Hi, I have been taking Thyroid-S for Hashimotos for a while. Built up slowly to 3.5 grains. Reduced down to 2 grains in the past few weeks though, as felt I may be a bit hyper.
I had blood tests done through Medichecks and got results today (see photo). I don't know what meds to take now. Do I stop for a few days, take just T3?
Dr Google says that Low TSH and Low T4 could mean a pituitary problem (tumour)?
GP & Endo think I still take Levo 75mcg & Liothyronine 10mcg.
This is a typical result from someone on NDT
Any T3 in NDT (or Liothyronine) will almost always suppress TSH
FT4 is frequently very low with NDT
What about vitamin levels?
For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also very important to test vitamin D, folate, ferritin and B12
Low vitamin levels are extremely common, especially if Thyroid antibodies are raised
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).
If/when also on T3, or NDT make sure to take last dose 8-12 hours prior to test, even if this means adjusting time or splitting of dose day before test
Is this how you do your tests?
Testing needs to be 6-8 weeks after any dose change
Hi many thanks for replying. I took this test privately through Medichecks, did not test for antibodies. Did not take meds for 24hrs before testing and booked it early and fasted.
B12, Ferritin ok, Vit D was low but not deficient.
Not really sure what to do as feeling 'tired, but wired' and have constant bad headaches.
I have Annual GP blood thyroid test booked for 11th Sept. I struggled to get them to test T3/T4, even though I am prescribed Levothyroxine & Liothyronine. They wont test antibodies or vitamins either. NHS give you diagnosis of Hashimotos, then wont test antibodies again, as they dont treat the inflammation, just replace the thyroid hormones.
So you left too long between last dose NDT and blood test, so FT3 would be slightly higher after 8-12 hour gap ......Perhaps over 5.0
Yes I have Hashimoto's too. Yes NHS refuses to retest antibodies....but if they did they might learn of gluten/dairy diet connection for many people
As I only use Medichecks (as on T3 and Levothyroxine) and NHS won't test T3 (?!!!...madness) ...I always get the thyroid plus ultra vitamin test
Both my GP and endo astonished to see that, after 26 years with Hashimoto's, and still both TPO and TG antibodies very high. After endoscopy confirmed gluten intolerant (not coeliac) 3 years ago, my TPO antibodies have fallen slowly at every Medichecks test since going strictly GFree.
How low is Vitamin D ?
Aiming to improve vitamin D 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
Local CCG guidelines
clinox.info/clinical-suppor...
Government recommends everyone supplement October to April
gov.uk/government/news/phe-...
If vitamin D is low, B vitamins may be too. As explained by Dr Gominack
healthunlocked.com/thyroidu...
What were actual results and ranges on B12, folate and ferritin
All four vitamins need to be optimal for Levothyroxine, T3 or NDT
Wow! Thank you for all the info. Why can't GP's & Endos have clinics to help people with Thyroid issues, like they do with diabetes. They seem to have no clue about vitamins/hormones affecting conversion of meds or anything! When I mentioned testing to my Endo, he poo-pooed it and said " you've been on these online forums havn't you"! My vitamin results are here. I have high chloresterol and liver issues, which fits with gallstone diagnosis I had after recent (private) ultrasound scan. This cost me £60, im sure the NHS could have done it more cheaply!
FERRITIN
13 - 150 R
54.9
ug/L
VITAMIN B12 - ACTIVE
37.5 - 188 R
62.1
pmol/L
VITAMIN D
50 - 175 R
48.9
nmol/L
Perhaps your endo hasn't read the research on importance of vitamins
New NHS England Liothyronine guidelines July 2019 clearly state on page 13 that TSH should be between 0.4-1.5 when treated with just Levothyroxine
Note that it says test should be in morning BEFORE taking Levo thyroxine
Also to test vitamin D, folate, B12 and ferritin
sps.nhs.uk/wp-content/uploa...
ncbi.nlm.nih.gov/pubmed/286...
Vitamin D deficiency is frequent in Hashimoto's thyroiditis and treatment of patients with this condition with Vitamin D may slow down the course of development of hypothyroidism and also decrease cardiovascular risks in these patients. Vitamin D measurement and replacement may be critical in these patients.
endocrine-abstracts.org/ea/...
Evidence of a link between increased level of antithyroid antibodies in hypothyroid patients with HT and 25OHD3 deficiency may suggest that this group is particularly prone to the vitamin D deficiency and can benefit from its alignment.
ncbi.nlm.nih.gov/pubmed/186...
There is a high (approx 40%) prevalence of B12 deficiency in hypothyroid patients. Traditional symptoms are not a good guide to determining presence of B12 deficiency. Screening for vitamin B12 levels should be undertaken in all hypothyroid patients, irrespective of their thyroid antibody status. Replacement of B12 leads to improvement in symptoms,
Folate supplements can help lower homocysteine
ncbi.nlm.nih.gov/pmc/articl...
Levothyroxine can decrease serum homocysteine level partly; still its combination with folic acid empowers the effect. Combination therapy declines serum homocysteine level more successfully.
Low ferritin frequent in hypothyroidism
endocrineweb.com/profession...
They dont know I am taking NDT though (they think its the devils work lol). I am prescribed 75mcg Levo + 10mcg Liothyronine per day, so GP may freak out if my bloods taken on 11th Sept are similar to these.
Please don't confuse her endo with facts. His mind is made up.
Can't be of much help to you I'm afraid not starting my ndt till late Oct. But I do know thar t4 does drop and t3 increases. But I'm hope someone on here will be able to advise you as I am interested to know too 😊
Your free T3 is too low it should be in top 1/3 of the range so you could actually increase your dose of ThyroidS by 1/4 grain to see if the free T3 levels improve. If my maths is right it should be over 5.7 but not over 6.8. Or you could forget all the numbers and just follow this guide as they did in the days before levothyroxine and TSH testing
tpauk.com/main/article/trea...
Hi thanks so much for your reply. The guide seems to say to raise ndt up slowly to when you feel your symptoms disappearing. I have had symptoms since 1995 lol. Never feel better! I have to have an annual GP blood test soon and they dont understand the results anyway - as long as your in range somewhere, it doesn't matter that you feel like death! Can you feel wired, shaky, headaches etc but still on the floor with fatigue if you are undermedicated with ndt? I thought I was taking too much.
Follow that guide it says you may have to go into overactive mode to find your sweet spot but you are not overmedicated because your free T3 is below optimal levels. I was lucky I took NDT and felt better and better until I felt perfectly normal again. These days i need a lot more than I did initially but I still feel loads better than when on levothyroxine. The rest of my hypo family are fine on it. I have the DIO2 gene combination for poor T4 to T3 conversion probably explains it. I just told the doc what my results meant and that cos o took NDT I had all the thyroid hormones I needed so the pituitary has no need to signal to make more hence my very low TSH. She admitted I knew more about it than she did and let it go. She had got all alarmed that I was not taking my medication but I assured her I always took it and understood the dire consequences if I did not. I look as fit as a fiddle for an old codger so it is hard fur them to make out I am making myself ill. I only ever used the TPAU guide in the link I gave you.,I am going to do a blood test but have failed to manage as I need to get up at 4am to do all the prep and be sure to have it done and dusted before needing to set off for work - all too much at present! Weekends no good cos it sits festering in royal mail’s bowels!
You should have left only 12 hours between NDT and blood test. Your free T3 is probably higher than it looks as you left too long between meds and test. 24 hours is for levo only. Otherwise these are typical results for someone on T3 or NDT
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