New here and getting lots of great advice after almost a year of not feeling right, and some early miscarriages.
In September 2019 my TSH levels were 4.09 & T4 15.6. At this point fertility consultant prescribed Eltroxin (Levo) and I am on the starting dose.
I just received copies of old blood test results from my previous GP and they are:
January 2019 TSH 4.48 & T4 16.9. Yet no one pointed this out to me back then, and I was simply told to take iron supplements!
May 2019 my TSH was 1.9 and T4 was 15.22. This is when I conceived (but lost this at 5 weeks). The first of three early losses since then.
Ferritin is always between 19-24. Cholesterol is 5.09 (range is 2.5-5) despite a healthy lifestyle (BMI 19). Mild haemolysis stated in both Jan & May results. Vitamin D was 79 nmol/L in Jan.
I don't understand why the TSH levels fluctuate?
TIA!
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Aloha79
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Fluctuations in Thyroid levels is usually due to autoimmune thyroid disease also called Hashimoto's
Bloods need retesting 6-8 weeks after each dose change (or brand change) in Levothyroxine
50mcg Levothyroxine is only a starter dose
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
NHS guidelines on Levothyroxine including that most patients eventually need somewhere between 100mcg and 200mcg Levothyroxine.
Also what foods to avoid (eg recommended to avoid calcium rich foods at least four hours from taking Levo)
For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested.
Also EXTREMELY important to regularly retest vitamin D, folate, ferritin and B12
Ferritin needs improving to at least half way in range. Has GP done full iron panel test? Are you on iron supplements?
Low vitamin levels are extremely common, especially if Thyroid antibodies are raised
All four vitamins need to be regularly tested and frequently need supplementing to maintain optimal levels
Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water . 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).
Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies or all vitamins
Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have special offers, Medichecks usually have offers on Thursdays, Blue Horizon its more random
If antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).
About 90% of all primary hypothyroidism in Uk is due to Hashimoto's.
Low vitamins are especially common with Hashimoto's. Food intolerances are very common too, especially gluten. So it's important to get TPO and TG thyroid antibodies tested at least once .
Medics have no specific treatment for the autoimmune aspect so frequently ignore/dismiss it as irrelevant and often won't even test antibodies
But as the patient you need to know and can do much to self help
Starting with regularly monitoring vitamins
According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps, sometimes significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)
Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies
While still eating high gluten diet ask GP for coeliac blood test first or buy test online for under £20, just to rule it out first
Assuming test is negative you can immediately go on strictly gluten free diet
(If test is positive you will need to remain on high gluten diet until endoscopy, maximum 6 weeks wait officially)
Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse
In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned
These seem ok? Could the reduction in TSH be due to the levo (am on 50)? Or natural fluctuations due to something like Hashimoto's? I have now had 4 readings since January (have been treated since third reading in Sept). From 4.48, to 1.9, to 4.02 and now to 1.54. Are fluctuations due to stress? I wonder if I am now ok to TTC.
Each new dose of Levo takes a full 6 weeks to build up in your body which is why retesting is usually recommending after 6 weeks so testing after two isn’t giving you helpful information unless you have been on that dose for the full six weeks.
Thank you. They were taking 21 day tests so took a full blood count too. I’m already booked in for the 6 week check.
However, I’m confused, why has my TSH level gone down? Why has it fluctuated all year? And my TPO levels seem normal, so does that rule out Hashimoto’s?
Could it be down to the time of day the tests were taken? FTS is highest in the early hours of the morning which is why we are advised to take the test as early as possible. If the TSH is taken later in the day then the value will be lower and the last thing we want is the doctor getting upset at such a low reading and so wanting to lower our medication! Do the levels get lower during the day so that could explain why your TSH readings vary so much
Thank you! I have had all of this done, and will do so again when 6 weeks post first Levo dose. I am not in the UK so have better access to these tests.
However, my TPO was <15 so not raised. How can I otherwise prove Hashimoto's?
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