How to try and improve yourself while being hypothyroid

[Jelley93]

Hi people I posted yesterday regarding the swallowing issue, this is a bit off the cuff and different however Id like some advice. With it being 2020 I am going to try and generally improve my general health despite being hypothyroid. I work 37 hours a week, cycle to work roughly 30 miles per week and dont smoke or drink. I weigh around 14 stone, im on 100mcg of levo daily. I was wondering whether there is a thyroid friendly diet, being a noob at this I wouldn't know where to start. Any answers welcome

[SeasideSusie Remembering]

I think the first thing you should do is post your current results for thyroid and vitamins to ensure you are

1) Optimally medicated with Levo

2) Have optimal nutrient levels

So if you can post your latest results, including reference ranges, for the following it would be good start:

TSH

FT4

FT3

Thyroid antibodies

Vit D

B12

Folate

Ferritin

14 stone may be the right weight for you, we don't know, but if you feel you are overweight that may point to be being undermedicated with Levo.

As for a thyroid friendly diet, avoid soy in all forms (except perhaps fermented soy), and eat a good, sensible, healthy diet, there's not really anything off limits (other than soy). If you have Hashi's (confirmed by raised antibodies) some people find that a strict gluten free diet helps, some have found they need to eliminate dairy.

[Jelley93 in reply to SeasideSusie]

My last blood test was august 2019. I asked if it was okay she said my result was 3.2 but im not sure what she meant

[SeasideSusie Remembering in reply to Jelley93]

Then you need to ask for a print out of your results. Are you in the UK? If so then you are legally entitled to a copy so just ask the receptionist but don't accept verbal or written results as mistakes can happen, make sure you get a printed copy.

If only one test was done then that would be TSH (which is totally inadequate to assess thyroid status) and if your TSH was 3.2 it will be within the reference range but far too high. The aim of a hypo patient generally, when on Levo, is for TSH to be 1 or below or wherever it needs to be for FT4 and FT3 to be in the upper part of their reference ranges, if that is where you feel well. So you can see why it's so important for us to have our test results.

[Jelley93 in reply to SeasideSusie]

Okay ill go after work and ask for a print out. Thank you I am in Leicester England

[shaws Administrator in reply to Jelley93]

Do you follow this advice re getting a blood test for thyroid hormones:-

1. The earliest possible blood draw (ensure you're well hydrated a couple of days before).

2. Fasting (you can drink water)

3. Allow a 24 hour gap between last dose of levo and test and take it afterwards?

This procedure gives the best result.

[greygoose]

I would add to the list of things to avoid in the diet with artificial sweeteners and processed seed oils. They are bad for everyone, but especially hypos. So, that really means avoiding processed foods in general because they all contain soy or artificial sweeteners or oils like rapeseed oil - or all of them together. The best thing you can do for your health is cook everything from scratch.

[SlowDragon Administrator]

If your TSH is 3.2 you are very under medicated

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.

nhs.uk/medicines/levothyrox...

First step is to get copies of your blood test results

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

The best way to get access to current and historic blood test results is to register for online access to your medical record and blood test results

UK GP practices are supposed to offer everyone 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

Ask GP to test vitamin levels

As you had Glandular Fever it's extremely likely you have Hashimoto's

But ideally you should have had antibodies tested by GP to confirm that

Best to check results from when diagnosed

You may need to get full Thyroid testing privately as NHS refuses to test TG antibodies if TPO antibodies are negative

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 dose of Levothyroxine 24 hours prior to blood 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)

Is this how you do your tests?

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

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

For thyroid including antibodies and 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 you can get vitamins and antibodies tested by GP Cheapest option for just TSH, FT4 and FT3 £29 (via NHS private service )

monitormyhealth.org.uk/thyr...

Guidelines on dose by weight is 1.6mcg Levothyroxine per kilo of your weight .....at 14stone that's approximately 137-150mcg daily

New NICE guidelines

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

Come back with new post once you get copies of results and members can advise on next steps

[Geetal in reply to SlowDragon]

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.

I read the NHS guidelines in your post. Is does not seem to refer to TSH in it. Do you have anything authoritative that refers to low TSH as being OK in various circumstances. My (new doctor-I changed about a month ago) seems fixated with the fact my TSH is very low and that this means that I am hyperactive despite my symptons being consistant with Hashi and my TPO way above range in fact too high to measure.

Kind Regards

[SlowDragon Administrator in reply to Geetal]

Many of us with Hashimoto's have extremely low TSH when correctly treated

Many NHS medics are obsessed with TSH being within range

On any replacement thyroid hormones the most important results are FT3....followed by FT4

But it's often a battle to get this idea across

Getting vitamins optimal can help improve TSH sometimes

As you have Hashimoto's are you on strictly gluten free diet?

[Geetal in reply to SlowDragon]

Many thanks. I was on gluten free but have lapsed back and am sleeping much more(10-11 hours a night). It sounds like I must go Gluten Free for ever-so be it.

Many thanks.

[SlowDragon Administrator in reply to Geetal]

Suggest you get back on the gluten free diet and retest thyroid and vitamins in 2-3 months

Make sure to do blood test as early as possible in morning before eating or drinking anything other than water and last dose Levothyroxine 24 hours prior to blood test

Stop any supplements that contain biotin a week before any blood tests

If testing iron or ferritin stop iron supplements a week before blood test

Important to regularly retest vitamin D, folate, B12 and ferritin

Always test TSH, FT4 and FT3

[Geetal in reply to SlowDragon]

Will do. Ill take your responses with to my Doctor at my appointment tomorrow.

Is the Health Forum a Quango?

Best Wishes

[SlowDragon Administrator in reply to Geetal]

Never mention an online support group to a GP ...their eyes glaze over

You can print this out ...NHS Guidelines

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...

Also this

Official NHS guidelines saying TSH should be between 0.2 and 2.0 when on Levothyroxine

(Many of us need TSH nearer 0.2 than 2.0 to feel well)

See box

Thyroxine replacement in primary hypothyroidism

pathology.leedsth.nhs.uk/pa...

New NICE guidelines on dose by weight ...can be helpful if pushing for dose increase

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

[Geetal in reply to SlowDragon]

I have speed read the documents and none really apply to my situation. Fortunately I have a healthy heart and am over 70. The only document dealing with lower TSH levels only goes as low as .2. Also I am taking T$ and seperately slow release T3. All of the documents seem to dislike T3 because of the price and that they dont have enough long term benefits of its efficacy because of small samples. One of the papers refers to the fact that there may be some people for whom their T4 is not converting properly to T3-that is me and I shall take a more leisurely read to find out in which of the papers Ive read through.

Thanks for all your help so far.

[SlowDragon Administrator in reply to Geetal]

As soon as we take any dose of T3 TSH is almost always suppressed .....one of the reasons medics don't like T3 ...they can't understand test results

Most important result is Ft3 followed by FT4 if taking T3 and Levothyroxine or NDT

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 dose of Levothyroxine 24 hours prior to blood 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)

If/when also on T3, 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

[Geetal in reply to SlowDragon]

Ive been taking my "test" doses of T4 about 30 hours before draw as I take it about 2or3am and the last slow T3at about 6pm the previous day which is only 14 hrs. I have the blood tests between 7.30-8am. For my next tests I shall drop off the T3 for the day before,

[Geetal in reply to SlowDragon]

I have just read an interesting article although for much of it I am out of my depth. Im now being sent more upto date papers this one is April 2019.

Debate

Open Access

Open Peer Review

Published: 18 April 2019

Time for a reassessment of the treatment of hypothyroidism

John E. M. Midgley, Anthony D. Toft, Rolf Larisch, Johannes W. Dietrich & Rudolf Hoermann

BMC Endocrine Disorders volume 19, Article number: 37 (2019) Cite this article

In particular the first two thirds of the para of Main text on page 2 and on page 5 second column a long sentence 10 lines down. On page 6 first column second paragraph, last sentence I shall try to get hold of Chengs paper. It will be useful if more future work is done but I am not hopeful as his paper dates back to 2010.

[Peanut31]

Hi

The experienced members have given you very good advice in that until you fully test your thyroid TSH, T3 & T4 including vitamins you really don’t know what’s going on.

It could be your not on enough thyroid medication.

I try and follow a healthy eating pattern and I have to say I feel so much better when I do.

I avoid processed foods, sugars and stick to clean healthy eating. I also try not to have too many carbohydrates, I follow LCHF eating and I feel so much better for this.

Over Christmas I did over indulge with sweets, chocolates and I feel absolutely rubbish, I feel tired, sluggish, bloated and my skin is awful.

However, you really need to sort your thyroid medication dosage first.

Best wishes

Peanut31