My wife was recently diagnosed with Hashis - I posted her blood results 3 months ago on here and received excellent advice.
A summary of her blood BEFORE treatment ->
TSH H 5.00 0.27 - 4.20 mIU/L
Free T4 14.10 12.0 - 22.0 pmol/L
Free T3 3.64 3.1 - 6.8 pmol/L
Immunology
Anti-Thyroidperoxidase abs H 37.3 <34 kIU/L
Anti-Thyroglobulin Abs H 200 <115 kU/L
She was given levothyroxine at 50mg for 4 weeks, then the dose was up'd to 100mg which she has been taking for the last 2 months. She has not been feeling a whole lots better, perhaps some improvement in the stability of her symptoms, but over all only a mild improvement I would say. She just repeated her blood and the results are as follows ->
Things to note are that she now has very high FT4 but her FT3 has only increased marginally. Does this suggest a conversion problem?
I note the her Iron levels are on the low side, could that explain the lack of conversion? I included her sex hormones too as I think they are a bit whacky too - Estradiol seems very high and that is raising SHBG and killing her free testosterone - this may not be with the scope of this forum tho.
She will she the Doc next week but I think we may need the help of a private Doc if she need to take T3, not sure NHS are doing that any longer?
Any thoughts on these results on ideas about her next steps would be much appreciated
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Ayea
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These all need to be optimal for good thyroid conversion
Yes her ferritin is very low and definitely won't be helping
What supplements is she currently taking?
Eating liver or liver pate once a week, plus other iron rich foods like black pudding, prawns, spinach, pumpkin seeds and dark chocolate, plus daily vitamin C can help improve iron absorption
Yes she did have those vitamins tested too, here are the results ->
Vitamin D (25 OH) 113
Deficient <30 nmol/L
Insufficient 30 - 50
Consider reducing dose >175
Vitamin B12 H 688
Deficient <145 pmol/L New range
Insufficient 145 - 300
Consider reducing dose >569
Serum Folate 35.50 (8.83 - 60.8 nmol/L)
I followed the advice given here (by you and Seaside Susy) after her first results and we have successfully boosted her vitamin D and the other vits seem good too. Her B12 always comes back on the high side, even when she is not supplementing. She is now on B vit supplement but it didnt make much difference to the B vit results. Everything seems good with the exception of her Iron. Her iron always falls low if she is not supplementing - when she supplements iron it improves.
Really what I am wondering, does this look like a conversion issue and if so will correcting the iron alone be enough for that to resolve - does iron have that much of an impact on this?
Her FT4 has gone up dramatically so the levo is working, but the FT3 has not moved much at all, so she is not really seeing the benefits.
Serum iron: 55 to 70% of the range, higher end for men - hers is 8%
TIBC (total iron binding capacity): Low in range indicates lack of capacity for additional iron, high in range indicates body's need for supplemental iron - hers is high in range
Saturation: optimal is 35 to 45%, higher end for men - hers is low at 13.97%
Ferritin: Low level virtually always indicates need for iron supplementation, high level with low serum iron/low saturation indicates inflammation or infection - hers is very low in range
This is likely to be part of the problem. Ask GP for a full blood count, this will show if she has anaemia, possibly iron deficiency anaemia with these iron results. These results don't indicate self help with these levels.
As SlowDragon says, testing Vit D, B12 and folate are also essential.
yes she had a full blood count too - and she follows a gluten free and dairy free diet...
Now 3 months ago her iron level appeared to be HIGH so the Doc told her to STOP supplementing iron...
3 month ago her iron and FBC looked like this ->
Full Blood Count
Haemoglobin 141 120 - 160 g/L
Red Blood Cells 4.34 3.80 - 5.80 x1012/L
Haematocrit 0.418 0.350 - 0.470 L/L
Mean Cell Volume 96.5 81 - 98 fl
Red Cell Distribution L 10.9 11.5 - 14.4 %
Mean Cell Haemoglobin 32.6 27.0 - 33.0 pg
MCHC 338 300 - 350 g/L
Platelets 315 150 - 400 x109/L
MPV 10.10 7 - 13 fl
White Blood Cells 3.7 3.0 - 10.0 x109/L
Neutrophils 2.21 2.0 - 7.5 x109/L
Lymphocytes L 1.09 1.2 - 3.65 x109/L
Monocytes 0.23 0.2 - 1.0 x109/L
Eosinophils 0.09 0 - 0.4 x109/L
Basophils 0.05 0 - 0.1 x109/L
Biochemistry
Albumin 43.5 35 - 50 g/L
Total Protein 68.6 60 - 80 g/L
Globulin 25.1 19 - 35 g/L
HbA1c-(IFCC) 30 20 - 42 mmol/mol
Iron 32.6 5.8 - 34.5 umol/L
Ferritin 42.0 13 - 150 ug/L
Transferrin Saturation H 57.00 20 - 50 %
TIBC 57.21 45 - 72 umol/L
CK H 277 26 - 192 IU/L
So 3 months ago IRON was top of range and Transferrin Saturation was high - she stopped supplementing iron - within 3 month her levels dropped to this ->
her full blood iron results taken NOW are
Full Blood Count
Haemoglobin 127 120 - 160 g/L
Red Blood Cells 4.05 3.80 - 5.80 x1012/L
Haematocrit 0.368 0.350 - 0.470 L/L
Mean Cell Volume 90.9 81 - 98 fl
Red Cell Distribution 12.2 11.5 - 14.4 %
Mean Cell Haemoglobin 31.5 27.0 - 33.0 pg
MCHC 346 300 - 350 g/L
Platelets 277 150 - 400 x109/L
MPV 10.10 7 - 13 fl
White Blood Cells 4.3 3.0 - 10.0 x109/L
Neutrophils 2.56 2.0 - 7.5 x109/L
Lymphocytes 1.20 1.2 - 3.65 x109/L
Monocytes 0.39 0.2 - 1.0 x109/L
Eosinophils 0.07 0 - 0.4 x109/L
Basophils 0.03 0 - 0.1 x109/L
Biochemistry
Albumin 38.7 35 - 50 g/L
Total Protein 61.9 60 - 80 g/L
Globulin 23.2 19 - 35 g/L
HbA1c-(IFCC) 31 20 - 42 mmol/mol
hs-CRP 0.19 <5.0 mg/L
Iron 8.1 5.8 - 34.5 umol/L
Ferritin 18.5 13 - 150 ug/L
Transferrin Saturation L 13.97 20 - 50 %
TIBC 58.00 45 - 72 umol/L
CK H 221 26 - 192 IU/L
So she went from High to low quite quickly as soon as she stop supplementing iron.
So when you say her Iron result dont indicate self help - do you mean she needs help beyond using supplements herself?
She started taking an iron supplement as soon as she got these results - hopefully that will raise her level quickly.
Her vits are ->
Vitamin D (25 OH) 113
Deficient <30 nmol/L
Insufficient 30 - 50
Consider reducing dose >175
Vitamin B12 H 688
Deficient <145 pmol/L New range
Insufficient 145 - 300
Consider reducing dose >569
Serum Folate 35.50 8.83 - 60.8 nmol/L
So these seem good (she supplemented after her first results showed she was low on all of these vits - that seems to be good now)
So what should her next steps be - supplement iron again and she if the FT3 improves?
So what should have happened, instead of stopping iron supplements, her doctor should have suggested a lower dose to maintain a decent level. Obviously there is a reason why she doesn't hold onto it once she stops supplementing, so a maintenance dose would be in order. Whatever she was taking which raised her level before, she should be able to find a dose which keeps her levels good but not too high. But you could always ask her GP why her levels dropped so dramatically when supplements stopped and maybe that could be investigated.
I would get her iron results up again, retest then see what her conversion is like. If still not good enough maybe consider adding T3.
But of course, having Hashi's always complicates things and thyroid levels will fluctuate.
I am very grateful. We will see how supplementing iron works but I am considering moving her care to a good private specialist as the NHS, with the best will in the world, just does not seem to be treating this condition - especially if T3 is required!
My wife took these result to her GP and his recommendation was to cut her Lovethyroxine from 100mg to 50mg and retest in 6 weeks...! Does that make any sense to anybody?
Makes no sense to me - how's that going to help if her T3 is already low? surely she should do what has been suggested here - leave the Levo dose where it is and supplement iron -- then retested in 6-8 weeks.
I think the Doc treating her is not thinking very carefully and is a bit clueless.
She is getting a bit desperate to find someone that knows how to help her as it's now been months and months of feeling pretty rough - can anybody recommend a good doc in London area (we live in the centre but will travel a bit for the right person). Someone with up to date medical knowledge and modern practises (i.e. understands that Hashis requires treatment and will prescribe T3 if it becomes necessary).
I think cutting her dose will make her feel dreadful - especially cutting it in half!
These are my wifes results - the Docs answer to the prolactin being high is that sometimes that comes out high - not something to worry about. Her Estradiol and SHBG are also pretty high (causing the High Testosterone and low Free Testosterone). My wife is 47 so this may be the beginnings of change - not sure if this would cause prolactin to come out high. Why do you ask, do you think it is something of note?
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