I’m new to the forum so please bear with me. I was diagnosed with an under active thyroid in May 2018, doctor started Levothyroxine at 25mg, gradually increasing to 125mg overtime with my last results 4.35 ulU/ml (Range 0.34-5.6) serum T4 11.6 pmol/L (Range 6.50-17.0), T3 has never been tested.
As my doctor now thinks that I’m well within range whilst taking 125mg Levo, I thought I would get medichecks ultravit done. I’m continuing to suffer from extreme fatigue, severe aches and pains all over my body, very low mood, constipation and fed up with falling asleep mid afternoon if I sit down, life is passing me by.
Medichecks came back with the following so looking for any help and advice please
Inflammation CRP HS 13.65mg/L (Range < 5)
Ferritin. 45.7 ug/L (Range 13 - 150)
Folate serum. 6.69 ug/L (Range >3.89)
Vitamin B12 active 156.000 pmol/L (Range 37.5-188)
The doctors write up suggests possible Hashimotos disease. Do I now need to go back to my doctor re the Hashimoto or because she thinks my TSH is well within her laboratory testing limits will she do anything about it. Do I need to see an endocrinologist? Which I’m will to pay for privately if necessary as I feel so unwell and fed up with the whole situation. Any help or advice would be appreciated.
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Daisy1624
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With your GP's tests, yes they are within range but your GP is ignorant of the fact that 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. We have two pieces of evidence which you can show your GP to support your request for an increase in dose.
1) 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.
2) You can also refer to NHS Leeds Teaching Hospitals who say
Thyroxine Replacement Therapy in Primary Hypothyroidism
TSH Level .......... This Indicates
0.2 - 2.0 miu/L .......... Sufficient Replacement
> 2.0 miu/L ............ Likely under Replacement
As for your Medichecks results:
TSH 3.25 mIU/L (Range 0.27-4.2)
Free T3 4.67 pmol/L (Range 3.1-6.8)
Free thyroxine 14.500 pmol/L. (Range 12-22)
These show undermedication and you need an increase in Levo - 25mcg now, retest in 6-8 weeks. Continue retesting/increasing by 25mcg every 6-8 weeks until your levels are where they need to be for you to feel well.
When doing thyroid tests, we advise:
* Book the first appointment of the morning, or with private tests at home no later than 9am. This is because TSH is highest early morning and lowers throughout the day. If we are looking for a diagnosis of hypothyroidism, or looking for an increase in dose or to avoid a reduction then we need TSH to be as high as possible.
* Fast overnight - have your evening meal/supper as normal the night before but delay breakfast on the day of the test and drink water only until after the blood draw. Eating may lower TSH, caffeine containing drinks affect TSH.
* If taking thyroid hormone replacement, leave off Levo for 24 hours before blood draw, if taking NDT or T3 then leave that off for 8-12 hours. Take your thyroid meds after the blood draw. Taking your dose too close to the blood draw will give false high results, leaving any longer gap will give false low results.
* If you take Biotin or a B Complex containing Biotin (B7), leave this off for 7 days before any blood test. This is because if Biotin is used in the testing procedure it will give false results (Medichecks definitely use Biotin, they have confirmed this and the amount of time to leave the supplement off).
These are patient to patient tips which we don't discuss with doctors or phlebotomists.
The doctors write up suggests possible Hashimotos disease.
Yes, 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.
Do I now need to go back to my doctor re the Hashimoto or because she thinks my TSH is well within her laboratory testing limits will she do anything about it.
You can point out your raised antibodies and that they suggest autoimmune thyroid disease (UK doctors don't use the word Hashimoto's) but 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.
Do I need to see an endocrinologist?
Not really, not all endos attach any importance to raised antibodies, most seem to be TSH obsessed and disregard everything else, although there may be the odd one out there who does understand it. Many, many members have been extremely disappointed with their endo appointments, even private ones.
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.
Hashi's and gut absorption problems tend to go hand in hand and can very often result in low nutrient levels or deficiencies. You do have some problems there.
**
Ferritin. 45.7 ug/L (Range 13 - 150)
It's said that for thyroid hormone to work properly (that's our own as well as replacement hormone) ferritin needs to be at least 70, preferably half way through range.
You can help raise your level by eating liver regularly, maximum 200g per week due to it's high Vit A content, also liver pate, black pudding, and including lots of iron rich foods in your diet
It's not a good idea to self supplement with iron tablets unless you have had an iron panel done. If this shows a high serum iron you wouldn't want to take iron tablets as that could raise it even more and too much iron is as bad as too little.
**
Folate serum. 6.69 ug/L (Range >3.89)
Unfortunately they don't have a proper range with a bottom and top limit, but if that was my folate level I'd want it in double figures. Eat lots of folate rich foods and you could take a B Complex which contains methylfolate rather than folic acid, but choose one with a low B12 (methylcobalamin) content as your B12 level is fine.
**
Vitamin B12 active 156.000 pmol/L (Range 37.5-188)
This is a good level. Are you supplementing?
**
Vitamin D 33.6 nmol/L (Range 50-175) = 13.44ng/ml
This is poor and in the Insufficiency category. Your GP may prescribe D3 to bring it up to 50 but you would be better off buying your own supplement.
The Vit D Council recommends a level of 125nmol/L (50ng/ml) and the Vit D Society recommends a level of 100-150nmol/L (40-60ng/ml).
To reach the recommended level from your current level, the Vit D Council suggests supplementing with 4,900iu D3 daily (nearest is 5,000iu)
Once you've reached the recommended level then you'll need a maintenance dose to keep it there, which may be 2000iu daily, maybe more or less, maybe less in summer than winter, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. You can do this with a private fingerprick blood spot test with an NHS lab which offers this test to the general public:
As you have Hashi's, for best absorption an oral spray is recommended, eg BetterYou, or sublingual drops, eg Vitabay Organics.
Your GP won't know, because they're not taught much about nutrients, but there are important cofactors needed when taking D3 as recommended by the Vit D Council -
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.
Check out the other cofactors too (some of which can be obtained from food).
Don't start all supplements at the same time. Start with one, leave it 1-2 weeks and if no adverse reaction then add the second one. Continue like this. If you have any reaction then you will know what caused it.
Thanks so much for such a comprehensive answer. I don’t take any medications other than Levothyroxine and I don’t take any vitamins or minerals at all, but obviously I need to start takings things now
B vitamins best taken in the morning after breakfast
Recommended brands on here are Igennus Super B complex. (Often only need one tablet per day, not two. Certainly only start with one tablet per day after breakfast. Retesting levels in 6-8 weeks ).
Or Jarrow B-right is popular choice, but is 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
Your antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).
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
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Thyroidectomy or not? Thyroidmegaly and multi modular goiter. 
methinks it's time to add some T3......thoughts ?
Teva, Teva, every where, Nor any tab of Venc
Novothyral 
