I have Recently felt unwell with severe headache intermittent vertigo and fatigue. My thyroxine has been reduced by 25mcg. Doctor going by TSH number. Am I underdosed? I have diagnosed PA being treated with injections.
Jul 2018Nov 2018Oct 2019
TSH[0.3 - 4.5] 0.07 0.07 0.11
FT3[3.1 - 6.8] 4.0 4.0 3.7
FT4[10.0 - 22.0]22.022.017.9
Apologies my columns have gone all haywire
well even the higher results show T3 less than 25% through the range with T4 at 100%. more experienced postrrs ll be along soon but it looks poss undermedicated due to poor conversion to me
When were vitamin D, folate, ferritin last tested?
Levels frequently drop when dose is reduced....leading to even worse conversion
Your conversion of FT4 to FT3 is poor
Oct 2019
FT4 is 59% through range
FT3 is only 16% through range
November 2018
FT4 100% through range
FT3 only 25% through range
Helpful calculator for working out % through range
Do you have Hashimoto's?
Autoimmune thyroid disease diagnosed by high thyroid antibodies
are you on strictly gluten free diet ...or tried it?
You are likely to need addition of small dose of T3 alongside Levothyroxine
Email Dionne at Thyroid Uk for list of recommended thyroid specialists who will prescribe T3
thyroiduk.org.uk/tuk/About_...
PS to my earlier response. Re gluten free no I’m not but I recently followed a weightwatchers diet and felt a whole lot better, no bread cakes biscuits which would seem to indicate a gluten and/or wheat intolerance. I will have to give gluten/wheat free another trial. Thanks again.
Poor gut function with Hashimoto's can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common.
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
if 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)
But if already on low gluten diet, not worth testing, just cut it out completely
Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse
ncbi.nlm.nih.gov/pubmed/296...
The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported
ncbi.nlm.nih.gov/pubmed/300...
The obtained results suggest that the gluten-free diet may bring clinical benefits to women with autoimmune thyroid disease
nuclmed.gr/wp/wp-content/up...
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
chriskresser.com/the-gluten...
amymyersmd.com/2018/04/3-re...
thyroidpharmacist.com/artic...
drknews.com/changing-your-d...
restartmed.com/hashimotos-g...
PS oops! Hadn’t read all your reply thank you very much for all the links. I’ve got lots of reading ahead but it all looks very helpful. I’m very grateful, thank you. 👍
Nov 2018 Vit D 42 [>50.0]
Nov 2019 Ferritin 68ug/L [12.0 - 250.0]
What is tested for always seems a bit random, they’re never requested by the same doctor twice. So it’s down to what that particular GP thinks is wrong at any given time. I believe when they’ve got you on thyroxine and B12 they automatically (wrongly) consider both of those things sorted.
It’s only recently that I’ve seen results for vit D and Ferritin, and until last few tests only ever got TSH numbers. I am to have another blood test (Thyroid) in Dec.
Thank you the for link to the calculator.
I have wondered about Hashimotos myself. When first diagnosed hypo 20 yrs ago not given any info just medication, so I don’t know about possible antibodies either. But as I have diagnosed PA with intrinsic factor antibodies I guess a similar process might have been involved in the thyroid.
You have given me a lot of very useful information and food for thought. I am really very grateful for the time you’ve taken to include links as well.
Thank you so very much. Hoping to see the doctor on Tuesday. Your assistance will be invaluable. Best regards.
As you can see, your vitamin D is too low but not low enough for Dr to prescribe. You will have to get your own supplements. Is the vitamins unit, nmol as is usual in the UK? If so, then generally a level around 100nmol is advised by vitamin D Council. As you do not have an upper lab range here, or a unit of measurement, it's hard to be certain.
42nmol/L [>50.0] yes nano mols. Actually the doctor did prescribe Vit briefly but since pharmacist can’t supply a small enough tablet told to buy my own. I buy Boots brand and take two 10ug tabs a day (this is equivalent dose to what GP prescribed). Thank you very much. I’m hopeless with numbers. I can look at them till I’m blue in the face and my brain just won’t work. Not dyscalculia but something!! Thanks again.
Vitamin D is far too low.
GP will only prescribe to bring vitamin D up to 50nmol. Aiming to improve by self supplementing 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.
Ideally retest twice yearly via vitamindtest.org.uk
Vitamin D mouth spray by Better You is good as avoids poor gut function. They do one that also contains vitamin K2 mk7
It's trial and error what dose each person needs.
Frequently with Hashimoto's we need higher dose than average
Suggest you increase dose to 2000iu-3000iu daily and retest in 3-4 months
Local CCG guidelines
clinox.info/clinical-suppor...
Government recommends everyone supplement October to April
gov.uk/government/news/phe-...
Magnesium
betterbones.com/bone-nutrit...
medicalnewstoday.com/articl...
livescience.com/61866-magne...
sciencedaily.com/releases/2...
Vitamin K2 mk7
betterbones.com/bone-nutrit...
Oh! You are being really helpful. Vit D spray would be much better for me as swallowing tablets is a problem. I had read about K2 so as it’s in the spray that would really sorted that problem too. Excellent. I have got magnesium tablets from boots but have to chew them as to big for me to swallow. I’ll search for an alternative if your links don’t show any. Very many thanks. I am so grateful. Best regards. 😊
Yes I can't swallow even medium size tablets.
Liquid options
Calm vitality magnesium powder is cheap and easy to use. Best to start on small dose as too much can cause diarrhoea. You mix with hot water and drink
Alternatively Re-Mag is excellent as doesn't upset gut. But it's expensive. Was developed by Carolyn Dean who wrote The Magnesium Miracle.
Oh brilliant. Thanks I’ll try the powder first as you say it’s cheaper. And check out the article too. Thank you so much 😊
10ug is equivalent to 400iu (International units) so you are taking 800iu of D3 which is a maintenance dose but unlikely sufficient to raise levels. I think there are some calculations of how much to take to reach your target dose on the Vitamin D Council website which recommends a target level of 100nmol. If it were me I would increase my dose to 2,500iu vit D3 and retest in 3 months then adjust dose. If you're in the UK, you won't be getting any vitamin D from Sunshine until March/April so you are relying on your stores.
The vitamin D Council has details of vitamin D co-factors and mentions magnesium and K2. Magnesium citrate or a spray containing magnesium chloride are the 2 kinds I use.
Thanks again I will check out the Vit D council. I knew they’d given me a maintenance dose but was worried about overdosing as it is fat soluble. I’ve also been wondering about magnesium. Very helpful. Thank you😊
Thank you. I think the gluten/wheat aspect is relevant in my case and I will sort that out. I have been tested for coeliac and it was negative. 😊
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