Lost on last results...still fatigued, anxious, depressed...

[jamiebgp]

Hi,

Ive been diagnosed over 2 years now with Hashi, most days are still a struggle with huge bouts of anxiety, depression, fatigue, brain melt and confusion as well as vision problems.Ive been to doctors, endos, specialists and still no better. I was initially on just Levo but had a massive dive into despair and depression leading to suicidal thoughts and a couple of stints with Crisis team. The psychologists saying mental health the doctors saying thyroid. Up until going onto Levo I had very little anxiety and my moods were pretty even. Since then I have been pretty much left to my own devices, self medicating on both Levo and T3 but I'm still feeling awful. I did my last batch of check with Medichecks but I'm at a loss as to where Im at as I know the T3 skews the results. I have listed the results below and was hoping somebody could help me translate where I'm at?

Any help much appreciated.

J

My meds are as follows:

AM - approx 6:45am

75mcg levo

18.75mcg T3

1PM

Better You Dlux Vitamin D Oral Spray 3000 IU 75ug (Just added this week)

18.75mcg T3

9PM

Citalopram 40mgs

Magnesium 375mg

Feverfew (for migraine)

RESULTS:

Inflammation

CRP HS 0.66 mg/L (Range: < 5)

Iron Status

Ferritin 166 ug/L (Range: 30 - 400)

Vitamins

Folate - Serum X 2.31 ug/L (Range: > 3.89)

Vitamin B12 - Active 74.500 pmol/L (Range: > 37.5)

Vitamin D 58.1 nmol/L

Deficient < 30

Insufficient 30 - 50 Consider reducing dose >175

(Range: 50 - 175)

Thyroid Hormones

TSH X 0.244 mIU/L (Range: 0.27 - 4.2)

Free T3 4.79 pmol/L (Range: 3.1 - 6.8)

Free Thyroxine X 9.290 pmol/L (Range: 12 - 22)

Autoimmunity

Thyroglobulin Antibodies 21.700 kIU/L (Range: < 115)

Thyroid Peroxidase Antibodies X 136 kIU/L (Range: < 34)

[Lalatoot]

Your FT3 is still low in range particularly for someone on T3. I suggest you need it well over half way through the range and towards the top.

Your FT4 is low. Some folks manage with low FT4 when on T3 but others need it more balanced with FT3 so again you are looking at it needing to be well over half way through its range.

I would say that you are undermedicated. You cannot increase both meds at the same time though.

These are my opinions as a fellow T4/T3 user.

Citalopram can affect the absorption of levothyroxine and reduce the effectiveness of a given dose.

I was on citalopram. The reason I had anxiety was that I was undermedicated and what my body lacked in thyroid hormones it made up for with adrenalin. I was able to keep going but I was an anxious person who had panic attacks.

[SeasideSusie Remembering]

Jamiebgp

Why do you say T3 skews results?

Your thyroid test results will reflect the thyroid hormone replacement you are taking if you have done the test correctly, by that we mean

* blood draw no later than 9am

* fast from evening meal/supper the night before

* water only to drink before the test

* last dose of Levo 24 hours before the test

* last dose of T3 8-12 hours before the test - splitting the dose and adjusting time the day before test if necessary

Is this how the test was done?

Folate - Serum X 2.31 ug/L (Range: > 3.89)

This is Folate deficiency, you should see your GP about this and he should prescribe folic acid.

Active B12 below 70 suggests testing for B12 deficiency you are a little above that and a better level would be 100+ so supplementing with sublingual methylcobalamin 1000mcg will help raise it. Use one bottle then retest to see what difference supplementing has made.

Vit D is too low. The Vit D Council recommends a level of 125nmol and the Vit D Society recommends 100-150nmol. To reach that level I would supplement with 5000iu and retest in 3 months.

I see you are taking magnesium which is one important co-factor of D3, another is Vit K2-mk7. D3 aids absorption of calcium from food and K2-mk7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissue where it can be deposited and cause problems.

It's hard to comment on your thyroid results until you say when you took last dose of Levo and T3.

[jamiebgp in reply to SeasideSusie]

Thanks guys, Seaside Susie - my tests were done exactly in accordance with your notes above. The reason I say skewed is because I’d read that taking T3 will leave your T4 results showing under as the T3 is direct into the system. Once again medicating to feel better as opposed to the results, correct me if I’m wrong?

Lalaloot - the Citalopram is maximum dose and has been since being on the Levo. I was only ever on 10mgs before this.

[SeasideSusie Remembering in reply to jamiebgp]

Jamiebgp

Taking T3 tends to lower, even suppress TSH, and tends to lower FT4 as well.

However, as you are taking both Levo and T3 then you wouldn't expect FT4 to be below range. You can tweak the doses to give you the FT4 and FT3 levels you need as an individual.

Some people on combination therapy do well enough with a low in range FT4 and most people usually like FT3 in the upper part of the range. Some, like me, seem to need both FT4 and FT3 in the upper part of the range. It's a case of finding what suits each of us best.

When I was adjusting doses to find what suited me best, when I lowered my dose of Levo and my FT4 went into the lower part of the range I felt dreadful, when I increased Levo to get my FT4 back into the upper part of the range again I felt much better. So it's a case of tweaking to find your optimal doses.

If I had your FT4 level on combination therapy I wouldn't be able to get out of bed.

If those were my results the first thing I would do is increase my dose of Levo, bring FT4 into range and that will very likely increase your FT3 level as well.

However, you need to address these nutrient levels as a priority so please go and see your GP about your Folate deficiency, and address the B12 and Vit D yourself as your GP won't do anything about those because you are in range. Optimal nutrient levels are needed for any thyroid hormone to work properly.

You say you followed the usual advice about timing of meds before blood test. So, did you alter your last T3 dose the day before and take it nearer bedtime (9pm - midnight) rather than 1pm? Assuming, of course, that your test was no late than 9am.

[Assiya in reply to SeasideSusie]

Are your anti bodies that high? Do you eat gluten free?

[SeasideSusie Remembering in reply to Assiya]

Assiya

You have replied to me and it's not my thread, I'm just responding.

[jamiebgp in reply to SeasideSusie]

Hiya,

On further inspection I didn't take the second dose T3 in the evening, still at 1pm. Im presuming this would show a lower T3 on the results?

[SeasideSusie Remembering in reply to jamiebgp]

jamiebgp

Im presuming this would show a lower T3 on the results?

Yes, that's correct. T3 has a short half life so if you leave longer than 12 hours between last dose and blood draw you will get a false low FT3 result.

If you had your blood draw at 9am and your last dose of T3 at 1pm the previous day then that's 20 hours.

I think your main priority here is to increase your Levo, get that FT4 into range and take it from there.

[jamiebgp in reply to SeasideSusie]

Hiya and thanks again for the advice. Would you suggest moving from 75mcg to 100mcg on my Levo, stay at the 18.75mcg T3 twice a day and get my vits in order, then test after 4-6 weeks?

[SeasideSusie Remembering in reply to jamiebgp]

That's what I would do. As your FT4 is below range I'd increase Levo by 25mcg, leave your T3 as it is for now. I would retest in 6-8 weeks, give levels time to stabilise, with some of us it can take even longer than that.

Definitely see GP about that folate deficiency. If he doesn't like the fact that you've had a private test done then he can always do his own.

Get that Vit D up to at least 100 and similar for Active B12.

Optimising nutrient levels will hopefully have a positive impact on thyroid hormones.

[HashiFedUp]

I had exactly the same thing. Severe anxiety including suicidal thoughts. This was before I was diagnosed. Hashimoto’s messes with your head, you can’t keep up with your life because you feel tired and ill all the time. Plus there are effects on things like serotonin and cortisol etc so they reckon that about half of all Hashimoto’s are on antidepressants at anyone time. You’re not alone trust me. I’m better now. Went private and saw an endo - I was private messaged on here - and he is a legend. Good luck. Private message me if you’re feeling low xx

[jamiebgp in reply to HashiFedUp]

Thank you, it's been a very hard slog the last couple of years. Hopefully with the advice here I can start to get back on track.

[HashiFedUp in reply to jamiebgp]

You’ll only find care and support from fellow sufferers who understand what you’re going through. Stay on the forum and keep going, don’t give up the fight 😘

[Batty1]

Thyroid issues can certainly cause all of what you have been feeling I went through simular when I lost my thyroid.....anti-depressants will mess with your Thyroid levels or at least mine did. Does your doctor increase your meds, ever?

[vocalEK]

I agree with SeasideSusie . Increase your levo dose by 25 mcg and retest in 6 weeks. Keep increasing every 6 weeks until your FT4 is at least half-way through the range. Here is a calculator you can use to see how much into range your FT4 and FT3 are. chorobytarczycy.eu/kalkulator

Ignore the words. Just type your result into the first field, then bottom and top of range into the next two fields for each of the FT hormones. Then click the button. "Oblicz" means "calculate."

Also follow her suggestions to get those vitamins into the optimal range. You'll be amazed at the difference in how you feel.

[paulla]

I totally understand, I have similar symptoms. All I can say, it is that I did not feel any better after I started Levothyroxine, then discovered that I also had problems with too much parathyroid hormone. This is turn causes high calcium levels. Now I avoid high calcium foods, e.g. dairy, nuts etc. It has helped.

Also I find using the mobile or being in houses with wifi makes my symptoms worse! I only use the mobile for emergencies and keep it turned off most of the time. It is very restricting!

Ask for parathyroid test. I had mine abroad, I think they are reluctant to do it here.

Hope it helps. Take care

[jamiebgp]

Thank you everybody for all your advice. I am staring my vitamin updates and moving to 100mcgs of Levo, let’s see how the next few weeks goes and I’ll report back. Once again, thank you X