In march I ordered a private thryoid test after having symptoms of fatigue and muscle pains.
My results were:
TSH: 4.41 (0.27 - 4.2)
FT3 : 5.02 (3.1 - 6.8)
FT4: 16.8 (12 - 22)
Thyroglobulin Antibodies: 1772 (0 - 115)
Thyroid Peroxidase Antibodies: <9 (<34)
I then went to the doctors were they did the nhs tests there which came out similar to the ones above (but forgot to ask for a printout so i dont have the results for that one) but didnt include the antibody tests. They started me out on 50mcg levothyroxine.
I then had more nhs tests at start of June where the doctor told me my tsh had just come back into range but not by much. He didnt mention what my ft4 levels were and i forgot to ask for printout of results again. He bumped me up to 75mcg levo.
I just had another medichecks done this week after 8 weeks on 75mcg levo, and also vitamin levels done Test was done early morning with 24 hours break from levothryroxine. Results were:
TSH: 1.21 (0.27 - 4.2)
FT3 : 3.83 (3.1 - 6.8)
FT4: 23.2 (12 - 22)
Thyroglobulin Antibodies: 409 (0 - 115)
Thyroid Peroxidase Antibodies: 10.9 (<34)
Vitamin D: 50.9 nmol/l (50-175)
Ferritin: 139 ug/l (30 - 400)
Follate serum: 4.24 ( >3.89)
B12 active: 105 pmol/l (37.5 - 188)
Still feeling fatigued and tired. I can see i need to start taking a follate and vitamin d supplement. Im a bit concerned that my ft4 level is quite high and my ft3 level has actually decreased from back in march.
Any advice on possible next steps would be much appreciated!
John
Written by
JPM90
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When FT4 is high and FT3 much lower it shows that you aren't converting well, don't let your doctor reduce your medication as that will make your FT3 even lower and that's the active hormone. As you say vits are low and these should be optimal for good thyroid health. So you are correct to increase the low vitamins. Look at SeasideSusie's posts for guidance on what you are aiming for but I completely reversed mine doing that plus they can help with some symptoms you may have as well as improving general well being. If you find though that you are still low you may have to add in a little T3.
First of all, please remember to always ask for a print out of your results from the receptionist at your GP surgery. It is a valuable tool for the future. Make a spreadsheet:
Date > name of test > result > reference range > dose of thyroid meds > notes on how you feel > whether dose was altered
This way you can refer back to it if your GP ever wants to change your dose and you know that it will make you worse, you can point out how you previously felt and where your levels were on whatever dose.
Your original private test in March showed these:
Thyroglobulin Antibodies: 1772 (0 - 115)
Thyroid Peroxidase Antibodies: <9 (<34)
Did you have comments with your results? If so it would have pointed out autoimmune thyroid disease aka Hashimoto's because of your very high Thyroglobulin antibodies.
Hashimoto's which is where the thyroid is attacked and gradually destroyed. Fluctuations in symptoms and test results are common with Hashi's.
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.
Vitamin D: 50.9 nmol/l (50-175) = 20.36ng/ml
This is too low. 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, based on the Vit D Council's suggestions you could supplement with 3,700iu D3 daily, nearest is 4,000iu.
As you appear to have Hashi's, for best absorption an oral spray is recommended - BetterYou, or you could look at sublingual liquid, both of these bypass the gut as they're absorbed through the mucous membranes in the oral cavity.
When 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:
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).
Ferritin: 139 ug/l (30 - 400)
Ferritin is recommended to be half way through range although I have seen that for males 150 is a good level. You're not far off that so I would just include some liver in your diet every week or two, no more than 200g per week due to it's high Vit A content. Other iron rich foods are liver pate, black pudding and some are listed here
This is pretty good result. Below 70 suggests testing for B12 deficiency, over 100 is OK.
Follate serum: 4.24 ( >3.89)
Although over the low limit, this is very low and I'd want mine into double figures. Folate rich foods can help but also I'd be taking a good B complex containing methylfolate (not folic acid) and as most B Complex supplements contain B12 then it should be methylcobalamin not cyanocobalamin. A good B Complex with 400mcg of each is Thorne Basic B. There is also Igennus Super B but at the recommended dose of 2 tablets it gives 400mcg methylolate but 900mcg methylcobalamin which isn't really necessary with your B12 level, so my suggestion is to go for the Thorne Basic B at the recommended dose of 1 capsule. That raised my bottom of range folate to the top of range in 2.5 months at the recommended dose.
When doing future thyroid tests, ensure you leave off Biotin/B Complex for 7 days before testing as when biotin is used in the testing procedure (which most labs do and Medichecks have confirmed they do) then it gives false results.
TSH: 1.21 (0.27 - 4.2)
FT3 : 3.83 (3.1 - 6.8)
FT4: 23.2 (12 - 22)
Still feeling fatigued and tired. I can see i need to start taking a follate and vitamin d supplement. Im a bit concerned that my ft4 level is quite high and my ft3 level has actually decreased from back in march.
The aim of a treated hypo patient generally is for TSH to be 1 or below or wherever it needs to be for FT4 and FT3 to be in the upper part of their reference ranges, if that is where you feel well.
Your FT3 is very low compared to your over range FT4, and it's low T3 that causes symptoms. This suggests that you need less Levo and add in T3. However, before adding T3 it's best to optimise nutrient levels. I'd work on your Vit D and folate for 3 months, retest and see where those levels lie and whether your FT4/FT3 balance has improved.
JPM90, I'd agree with others that your latest rests suggest you need T3 in addition to your Levothyroxine because conversion is poor.
It is worth trying to raise vitsmins and maybe try being gluten free before that, as your conversation may improve.
Unfortunately on the NHS at the moment it's very hard to get a prescription for T3.
Something that may explain your lowering T3, when you were first diagnosed your actual hormone levels look very good. A person with a healthy thyroid will have freeT4 and freeT3 in the middle of the range. Yours were around that point in your first set of results. But TSH was raised, which is the bodies way of indicating it wants more hormone, alongside high antibodies. Something we often see with freeT3, though, is that the body will pull out all the stops to keep it at a good level while the thyroid is failing. Its quite common to see hypothyroid sufferers smith quite good looking freeT3 results when they are diagnosed. It seems to be the case on the forum that this inflated freeT3 doesn't actually prevent symptoms.
It's possible that was your situation, and now that you're taking thyroid hormone replacement your body is no longer in this mode of very efficiently converting to T3.
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