New User Looking for help with results - Thyroid UK

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New User Looking for help with results

Optimum_Dad
Optimum_Dad

Hi, looking for some help interprating results from medichecks

I have been diagnosed hypothyroid roughly 9 years and been on 50mcg Levothyroxine ever since, first diagnosis was because of depression and family history of Hypothyroid. Doctor actually said 'i will eat my hat if you have a thyroid problem' (always been like a beanpole) 2 weeks later i had a call 'your thyroid is undernourished can you come in' no explanation just take these and youll be better, didnt ask questions either due to the desperation that this would take away the awful feelings.

Levo gave me a boost initially but still not right with lingering lesser depression and dry skin, fatigue (2pm onwards is a struggle).

Depression got slightly better 3 years ago when lowering sugar/refined carbs and grains coupled with exercise, but depression/motivation/fatigue/dry skin is still there.

anyway results are here:

CRP HS = 0.45mg/L range 0-5

Ferritin = 304ug/L range 30-400

Folate (Serum) = 2.5ug/L range 3.89-19.45

Vitamin B12 (Active) = >300pmol/L range 37.5-188

Vitamin D = 62nmol/L range 50-75

TSH = 2.74mIU/L range 0.27-4.2

Free T3 = 3.68pmol/L range 3.1-6.8

Free Thyroxine = 15.5pmol/L range 12-22

Thyroglobulin Antibodies = 435kU/L range 0-115

Thyroid Peroxidase Antibodies = 31.8 kU/L range 0-34

Side note: diet has progressed over the 3years from low carb to Ketogenic to currently Meat, eggs, fish, cheese and very small amount of veggies. This probably explains the low folate and high B12. Been slack of late and not eating liver so need to add back in to up my folate, maybe with some greens. Eating this way has had a noticeable effect on my resilience to the depression, but its till there.. only way i can explian it sorry. Diet was awful before starting low carb journey.

Any help would be madly appreciated

13 Replies
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You are under-medicated, you may feel better when your fT4 is around 20 and your fT3 around 5.

SlowDragon
SlowDragonAdministrator

50mcg Levothyroxine is only a starter dose

TSH is too high, FT3 far too low and FT4 has plenty room for increase in dose

See GP and request 25mcg dose increase in Levothyroxine and bloods retested in 6-8 weeks

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).

Is this how you did this test?

The aim of Levothyroxine is to increase the dose slowly in 25mcg steps upwards until TSH is under 2 (many need TSH significantly under one) and most important is that 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.

nhs.uk/medicines/levothyrox...

Also what foods to avoid (eg recommended to avoid calcium rich foods at least four hours from taking Levo)

Folate is too low, deficient. GP should prescribe folic acid

Vitamin D is too low. GP will only prescribe to bring vitamin D up to 50nmol. Aiming to improve by self supplementing to at least 80nmol and around 100nmol may be better .

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

Retesting twice yearly via vitamindtest.org.uk

Vitamin D mouth spray by Better You is good as avoids poor gut function.

It's trial and error what dose each person needs. Frequently with Hashimoto's we need higher dose than average

As your TG antibodies are very high and TPO antibodies only just below top of range, you very likely have Hashimoto's

Have you ever tried strictly gluten free diet?

SlowDragon
SlowDragonAdministrator

Official NHS guidelines saying TSH should be between 0.2 and 2.0 when on Levothyroxine

(Many of us need TSH nearer 0.2 than 2.0 to feel well)

See box

Thyroxine replacement in primary hypothyroidism

pathology.leedsth.nhs.uk/pa...

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,

"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)."

You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctor

 please email Dionne at

tukadmin@thyroiduk.org

Depression is frequently linked to low FT3

SlowDragon
SlowDragonAdministrator

Have you been supplementing any vitamin B12 ?

Any multivitamins?

Any vitamin supplements at all?

If not been supplementing.....high B12 needs investigation

can be due to functional deficiency

You may inadvertently felt better on Keto type diet as this would cut gluten out

Hi, thanks for the replies!

Yes did the testing as per all the requirements mentioned.

I do not currently take supplements, I think the high b12 is due to my high meat/fish intake. I am gluten free by default.

I will definitely look into vit D supplementing and get the folate sorted via diet.

Going to call the GP and express concerns to get the Levo upped by 25mcg and see how that goes.

Worrying thing is having to get these tests done myself after 9 years to show possible hashimotos and Hashimoto never being mentioned by doctors at all.

Is there any history of Hashimoto being reversed as it is auto immune, seen some stories online but always skeptical.

Thanks again for taking the time to reply

SlowDragon
SlowDragonAdministrator
in reply to Optimum_Dad

UK medics are in the dark ages with regard to autoimmune diseases generally, and Hashimoto's especially

They only offer Levothyroxine as Treatment regardless of cause....so think it irrelevant to test as it doesn't change treatment offered

But Hashimoto's is as much a disease of the gut as the thyroid....and patients need to know

Most of us only made progress after taking control ourselves and getting FULL Thyroid and vitamin testing.

NHS testing only a TSH is completely inadequate

Hence over 100,000 members on here

Getting Levothyroxine dose increase and working on getting vitamins optimal is first step

Making sure absolutely strictly gluten free

Your B12 may be high, because other B vitamins may be low

The way someone described it to me .....all the B vitamins need to go through the gate together ....if one's missing, the others can't go through ...this may explain high B12

You might want to do further testing of MMA and homocysteine

High homocysteine would indicate B12 deficiency despite high B12 levels in blood

Using test of Homocysteine levels to check for low b12

b12-vitamin.com/homocysteine/

Good explanation on homocysteine

veganhealth.org/b12/hcy

B12 deficiency symptoms

b12deficiency.info/signs-an...

MMA and homocysteine testing (not available on NHS)

nutris.viapath.co.uk/pages/...

Or as B vitamins are water soluble you could just try Supplementing a good quality daily vitamin B complex, one with folate in not folic acid may be beneficial.

chriskresser.com/folate-vs-...

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

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

Autoimmune diseases have strong genetic connection, often running in families.

NICE guidelines on full replacement Levothyroxine dose per day is approx 1.6mcg per kilo of your weight

So if, for example weigh 10 stone = 63kg

1.6mcg x 63 = 100.8mcg dose

No joy with Gp, had a call back and TSH is bang on apparently and won’t change dosage. Mentioned the range might not be optimal for me and he went on that the range is what he has to go by. Frustrating

This thyroid panel is absolutely ridiculous for them to say is fine. Your freeT3 is in the floor, and TSH far too high.

Unfortunately sometimes we have to fight to get good care from doctors :( I'm not as good on what to do as some on the site are, so you will find good advice elsewhere. Get hold of the Dr Toft Pulse article mentioned above, get hold of the guidelines mentioned above and any other documents you can.

A friend had good success just going into the GP every week or so to say she was still unwell. You can try every GP in the practice, you may find one is more knowledgeable.

jimh111
jimh111
in reply to Optimum_Dad

TSH increases exponentially as thyroid hormones fall. Thus, the 'middle' of the interval is not the arithmetic mean. S/he needs to learn logarithms, hit him/her over the head with one of Napier's bones. Maybe ask for a second opinion or insist they speak to the local endocrinologist.

helvella
helvellaAdministrator
in reply to jimh111

Nor is it a "normal" (Gaussian) distribution. Hence applying the usual statistics applicable to Guassian distributions is inappropriate.

Your diet is pretty much the opposite of a Vegan one, and although I am not a Vegan (I am gluten, lactose and casein free and avoid processed foods and sugar) I do think that a vegan diet has a few elements in abundance that yours lacks as well as folate and they are Magnesium and non-soluble fibre which are so important for a healthy gut biome. In order to process all that protein, calcium and b12 (which is weirdly high - so please check it out) you need Magnesium. Stores of Magnesium are in the bones and muscles and these get depleted leaving our bones chalky and brittle and causing muscular stiffness and spasms.

Read (buy or borrow) The Magnesium Miracle by Dr Carolyn Dean or Dr Chaterjee's Four Pillars books. I trust these two doctors as they have to answer to other medical doctors as well as nutritionists. They are both very very smart and are successful in treating type 2 diabetes, autoimmune issues and anxiety and chronic pain.

Magnesium also helps us use vitamin D and is very anti-inflammatory. It is vital for healthy adrenal glands and helps control cortisol. Poorly adrenals can make us thyroid hormone resistant. My guess is that you are going to need to look at your adrenals as well as your thyroid and could introduce things like pumpkin seeds, Cavalo Nero or raw cacao to increase Magnesium as they are still low carb - but seriously you should supplement as our soils are low in this mineral (topical gels are very good). It works very well with b6 which may be low in you as well as folate. (B6 works with B12 and folate and Magnesium to lower homocysteine).

Thanks for the suggestions.

Hi, with regards to the comments and the doctors refusal to budge on current dose Is it worthwhile self increasing my dose of Levo from 50 to 75?

The other issue then is I only have 3 month supply which will run out in 2 months if I do. Can I purchase 25mcg or 50mcg Levo somewhere? (Please dm if I can)

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