lot higher. 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.
Ferritin is over range. Are you supplementing? If not then raised ferritin can be caused by inflammation or infection.
Active B12 is good.
Folate, although "in range", I would prefer mine to be in double figures.
Vit D. 60.9. (50 - 175) I take Adcal prescribed by doctor
How much Adcal - what is the dosage you take?
What was your level when prescribed?
Why Adcal - it contains much more calcium than D3 - 750mg calcium : 200iu D3. Was your calcium tested and found to be deficient? If not then you don't need to supplement calcium.
Are you taking the important cofactors needed when taking D3 as recommended by the Vit D Council -
Your GP wont know about these because they don't get much training in nutrients. As you are taking calcium then they are very important.
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.
D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds if taking tablets/capsules/softgels, no necessity if using an oral spray
Magnesium helps D3 to work. We need Magnesium so that the body utilises D3, it's required to convert Vit D into it's active form. So it's important we ensure we take magnesium when supplementing with D3.
Magnesium comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds if taking tablets/capsules, no necessity if using topical forms of magnesium.
I have no idea what my vitamin D level was when I was given the adcal tablets which are 750mg each and I take 2 a day one at lunchtime and one early evening, I do have osteoarthritis so maybe that is also the reason.
I do not take a ferritin supplement.
In the past year I have had a melanoma insitu which was removed, more osteoarthritis, this time in my knees and in March this year was put on 10mg of Lipitor which will be reviewed early July when I have another cholesterol blood test at the doctors surgery. I have lots of different symptoms of hypothyroidism so am really grateful for any help.
As for the calcium, as Vit D aids absorption of calcium, and calcium is in many foods, I am not medically trained but I do wonder whether you should be taking this. I have osteoarthritis and my calcium level is absolutely fine and I don't supplement with calcium but I do take D3. I would ask your GP if your calcium was tested, if not I would ask for it to be tested now. You can see that the amount of D3 you are taking is nowhere near enough to raise your Vit D level to where it is needed. And the cofactors mentioned above are extremely important, the Vit K2 particularly so considering how much calcium you are taking on top of dietary calcium.
Raised cholesterol is a symptom of hypothyroidism. Taking statins is very questionable, particularly for females. You might find reading through this recent post informative
As said above, you have Hashi's which is the most common cause of hypothyroidism, so following the suggestions given should be helpful.
As you have Hashi's, for best absorption an oral D3 spray is recommended, eg BetterYou, or sublingual drops, eg Vitabay Organics, so you may wish to consider those instead of the prescribed tablets, and also take the important cofactors mentioned.
Since my last post I have been back to my doctor and showed her the test results from Ultravit, she did further blood tests to try and find out what was going on but they all came back within range I.e.
haematocrit 0.445 I/L. 0.36-0.46
Mean corpuscular volume 90fl. 82-98
mean corpus haemoglobin (MCH) 28.9pg. 27.3-32.6
mean corpus Hb. Conc. ( MCHM). 321g/l. 320-350
Red blood cell distrib. Width. 14.7%. 9.9-15.5
Platelet count 238 10^9/L. 150-400
Serum total 25-OH vit D level. 63 no longer/L. N/A
Serum TSH. level. 2.14mlU/L
Serum C creative protein level. 2mg/L. <5
Total white cell count. 7.5. 10^9/L. 3.7-11.1
Red blood cell (RBC) count. 4.95 10^12/L. 3.88-4.99
Haemoglobin estimation. 143g/l. 120-150
Neutrophil count. 4.1 10^9/L. 1.5 - 7.4
Lymphocite count. 2.3 10^9L. 1.1 - 4.0
Monocyte count. 0.6. 10^9/L. <0?95
Eosinophils count. 0.4. 10^9/L. 0.0 - 0.7
Basophils count. 0.1. 10^9/L. <0.2
Erythrocyte sedimentation rate 2mm/hr. 1-15
These test were done to find out why my Ferritin level was 163. 13-150
Thyroid peroxidase antibodies 121. . 0-34
TSH 5.52. 0.27-4.2.
My doctor did not mention anything about Hashimoto or autoimmune, I did ask why results fluctuate so much and she, said maybe I had a bit of infection (none that I am aware of)
This is not much better than your previous result.
Have you increased your dose of D3 as suggested above?
Have you started to take D3's important cofactors as mentioned above?
Did you ask for calcium to be tested as suggested above?
Serum TSH. level. 2.14mlU/L
This still shows undermedication. As mentioned above 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. You should have an increase in our dose of Levo of 25mcg Levo and retest in 3 weeks. If your GP says you don't need it, ask for FT4 and FT3 to be tested.
Also, point out that 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.
My doctor did not mention anything about Hashimoto or autoimmune, I did ask why results fluctuate so much and she, said maybe I had a bit of infection (none that I am aware of)
As mentioned above, 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. An infection would not raise thyroid antibodies. In fact, the fact that you have Hashi's could be the cause of your raised ferritin. Ferritin can be raised with infection or inflammation. Hashi's is an autoimmune disorder and can cause inflammation. You might want to show this NHS article to your GP:
I did not start taking Vit D3 as I wanted to wait until after I had the results of the latest blood test (I thought they would be more accurate following the ultra vit bloods which showed abnormal results).
I have purchased a vitamin D3 spray also selenium tablets and printed off articles on gluten free diets, all of which I will now start taking.
I assumed my doctor had tested me for calcium along with the vitamin D test due to being given the adcal tablets.
I asked in the past about T3 testing and was told I did not need it.
I was told that my TSH 4 was as it should be and that I was on the correct dose of Levo thyroxine.
I will print off the article you mentioned by Dionne at TUK and take that along with me at my next appointment.
Most GP's are clueless about the difference between being hypothyroid due to autoimmune thyroid disease (Hashimoto's) and just being hypothyroid
With Hashimoto's we frequently need TSH very low, to stop,the wild fluctuations in levels
Most important results are FT3 and FT4. TSH is frequently very unreliable as levels swing so much
SeasideSusie or humanbean may comment on iron results
I don't know much about iron, but these results seem to suggest Anaemia
MCH & MCHM very near bottom of range
Red blood cell width - right at top of range
Vitamin D is too low for someone with Hashimoto's. But as result is over 50nmol, its too high for NHS prescribed vitamin D. You will need to self supplement to improve vitamin D to at least 80nmol and around 100nmol may be better
Getting Coeliac blood test before trying strictly gluten free diet
Push GP to increase dose of Levothyroxine by 25mcg and get retested 6-8 weeks later
Thank you so much for your response. I think I had a blood test for Coeliac a year or so ago.
I will print off the article by Dionne at TUK as recommended and go back to the doctor again. I will do as you suggest and ask for an increase in levothyroxine.
See your GP for 25mcg dose increase in Levothyroxine and bloods should be retested 6-8 weeks later
As SeasideSusie says, your vitamin D is still too low. Better You vitamin D mouth spray works best when we have Hashimoto's
Have you ever tried strictly gluten free diet?
Gluten free diet many of us with Hashimoto's
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
While still eating high gluten diet 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
If you have an underactive thyroid (hypothyroidism), treatment may be delayed until this problem is treated. This is because having an underactive thyroid can lead to an increased cholesterol level, and treating hypothyroidism may cause your cholesterol level to decrease, without the need for statins. Statins are also more likely to cause muscle damage in people with an underactive thyroid.
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).
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
NHS guidelines on Levothyroxine including that most patients eventually need somewhere between 100mcg and 200mcg Levothyroxine.
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