New diagnosis

[rubyminx62]

Hi - New to the site today and looking for advice. Blood tests have shown low thyroid but normal T4 ? GP is starting me on low dose of medication for 6 weeks to see if there is any improvement in tiredness, slow thinking, leg cramps and low energy. I also take Fluoxetine 20mg per day and esomeprazole 40 mg every 3 days ( for Barrett's oesophagus). I am intolerant to gluten/ lactose ( recently discovered) and have IBS.

Any advice welcome !

[SlowDragon Administrator]

First thing is, do you have any actual blood test results? if not will need to get hold of copies.

You are legally entitled to printed copies of your blood test results and ranges.

Important to see exactly what has been tested and equally important what hasn't been tested yet

UK GP practices are supposed to offer online access for blood test results. Ring and ask if this is available and apply to do so if possible, if it is you may need "enhanced access" to see blood results.

In reality many GP surgeries do not have blood test results online yet

Alternatively ring receptionist and request printed copies of results. Allow couple of days and then go and pick up.

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also EXTREMELY important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially if you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies

As you have lactose and gluten intolerance it sounds like autoimmune thyroid disease is likely

How much Levothyroxine have you been prescribed?

Standard starter dose is 50mcgs

Bloods should be retested 6-8 weeks after each dose change in Levothyroxine

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 .

Last Levothyroxine dose should be 24 hours prior to test, (taking delayed dose immediately after blood draw).

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

Low vitamin levels are common with gluten intolerance

Leg cramps can be low magnesium

Magnesium levels can be low on PPI too, (omeprazole)

gov.uk/drug-safety-update/p...

B12 low due to ppi too

pulsetoday.co.uk/clinical/m...

Private Thyroid and vitamin tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies or all vitamins

thyroiduk.org.uk/tuk/testin...

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 and dairy

So it's important to get TPO and TG thyroid antibodies tested at least once .

Link about thyroid blood tests

thyroiduk.org/tuk/testing/t...

Link about antibodies and Hashimoto's

thyroiduk.org.uk/tuk/about_...

thyroiduk.org.uk/tuk/about_...

List of hypothyroid symptoms

thyroiduk.org.uk/tuk/about_...

[rubyminx62 in reply to SlowDragon]

Thank you very much Slow Dragon.

I will call into my GP this afternoon to collect prescription and will request a print out of the blood tests. They're usually pretty good about print outs. Interestingly, I had to use a private Nutritionist in May 19 after a period of illness which had left me exhausted. I was getting nowhere with my GP. It was her that recommended various blood tests, including some of those you've mentioned, that first highlighted that I was 'borderline'. I also went on a FODMAP diet under her guidance, which highlighted the gluten and lactose intolerances. My vit D was fairly low at the time.

My Nutritionist added that the parametres for diagnosis in the UK is pretty wide and so being borderline could produce some symptoms. Since then I have been fairly vocal about having a repeat test - hence the diagnosis today, which must indicate a further drop.

I'll research Hashimoto . If you don't mind, I'll add the blood results and medication on here later and would welcome any advice.

Best wishes,

RM

[SlowDragon Administrator in reply to rubyminx62]

NHS understanding and treatment of Hashimoto's is woeful

It's as much a disease of the gut as the thyroid

Read posts on here daily to learn as much as possible

[rubyminx62 in reply to SlowDragon]

Hi SD,

My blood results today are as follows - 'serum free T4 level 11.9 pmol (12-22)'.

'serum TSH level 3.08 mU/L (0.27 - 4.20).

In Jan 2019 they were 'serum free T4 level 12.7 pmol/L (10.6 - 23.2).

serum TSH level 3.71 mU/L (0.3 - 4.2).

In May 2019 my serum folate was 7.9 ug/l ( 3.9 - 26.8)

and serum Vit B12 was 520ng/L ( 197-771).

'serum peroxidase Ab conc 11IU/ml (<34)

serum ferritin 151.0 ug/L (13-300)

serum transferrin 2.17 g/L (2.0 -3.6)

serum iron level 7.8 umol/L (10-30)

Transferrin saturation index 14.4 % (<55)

Serum T4 level was 12.2 pmol/L (12-22)

serum TSH level was 2.63 mU/L (0.27 -4.20)

I have been prescribed 25mcg per day and will begin tonight.

Incidentally, I have recently had an MRI scan completed for ongoing gut issues and will be receiving the results tomorrow, plusI have a cardiology appointment on Thurs morning for chest pains and palpitations.

Any advice would be very much appreciated.

RM

[SlowDragon Administrator in reply to rubyminx62]

You need TG thyroid antibodies tested too

thyroiduk.org.uk/tuk/about_...

NHS refuses to test TG antibodies if TPO antibodies are not raised so would need to test privately

Many Hashimoto's patients only have raised TG antibodies

And 20% of Hashimoto's patients never have raised antibodies

healthunlocked.com/thyroidu...