New blood test results. Advice, please?

[Hypothyroid-Marvin]

Hi all

I’m a first time poster, but I’ve learnt a lot from this site already.

Sorry if it’s a bit long. Feel free to skip to latest test results at the end.

I am male, in my 50s, and I was diagnosed hypothyroid in Aug 2017.

Hashimotos confirmed:

Anti-Thyroidperoxidase antibodies AntiTPO (TPEX)

Sept 2017 53 iu/mL (0-34)

April 2018 55.7 kIU/L (0-34)

Abnormal High, in keeping with autoimmune thyroiditis, reason for hypothyroidism. Optimal <15

.

TSH blood test results

Aug 2017 (Before Hypothyroidism diagnosis) 5.36 mIU/L (0.27 - 4.20) High

Sep 2017 (Taking 50 mcg Levothyroxine) 1.53 mIU/L (0.27 - 4.3)

Feb 2018 2.89 (0.27 - 4.3)

April 2018 3.54 mIU/L (0.27 - 4.3) (Taking 50 mcg Levothyroxine)

June 2018 3.3 (0.27 - 4.20)

Borderline high. Optimal is 0.4 - 2.5 (NICE guidelines) or at highest 1.8 - 3, needs to be in lower part of normal range

July 2018 (Taking 75 mcg Levothyroxine) 0.46 mIU/L ( 0.27 - 4.3) optimal

Aug 2018 (Taking 75 mcg Levothyroxine) 0.55 mIU/L (0.27 - 4.2) optimal

Free Thyroxine (FT4)

Aug 2017 11.4 pmol/L

Sept 2017 17.4

Feb 2018 16.5

April 2018 15.3 pmol/L

June 2018 17.4 pmol/L

(Range 12.0 - 22.0)

Good. Needs to be upper part of normal range

July 2018 19.4 pmol/L (Range 12.0 - 22.0) Within normal range, close to top quarter

Aug 2018 18.2 (12.0 - 22.0) slightly lower

Top quarter for FT4 is 19.75-22.0 (22-12=10, 10x0.75=7.5, 12+7.5 = 19.75)

Triiodothyronine (FT3)

April 2018 5.29PMOL/L (3.1 - 6.8) Within normal range, close to top quarter

July 2018 5.3 pmol/L (3.1 - 6.8) Within normal range, close to top quarter

Aug 4.9 pmol/L (3.1 - 6.8) slightly lower

Top quarter is 5.38-6.8 (6.8-3.1= 3.7, 3.7x0.75 = 2.775, 3.1+2.775= 5.3775)

FT4: FT3 conversion ratio 19.4:5.3 = 38.8 : 10.6 (Good conversion is between 3:1 and 4:1)

I am currently taking 100 mcg Levothyroxine, alternating the next day with 75mg, which feels about right.

I was referred to an NHS endocrinologist (diabetes specialist) in Nov 2018, who didn’t have any great insights, but she told me to keep doing what I’m doing to manage my condition.

I try to be an informed, active patient, so I have been following Seaside Susie’s helpful advice to others about supplementing with vitamins and minerals to try to keep my previously low levels within optimal ranges.

My daily supplements are:

Vitamin D 4000iu D3 + Better You D3 oral spray

Organic Turmeric (curcumin) with black pepper and ginger 1380 mg

Vitamin K2-MK7 600 ug to direct calcium to bones.

D3 and K2 are fat soluble so taken with fattiest meal of the day, D3 four hours away from thyroid meds.

Magnesium to help the body convert Vit D into its active form.

Igennus Triple Magnesium Complex with Magnesium Citrate, Taurate and Bisglycinate

Magnesium Malate 200mg

Handful of Magnesium crystal flakes in the bath

.

Vitamin C + B super B Complex containing methylcobalamin B12 900 micrograms; ascorbic acid 160 mg; B3 48 mg, B5 36 mg, B1 20 mg, B6 20 mg, B2 14 mg, B7 Biotin 300 micrograms + B12 oral spray

.

L-Methylfolate 400 ug

Bio-Selenium 100 ug + Zinc 15 mg

Acidophilus Plus and kombucha to maintain my gut flora/pro biotics.

I am vegetarian and I have been gluten free for 2 years, which does seem to be helping to avoid bloating and immune problems, and my weight seems about right too.

I don’t feel great at the moment though. I am not sleeping well, I wake up every day before 4 am. I sweat excessively at night and in the day, and I suffer from brain fog and panic attacks.

I’m due to see a new doctor later this month, having changed my GP practice because they were so bad, and I wonder if anyone has any suggestions for me to ask her, or recommendations for me to try?

Latest Jan 2020 blood test results:

Taken as always first thing in the morning, after fasting, before daily dose of Levothyroxine.

Serum free T4 19.9 pmol/L (12.00 – 22.00)

Serum TSH 0.5 miu/L (0.27 – 4.20)

Serum free T3 4.8 pmol/L (3.10 – 6.80)

! Renal profile

! Serum potassium 5.5 mmol/L (3.50 – 5.10)

! Serum lipids – Cholesterol raised

! Serum cholesterol 5.5 mmol/L (3.00 – 5.00)

Serum ferritin 141 ug/L (30.00 – 400.00)

25 Hydroxy Vitamin D 89 nmol/L (50.00 – 120.00)

Serum folate >20.0 ug/L (3.90 – 26.80ug/L)

Serum vitamin B12 390 ng/L (197.00 – 771.00)

Haemoglobin A1c level 39 mmol/mol (20.00 – 41.00)

! Full blood count

Total white blood cell count 5.7 10*9/L (3.70 – 9.5010*9/L)

! Haemoglobin estimation 174 g/L (130.00 – 170.00)

Haematocrit 49.5% (40.00 – 50.00%)

Mean corpuscular volume 95.2 fL (83.00 – 101.00 fL)

! Mean corpusc. Haemoglobin 33.5 pg (27.00 – 32.00)

Thanks in advance to anyone who takes the time to reply. We are very fortunate to have such great advice and support on this forum.

[greygoose]

Hi Marvin, welcome to the forum.

The problem would appear to be that you are not a very good converter. Your FT4 is reasonably good at 73.9% through the range, but your FT3 is only 45.95%, which is doubtless too low for you. Which is probably why your cholesterol is slightly above range - but I wouldn't worry about that. Your poor conversion could be due to your suboptimal nutrients - although they're not that bad, apart from your B12. Or, it could be for a host of other reasons - including the simple fact of having Hashi's. So, what you really need is a little T3 added to your levo.

It's low T3 that causes symptoms. Raise the T3 and, hopefully, the symptoms will eventually disappear. But, it's not easy to get, these days.

[SlowDragon Administrator]

Your Ft3 is dropping at each blood test

You have two options

Increase levothyroxine further.....some can tolerate over range Ft4 ...but others can’t

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,

"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l.

Most patients will feel well in that circumstance. But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."

You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctor

 please email Dionne at Thyroid UK

[e-mail]

Alternatively adding small dose of T3 alongside levothyroxine

Email Dionne at Thyroid UK for list of recommend thyroid specialist endocrinologists who will prescribe T3

As a vegetarian you probably need B12 levels higher.

High cholesterol is linked to being under medicated and especially low Ft3

nhs.uk/conditions/statins/c...