I have had Hashimotos for 30 years, (now 61). Had part of my small bowel taken out because of adhesions 13 years ago.
I read somewhere that sometimes after bowel surgery more thyroid may need to be taken to be efficient My query is would the same levels of T4 be floating around in my body as before the op but just not be reaching my cells and the organs? So would my T4 levels need to be on the very high side? Sorry I am not putting this very well. I am wondering how we know that even though our levels are showing fine, is the Med reaching the cells and organs?
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smilingjane
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Morning smilingjane 🤗 Yes I think you’re right, it’s mostly absorbed in the small intestine, this is one reason why I always take a glass of water with my tablets in the morning and on an empty stomach as it’s pushed into the small intestine more quickly.
So yes you may need a higher dose than someone who hasn’t had this type of surgery.
But you should be able to adjust and monitor with blood tests and symtoms just as everyone else does as the blood tests show what’s circulating. I take you are feeling symptomatic because you’ve written this post?
Most of us Hashimotos patients need a much higher level of FT4/FT3 and our TSH is lower than those without the condition. So maybe you are ‘in range’ and so your GP is saying ‘no action needed’ but actually you still feel symptomatic. I would therefore push for an increase.
Whatever you’re absorbing would reflect in your blood tests and no two people are the same regardless of whether or not they’ve had bowel surgery.
I’m not medically trained and I might have got that completely wrong 😬 but it sounds right to me.
Do you have recent blood test results? Do you taken vitamin and mineral supplements? There are a lot of mouth sprays available that would be better for absorption, have you tried these?
I do take vit supps but space them out from all other meds.
Thing is how do I know that T4 etc is actually being absorbed by my cells and organs? Because my levels are showing up as fine in my blood stream, does that mean they are actually reaching the cells etc?
So basically your blood tests are good and so therefore you should be feeling well but are you not feeling well? Are you still symptomatic?
Good replies from the more educated members of the forum who know they’re science. I’m all about the feels 🤗😂
How do you feel? That’s the best question. If you feel good I’d assume that cellular action is Aokay 👌 If not then you need a Levo increase. It would be best to get a FT3/4 test before you do this so you can actually see what your conversion is like 🥰
Your last post indicated you had good levels of T4 circulating. However the Levo you are taking is a storage hormone and it is the FT3 that is the ACTIVE thyroid hormone needed in every cell of your body to function well. Also you are only over-medicated if your FT3 is over range - from reading the post/replies above it had not been tested so reducing based on the TSH is wrong. Having thje FT4 and the FT3 tested at the same time would indicate if you are converting well into the Active hormone. Conversion is aided by good levels of the vitamins and minerals mentionbed below ...
Did you manage to have the B12 - Folate - Ferritin - VitD tested as suggested in your post above ?
I dont really understand about the in range concept? For example my Ferratin is 150 which I understand to be fine, but where is there a range in that and what does that mean?
I sort of understand the Hypothalus/patuitary gland and thyroid but my difficulty is understanding why our bodies can be seen by blood tests to be free moving with plenty of t3/4 and yet it is not being effective, why??
The range is usually written after the result. eg. B12 356 ( 180-900 ) So a result that is in range and will be declared normal/fine/ok by your GP however you may feel better with a higher level. ( just an example ! )
The link I gave you above describes the workings of the thyroid - did you have a read ? thyroiduk.org
The blood test tells us what is circulating but not what is in the cells where it is needed ... but it's the best we can do 😊 The more we have circulating - the more chance we have of enough reaching our cells to enable us to feel better.
Did you see the actual results of your vitamins and minerals ? They all need to be optimal for good conversion of the T4 ( inactive ) into the ACTIVE T3 needed in every cell of your body ... hope that helps 😊
If I've understood you correctly, you're talking about Thyroid Hormone Resistance - poor absorption at a cellular level, which has nothing to do with the gut. There is no test to see what gets into the cells. But, people with THR usually have good levels of hormone in the blood, but still suffer from hypo symptoms. It something very few doctors have any understanding of, so can be difficult to convince them, I'm afraid.
Hi Greygoose, forgotten whether I replied or not, so to say thank you. I have another answer to my questions. Yes its the THR aspect. I wander if an endo would be more helpful than GP.
Bowel surgery would not affect thyroid hormone action in the cells. (thyroid hormone always reaches the cells and organs, except in some very rare genetic disorders). Bowel surgery can affect blood hormone levels. It can reduce absorption of thyroid hormone tablets. Also, thyroid hormone is recycled, it enters the gut and is reabsorbed. So, bowel surgery can theoretically affect T4 and T3 levels (even if you are only taking levothyroxine). I think it's important you have TSH, fT3 and fT4 measured to make sure you have good fT3, fT4 levels.
Your previous post mentioned:
Serum TSH level 0.12 mu/l 0.30 - 4.50 mu/l
Serum free T4 level 21.2 pmol/L 10.00 -22.00pmol/
Consistant with levothyroxin over replacement.
These results are perfectly OK if on levothyroxine. The comment would have been made by a biochemist who has no knowledge of hypothyroidism, they only see the numbers not patients. It is usual to see fT4 near the upper limit and TSH a little low in patients treated with levothyroxine, this profile is needed to obtain normal T3 levels. i would avoid any investigations into 'chronic fatigue', it's used as a means of putting the blame on the patient when they should be properly investigating hypothyroidism. You need TSH, fT3, fT4 measured as a first step. It's difficult for GPs to get fT3 tested, they have to put their foot down and tell the biochemist it must be done.
smilingjane I think that you are confusing different issues. When something is taken orally, whether food or drugs say, it needs to get from the GI tract to the blood supply, and there are different factors that can affect that - low stomach acid, hypo or hyper gut motility, leaky gut, surgery etc. So when absorption is affected in that way, you might need to take steps to improve it, which will depend on the problem you have eg meds to improve gut transit, dietary exclusions to improve leaky gut, taking meds designed to avoid the oral route ie by sub-lingual or bucal administration for instance, or increasing the dose of any oral meds required, beyond that which might otherwise be needed, etc. Whether or not you are absorbing any oral meds taken, and how well, will be demonstrated by their levels in your blood. But that is entirely different and separate from whether your FT3, the active thyroid hormone, is taken up by cell receptors and utilised by the body.
Thank you so much for that. I am starting to understand the complexities of absorption and the whole digestive system. Very complicated. Thank you again for taking time out to reply. I will continue to research what you have written to understand .....
Saw your other post requesting info on thyroid specialists
BEFORE seeing any thyroid specialist we would ALWAYS recommend getting FULL Thyroid and vitamin testing
For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also EXTREMELY important to regularly retest vitamin D, folate, ferritin and B12
Low vitamin levels are extremely common, especially with Hashimoto's
What vitamin supplements do you currently take?
Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water . 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
Vitamin levels need to be optimal, not just within range
Vitamin D at least around 80nmol and around 100nmol may be better
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I am going to talk to my GP and request that these tests are done,
New here. 
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