Have just got back private blood results from blue horizon.
These were taken first thing on waking before food or drink.
Not on any medication but take vitamin D3 and K2 supplements.
Cortisol is high. Feel rubbish in the morning mainly anxiety and nervy feel better as
Day progresses. Could this be due to high cortisol levels.
Have posted blood results
Any thoughts much appreciated.
Thank you
ali56
Looking back at your previous posts you have mentioned several times that you have been treated for Graves Disease, and many responses have mentioned that you have Hashi's and was Graves ever confirmed by positive TSI/TRAb antibodies.
I haven't read all the posts but it's possible that you never had Graves at all, unless you have confirmed somewhere that you did test positive for the TSI/TRAb antibodies. As explained in replies, this is a very common mistake that doctors make, they automatically assume Graves Disease when they see high FT4/FT3 levels and low TSH, but that is what a Hashi's hyper swing produces.
Your current results once again show an over range TSH with raised TPO/Tg antibodies and you should be prescribed Levo according to this article:
Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (the magazine for doctors) in answer to Question 2:
Question 2 asks:
I often see patients who have an elevated TSH but normal T4. How should I be managing them?
Answer:
The combination of a normal serum T4 and raised serum TSH is known as subclinical hypothyroidism. If measured, serum T3 will also be normal. Repeat thyroid function tests in 2 or 3 months in case the abnormality represents a resolving thyroiditis.
But if it persists then antibodies to thyroid peroxidase should be measured. If these are positive - indicative of underlying autoimmune thyroid disease - the patient should be considered to have the mildest form of hypothyroidism.
In the absence of symptoms, some would simply recommend annual thyroid function tests until serum TSH is over 10mU/l or symptoms such as tiredness and weight gain develop. But a more pragmatic approach is to recognise that the thyroid failure is likely to become worse and try to nip things in the bud rather than risk loss to follow up.
Treatment should be started with levothyroxine in a dose sufficient to restored serum TSH to the lower part of it's reference range. Levothyroxine in a dose of 75-100mcg daily will usually be enough.
You can obtain a copy of the article by emailing Dionne at
tukadmin@thyroiduk.org
print it and highlight question 2 to show your doctor.
How much Vit D supplement are you taking? With your current level you should be taking 4,000iu D3 daily according to the Vit D Council if you want to reach their recommended level of 125nmol/L.
As you are taking K2 with your D3, are you also taking D3's other important cofactor - magnesium? Magnesium helps D3 to work. We need Magnesium so that the body utilises D3, it's required to convert Vit D into it's active form. So it's important we ensure we take magnesium when supplementing with D3.
Magnesium comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds if taking magnesium as tablets/capsules, no necessity if using topical forms of magnesium.
naturalnews.com/046401_magn...
drjockers.com/best-magnesiu...
Your B12 could be higher. 386pmol/L = 523pg/ml. According to an extract from the book, "Could it be B12?" by Sally M. Pacholok:
"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".
"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."
A good bioavailable B Complex will help, eg Thorne Basic B or Igennus Super B.
I'm not good with serum cortisol tests but I think your interpretation is probably right.
Hi SeasideSusie
Thank you for your prompt reply had trab antibody tested privatley as endo said no need to test antibodies. The test came back negative!!! My gp won’t
Prescribe thyroxine as not over 10u/l. Will definitely get some magnesium.
Have got solgar sublingual methycolabalam 1000mcg . When vitamin D was really low gp put me on loading dose which raised it to 106 then told me to take 800iu daily which I have been doing obviously not enough.
Thanks again
Ali
ali56
had trab antibody tested privatley as endo said no need to test antibodies. The test came back negative!!!
So, as suspected by responders in previous replies, Graves was never the problem so Carbimazole was never the correct treatment for you. It's been Hashi's all along.
My gp won’t Prescribe thyroxine as not over 10u/l.
That level is for Primary Hypothyroidism, what you have is autoimmune thyroid disease (which patients call Hashimoto's).
Your TSH is over range, this is regarded as Subclinical Hypothyroidism. Maybe remind your GP of the latest NICE Guidance for Thyroid disease: assessment and management:
nice.org.uk/guidance/ng145/...
Scroll down to Section 1.5:
Tests for people with confirmed subclinical hypothyroidism
Adults
1.5.1 Consider measuring TPOAbs for adults with TSH levels above the reference range, but do not repeat TPOAbs testing.
Treating subclinical hypothyroidism
1.5.2 When discussing whether or not to start treatment for subclinical hypothyroidism, take into account features that might suggest underlying thyroid disease, such as symptoms of hypothyroidism, previous radioactive iodine treatment or thyroid surgery, or raised levels of thyroid autoantibodies.
1.5.4 Consider a 6-month trial of levothyroxine for adults under 65 with subclinical hypothyroidism who have:
•a TSH above the reference range but lower than 10 mlU/litre on 2 separate occasions 3 months apart, and
•symptoms of hypothyroidism.
If symptoms do not improve after starting levothyroxine, re-measure TSH and if the level remains raised, adjust the dose. If symptoms persist when serum TSH is within the reference range, consider stopping levothyroxine and follow the recommendations on monitoring untreated subclinical hypothyroidism and monitoring after stopping treatment.
Suggest a trial of Levo based on this Guidance and Dr Toft's article.
**
Have got solgar sublingual methycolabalam 1000mcg .
You don't really need that. When taking B12 (methylcobalamin) we need a B Complex as well to balance all the B vitamins. The amount of methycobalamin in either of the two B Complex supplements I have suggested above is enough to raise your B12 level. Your level isn't dire, it needs a boost.
Thank you for the links I think the problem is gp’s don’t have the knowledge to treat thyroid problems.
Ali
You may need to go over GP head
But the significance of high thyroid antibodies means you should be started on levothyroxine
Email Dionne at Thyroid UK for list of recommend thyroid specialist endocrinologists
First step is to improve vitamin levels and try strictly gluten free diet
Vitamin D, folate and B12
Low vitamin levels affect Thyroid hormone
Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten intolerance. Second most common is lactose intolerance
According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find strictly gluten free diet reduces symptoms, sometimes significantly. Either due to 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 strictly gluten free diet for 3-6 months
If no noticeable improvement, reintroduce gluten and see if symptoms get worse
chriskresser.com/the-gluten...
amymyersmd.com/2018/04/3-re...
thyroidpharmacist.com/artic...
drknews.com/changing-your-d...
restartmed.com/hashimotos-g...
Non Coeliac Gluten sensitivity (NCGS) and autoimmune disease
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
restartmed.com/hashimotos-g...
Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.
Hypothyroid without Hashimotos?
Hypothyroid 
High Cortisol results 
Not hypothyroid?
Could be be hypothyroid/subclinical?
