Help with results please

hi there, I just got the below from Medicheck and wonder if any thoughts? My TSH had been 11 before levo increase 3-4 weeks ago (now 200mcg) so it's great that it's on its way down - am I being too optimistic in assuming it might improve more, given the dose increase is fairly recent? Given I'm hopefully still improving does the T3 look ok (ish)? will it continue to improve as the TSH drops?

Inflammation

CRP HS 1.03 mg/L (Range: < 5)

Iron Status

Ferritin 102 ug/L (Range: 13 - 150)

Vitamins

Folate - Serum 14.61 ug/L (Range: > 3.89)

Vitamin B12 - Active 88.300 pmol/L (Range: 37.5 - 188)

Vitamin D 86.2 nmol/L (Range: 50 - 175)

Thyroid Hormones

TSH 3.93 mIU/L (Range: 0.27 - 4.2)

Free T3 4.53 pmol/L (Range: 3.1 - 6.8)

Free Thyroxine 14.900 pmol/L (Range: 12 - 22)

Autoimmunity

Thyroglobulin Antibodies X 564.000 kIU/L (Range: < 115)

Thyroid Peroxidase Antibodies X 444 kIU/L (Range: < 34)

And any thoughts on the autoimmunity being so high? - I assume it doesn't really matter and just reflects the fact I've got Hash - or is it a sign of flare? I'm really ignorant about this side of things.

Vits look ok to me but am aware there is debate about what's seen to be an ok level.

I've been feeling dreadful for months - dead on my feet is a phrase heard often :). But I had thought over the weekend I was starting to feel more human (managed a bike ride and not to bite the heads off all my family ALL weekend :D) so I'm hoping these results generally looks good.

thanks in advance X

[greygoose]

Why did you test just four weeks after an increase in dose? That's too soon. You should leave six to eight weeks. It's impossible to guess what might happen in the next two weeks, but, I think it's pretty certain that you need another increase in dose.

You do have Hashi's, and whilst the antibody levels aren't important in themselves, it is important to know you have Hashi's so that if your Free levels suddenly shoot up, you know you haven't 'gone hyper', and you're not suddenly, magically over-medicated, it's just the Hashi's doing what it does and you're having a Hashi's 'flare'. 'Flare' is really not a good name for it, because people confuse it with 'flare up' of symptoms. I think a better name is Hashi's 'hyper' swing.

[Hidden in reply to greygoose]

Thanks Greygoose - Yes I agree it was daft doing the test when I did. I was feeling fairly desperate at that point and just wanted more info (particularly to see if the vitamins etc might be rubbish and therefore contributing to how I felt). Would have been much more sensible to wait I do agree (rolls eyes at self).

Ah, I don't think i realised Hashi's did that - so it could suddenly "flare" ie produce more thyroxine (or whatever the natural thing is called), but then drop back quickly - is that right? Surprising how ignorant you can be after 25+ years with the condition. Thank you!

[greygoose in reply to Hidden]

OK, so 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.

How long it takes for levels to come down again will vary from person to person. But I don't think it will ever be quick.

[MaisieGray in reply to Hidden]

Hidden The thyroid doesn't produce more hormones in the way that it would if hyperthyroid; what happens is that as the result of the Hashi attack, the damaged cells release their hormones into the blood stream, raising blood levels. But there isn't an actual increase in produced hormones. How long it takes to settle down will vary.

[Hidden in reply to Hidden]

thanks both, really interesting. I'm coeliac so 100% gf anyway, and did take selenium for years back when diagnosed (i must have read something about it somewhere along the way) but stopped years ago. Will start it again. Keeping the TSH suppressed might be more of a struggle as you say, but good advice about dropping the meds for a few days if feeling hyper. Though I'm not sure I'm very aware of how either feel if I'm honest Must focus harder on it. thanks again X