In Hashimoto’s, what should I re-test for when all my bloods are in the lower range of normal

[Noelnoel]

My GP is calling me this morning and I’d like to know which re-tests are most essential. I have Hashimoto’s which when last tested, was found to have stabilised. That is, everything was at the lower end of normal but the only thing is, my temperature remains at 36.2 and I cannot shift the last 8lbs or so if weight to take me into what feels right for me. I exercise 4 times a week, eat well, exclude gluten and dairy most of the time but still ...

Metavive and adrenavive as prescribed by Dr P are what have set me on the path to feeling better. I know it’s short notice I ask if you all but I want to ask my Dr to re-test and she will but I don’t want to over-step the mark and ask for everything under the sun. Up till now she’s been understanding and accommodating. What are the most essential ones that will give me a clue as to what I need more of. I know free t3 needs to be optimal for weight loss but I’m not sure that upping my metaivive will be the right/safe thing to do. I’ve experimented in the past with more/less of the different types of metavive but I just can’t seem to get quite there. Apart from poor sleep, being slightly overweight I feel ok but something still isn’t quite right

Any pointers will be gratefully received

Thanks

[greygoose]

You want TSH, FT4 and FT3, but doubtful you'll get FT3 on the NHS.

No point in retesting antibodies once you know you have Hashi's.

If possible, it would be a good idea to get vit D, vit B12, folate and ferritin.

But, I guess that's all academic, now, because you've probably already had the call! Sorry about that, I'm a late riser!

[SlowDragon Administrator]

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

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 .

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, or Metavive make sure to take last 1/2 or 1/3rd of daily dose 8-12 hours prior to test, even if this means adjusting time or splitting of dose day before test

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 GP to test vitamins then cheapest option for just TSH, FT4 and FT3 £29 (via NHS private service )

monitormyhealth.org.uk/thyr...

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

[Noelnoel in reply to SlowDragon]

Thank you SlowDragon and for the recommendation about what private companies to use. Helpful

Can you explain the bit about splitting the dose please? For my latest couple of tests I’ve taken my metavive and supplements as normal just to check that they’re doing their job; and they do because lately, as I said, everything is normal, albeit within the lower range. I usually take my meta and adrenavie on and empty stomach first thing in the morning, then supplements after breakfast. In the evening I do the same

just before and after dinner. I feel that this way, Incan monitor the regime is right. Am I wrong to do it this way?

If I take my last dose around 6.30pm and get to the pathology dept as soon as they open (8.30 I think)the following day, would this be too long a gap for getting bloods done?

Also, your statement below

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

Very curious to know why?!!

[Noelnoel in reply to Noelnoel]

And yes, strictly GF apart from the times when I’m not. By that I mean, once in while I’ll have toast at breakfast or, if I’m in an Italian restaurant I’ll have the real deal pasta. Absolutely no substitute

[SlowDragon Administrator in reply to Noelnoel]

Strictly gluten free diet does mean strictly....every time we eat gluten it can take 6 months to recover from

chriskresser.com/the-gluten...

Good gluten free bread for toast

B Free brown seeded

Warburtons Sourdough

must only make toast in separate GF toaster...or coeliac UK make toaster bags for using in a standard toaster

[SlowDragon Administrator in reply to Noelnoel]

Ideally you would take last dose a bit later than normal on evening before blood test so that maximum gap is approximately 12 hours

[Noelnoel in reply to SlowDragon]

Your statement below, intrigued to know why we shouldn’t mention it

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

You know, I once knew this was the case regarding gluten - that it can take 6 months to recover from a dose but you know what, I’d completely forgotten about it; conveniently, some would say and perhaps that’s true. Anyway, it’s incredibly helpful to be reminded. Have you ever considered posting a monthly list of tips/reminders of the things that have been proven to help improve health and likewise, to be detrimental? Thyroid-centric of course

[SlowDragon Administrator in reply to Noelnoel]

Regarding advice to get test early

Most medics deny its relevant...yes even the guidelines are clear

If you say you haven’t taken levothyroxine or flag up that you want early test they will frequently try to block testing on both counts

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...

Research shows TSH may drop after eating

ncbi.nlm.nih.gov/pubmed/252...

Plus you need to have empty stomach to take delayed levothyroxine after blood test

[Noelnoel in reply to SlowDragon]

I’m not sure I understand but thanks for trying to explain. Like I said, it’s very useful to have these tips

[SlowDragon Administrator in reply to Noelnoel]

Only very few thyroid specialist endocrinologists seem to be aware that timing of last dose of levothyroxine and timing of testing is important

Since there’s ridiculous over reliance on TSH as GOD....regardless of a patient’s symptoms it’s important to try to get TSH as high as possible and Ft4 as low as possible....either to maintain current dose because you feel well....or even more importantly if you need dose increase in levothyroxine