I have been taking thyroxine for about 30 years. My TSH usually comes back “within normal rage”. My last blood test but must have been out of range as I was asked to increase my thyroxine dosage to 125 mcg daily (it had been 125 mcg every other day). I was feeling particularly tired and awful at the time and the increase didn’t help so I recently sent for a Bluehorizon thyroid test and the results are below.
CRP 0.66 mg/L (<5.0)
Ferritin 131.0 ug/L (13-150)
TSH 0.68 mlU/L (0.27-4.20)
T4 Total 91.7 nmol/L (66-181)
Free T4 16.30 pmol/L (12.0-22.0)
Free T3 3.69 pmol/L (3.1-6.8)
TPO abs 156.0 klU/L (<34)
TG abs 771 kU/L (<115)
Vit B12 229 pmol/L (145-300 insufficient)
Folate 8.29 nmol/L (8.83-60.8)
Any help with results greatly appreciated. I am seeing GP on Monday to discuss.
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sweepandollie
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I take it the GP only tests TSH? Are you labs always done early morning and fasting? How long had you been on 125 daily when these tests were done? And, did you leave a 24 hour gap between your last dose of levo and the blood draw?
Your FT3 is still very, very low. Not surprising you have symptoms. Your FT4 is quite low, too. So, another increase in dose wouldn't go amiss. But, if your doctor doses by then TSH - which he shouldn't do! - then you'll probably have a battle on your hands.
Did you already know you have Hashi's?
Your vit B12 and folate are much too low. But your ferritin is good. Have you had your vit D tested?
I had been taking 125 for at least 6 months. I take thyroxine in the evening so didn’t take any as blood was taken at 8 am on empty stomach. I had no idea I had Hashi’s. Only ever had THS taken in all the years I have been taking thyroxine. They didn’t include Vit D test. Thanks for your help. Also having trouble with gut. Think I will have to lay it on thick at the doctors.
Ah, so you left rather a long time between your last dose of levo and the blood draw - about 36 hours? That means you have a false low FT4, there. You should only leave 24 hours. So, perhaps you don't need an increase in levo, and you are just a poor converter. But, those labs aren't really very helpful because the FT4 isn't correct, I'm afraid.
Do you know how Hashi's works? Here's a brief run-down:
Hashi's is an autoimmune disease, where the immune system attacks and slowly destroys the thyroid.
After every attack, the dying cells release their stock of thyroid hormone into the blood stream, causing the levels of the Frees to shoot up - FT4 to around 30 something, FT3 around 11/12 - and the TSH therefore drops to suppressed.
There is no knowing how long these high levels will persist, but eventually, they will drop by themselves as the excess hormone is used up or excreted, and not only will you become hypo again, but slightly more hypo than before, because there is now less thyroid to make hormone.
Therefore, it's very important that your doctor does not reduce your prescription, because you’re going to need it again! If you start to feel over-medicated at that point - some do, some don't - the best thing is to stop levo for a few days, then, when you feel hypo again, start taking it again. It's very important to know one's body, and how it reacts.
There is no cure for Hashi's - which is probably one of the reasons that doctors ignore it - apart from the fact that they know nothing about it, of course!
However, between the 'hyper' swing, and the descent back into hypothyroidism, there can be a phase - quite a long one, sometimes - of normality, where the person is neither hypo nor 'hyper'. This is where people sometimes start talking of having 'cured' their Hashi's, by whatever means. But, it doesn't last. Eventually, you will go hypo again.
But, there are things the patient can do for him/herself to help them feel a bit better.
a) adopt a 100% gluten-free diet. Hashi's people are often sensitive to gluten, even if they don't have Coeliac disease, so stopping it can make them feel much better. Worth a try. Some say that going gluten-free will reduce antibodies – I’ve never seen conclusive proof of that, but, you should be aware that even if you get rid of the antibodies, you will still have Hashi's, because the antibodies are not the disease.
b) take selenium. This is not only reputed to reduce antibodies, but can also help with conversion of T4 to T3 - something that Hashi's people often find difficult.
c) the best way to even out the swings from hypo to 'hyper' (often called Hashi's Flares, but that doesn't really sum up the way it works) is to keep the TSH suppressed. This is difficult because doctors are terrified by a suppressed TSH, for various false reasons, and because they don't understand the workings of Hashi's. But, TSH - Thyroid Stimulating Hormone (a pituitary hormone) - tries to stimulate the thyroid to make more hormone, but it also stimulates the immune system to attack. So, the less gland activity there is, the less immune system activity there will be, meaning less attacks, gland destruction slowed down and less swinging from hypo to hyper and back.
With the rather long delay between testing and taking T4, you might have lost 5-10% of your stable T4 level when tested. But even then your FT4/FT3 ratio is 4.4/1. That's on the edge of inefficient conversion and with the delay between taking T4 and measuring, that ratio would be higher had you only been say 12 hours before testing. So you might be a cndidate for some T3 in addition to T4. This needs retesting in proper conditions.
I think you need to increase your folate and B12 as a first step. Your GP should give you a loading dose of B12 injections. Thyroid hormones cannot be used properly by the body if certain vitamins and minerals are low. Vitamin D needs taking as well. Sorting these out might help you feel better.
What are your gut symptoms? I am convinced that Vitamin C is very good for tummy problems. My child has been cured of chronic constipation after taking it for a month and it is known to help absorbtion of both iron and thyroid hormones. I imagine it helps people absorb nutrician all round. Acid indigestion may well be down to needing more thyroid hormones.
I have dreadful trouble with flatulence especially at night. The pains wake me up. Also greasy foods give me gut pains. Not been diagnosed with IBS but am pretty sure I have it. I therefore avoid almost all foods which are wind inducing. I also have food intolerances - wheat, eggs and cow’s milk. Don’t have acid indigestion. I do eat a lot of fruit so no constipation!
Not sure what to suggest. Peppermint tea and maybe try the vitamin C it is good for you anyway.I use some digestive enzymes called 'super enzymes' by NOW available on amazon, they are good for tummy gripes.
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