Help with Blood test results please-Hashimotos/Hypo please

[Lassithi]

My symptoms have persisted since being diagnosed in July 2019 although GP says bloods are fine and symptoms must mean something else.

I have an endo appointment on Friday, first one which is now by telephone and want to be as prepared as possible.

Serum TSH level: (range: 0.35-5.0)

July 19: 9.98

Sept 19: 3.46

Dec 19: 0.86

March 2020: 0.73

Serum Free T4: (range: 11.0-23.0)

July 19: 12.7

Sept 19: 21.00

Dec 19: 24.7

March 2020: 18.00

Serum T3: (range: 3.9-6.8)

Aug 19: 4.14

March 2020: 4.40

PTH: (range:1.6-6.8)

Dec 19: 4.0

Mar 20: 3.80

HbA1c-1FCC: (range: 20-41)

Dec 19: 38

Anti-CPP antibody level: (range: 0-6.9)

Dec 19: 0.6

Sethyroid peroxidase Abconc: (range: 0-24)

Jul 19: 509

Sep 19: 746

Mar 20: Abnormal 441

Serum B12: (range: 200-900)

Mar 17: 841

Dec 19: 641

Mar 20: 640

Serum Vit D: (range: 50-110)

Dec 19: 74.0

Mar 20: 70.0

Apologies in advance for the long post.

[SlowDragon Administrator]

Looking at previous posts....you are on 100mcg levothyroxine?

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 ?

Ft4 is 58% through range (not high enough)

Ft3 only 17.23% through range

Helpful calculator for working out percentage through range

chorobytarczycy.eu/kalkulator

So you are very poor converter....very common with hashimoto’s

But also have room for dose increase in levothyroxine to get Ft4 higher

Getting all four vitamins optimal can help improve conversion of Ft4 to Ft3

What vitamin supplements are you currently taking?

Vitamin D

GP will only prescribe to bring levels to 50nmol.

ouh.nhs.uk/osteoporosis/use...

But improving to around 80nmol or 100nmol may be better

ncbi.nlm.nih.gov/pubmed/218...

vitamindsociety.org/pdf/Vit...

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

Test twice yearly via vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function. There’s a version made that also contains vitamin K2 Mk7

It’s trial and error what dose we need, with hashimoto’s we frequently need higher dose than average

No folate or ferritin results?

Are you on strictly gluten free diet?

Your antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).

Hashimoto's frequently affects the gut and leads to low stomach acid and then low vitamin levels

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...

[Lassithi in reply to SlowDragon]

Thank you for a detailed response with lots of reading material. Yes I followed the advice for latest blood test although hadn’t done this before. I think I may have other results you enquires about and will look tomorrow and reply.

I really appreciate your help,

Thank you 🙏