Hi all
I was given results of my thyroid Tests yesterday and my gp has told me i have hashimoto's but that i do not require or need treatment as my tsh, t3 and t4 are all in range. My results are as follows
Tsh 1.18(0.05-5)
T4 13.5 (9-22)
T3 3.8 (3-6)
Tpo 430 (0-6)
Folate 3 (3-20)
Ferritin 52 (15-200)
B12 317 (187-800)
My gp says these numbers are all great and there is no need to do anything. He will retest in 3 months.
Any advice on this would be appreciated
The numbers are not ALL great,FT4 and FT3 should really be in the top half of the range.You should also have ferritin,folate,B12 and D3 checked.I n3 months your GP will probably only test TSH which looks OK now and probably will do so then which is why many on the forum use private testing.
What really matters is your sumptoms!
Linzr
my gp has told me i have hashimoto's but that i do not require or need treatment as my tsh, t3 and t4 are all in range.
That's correct. Your raised TPO antibodies confirm Hashi's but at the moment there hasn't been enough damage to your thyroid and you are still producing adequate amounts of hormone. Your TSH will need to go over range, or FT4 below range, before you will be prescribed Levo, so make sure you keep getting your levels checked regularly.
Make sure that future thyroid tests are always done no later than 9am, nothing to eat or drink except water before the test. This gives the highest TSH which is what you need for diagnosis.
Some members have found that adopting a strict gluten free diet can help, although there is no guarantee.
Gluten contains gliadin (a protein) which is thought to trigger autoimmune attacks so eliminating gluten can help reduce these attacks.
You don't need to be gluten sensitive or have Coeliac disease for a gluten free diet to help.
Gluten/thyroid connection: chriskresser.com/the-gluten...
stopthethyroidmadness.com/h...
stopthethyroidmadness.com/h...
hypothyroidmom.com/hashimot...
thyroiduk.org.uk/tuk/about_...
Supplementing with selenium l-selenomethionine 200mcg daily is said to help reduce the antibodies.
I don't agree that your vitamins are great.
Folate 3 (3-20)
Folate is recommended to be half way through range. You are on the verge of folate deficiency. See cks.nice.org.uk/anaemia-b12...
Folate level
◦Serum folate of less than 7 nanomol/L (3 micrograms/L) is used as a guide to indicate folate deficiency.
◦However, there is an indeterminate zone with folate levels of 7–10 nanomol/L (3–4.5 micrograms/L), so low folate should be interpreted as suggestive of deficiency and not diagnostic.
You might want to discuss this with your GP, referring the this Clinical Knowledge Summary. If GP wont do anything about it, you can help yourself by eating folate rich foods and taking a good bioavailable B Complex containing 400mcg methylfolate, eg Thorne Basic B or Igennus Super B (at the recommended dose).
B12 317 (187-800)
What is the measurement for this - pmol/L, pg/ml or ng/l (the latter two are the same).
If it's pg/ml or ng/L then the following applies:
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."
Your GP wont agree, he'll just say it's within range so it's fine so this is something you need to address yourself.
Either of the B Complex supplements mentioned above will do, Thorne Basic B has 400mcg methylcobalamin (B12) in the recommended dose of 1 capsule, Igennus Super B has 900mcg methylcobalamin plus 400mcg methylfolate in the recommended dose of 2 tablets.
Ferritin 52 (15-200)
Ferritin is recommended to be half way through range so yours is low, your GP wont agree he'll just say it's within range so it's fine. You can help raise your level by eating liver regularly, maximum 200g per week due to it's high Vit A content, also liver pate, black pudding, and including lots of iron rich foods in your diet
apjcn.nhri.org.tw/server/in...
Don't consider taking an iron supplement unless you do an iron panel, if you already have a decent level of serum iron and a good saturation percentage then taking iron tablets can push your iron level even higher, too much iron is as bad as too little.
Hashi's causes gut/absorption problems so can cause low nutrient levels and deficiencies so it's important to optimise these.
Did you have Vit D tested as well? It's important that this is also done. If GP wont do it then you can do this with a private fingerprick blood spot test with an NHS lab which offers this test to the general public:
Come back with result for further help.
Don't start all supplements at once. Start with one, give it a week or two and if no adverse reaction then add the next one. Again, wait a week or two and if no adverse reaction add the next one. Continue like this. If you do have any adverse reaction then you will know what caused it.
Looking at previous posts
You are still only on 50mcg 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?
You need 25mcg dose increase in levothyroxine
FT4 is far too low...should be up near top of range
Ft3 needs to be at least half way through range
The aim of Levothyroxine is to increase the dose slowly in 25mcg steps upwards until TSH is under 2 (many need TSH significantly under one) and most important is that FT4 is in top third of range and FT3 at least half way through range
NHS guidelines on Levothyroxine including that most patients eventually need somewhere between 100mcg and 200mcg Levothyroxine.
nhs.uk/medicines/levothyrox...
Also what foods to avoid (eg recommended to avoid calcium rich foods at least four hours from taking Levo)
See different GP
Your vitamin levels are poor, because you are under treated
B12 and folate on the low side. Folate is rock bottom
Supplementing a good quality daily vitamin B complex, one with folate in not folic acid may be beneficial.
chriskresser.com/folate-vs-...
B vitamins best taken in the morning after breakfast
Igennus Super B complex are nice small tablets. Often only need one tablet per day, not two. Certainly only start with one tablet per day after breakfast. Retesting levels in 6-8 weeks
Or Thorne Basic B or jarrow B-right are other options that contain folate, but both are large capsules
If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before any blood tests, as biotin can falsely affect test results
endo.confex.com/endo/2016en...
endocrinenews.endocrine.org...
Low B12 symptoms
b12deficiency.info/signs-an...
Ferritin is on low side, look at increasing iron rich foods
No vitamin D result
Test here
All four vitamins need to be regularly tested and frequently need supplementing to maintain optimal levels
Post re how to push for dose increase in levothyroxine
healthunlocked.com/thyroidu....
NICE guidelines
nice.org.uk/guidance/ng145/...
1.3.6
Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.
BMJ also clear on dose required
If you can’t get GP to increase dose email Dionne at Thyroid UK for list of recommend thyroid specialist endocrinologists
thyroiduk.org/tuk/About_Us/...
Hi slowdragon
NO im not currently on medication.
It was stopped in january as the levo (teva) didnt agree with me so my gp suggested a trial away from levo which i was happy to do. This is my second lot of results since coming off levo but last month he did the antibody test for graves by mistake. So last week when i was due back i took advantage pushed for t3/4 and the iron panel. Unfortunately they didnt do vit d but said to me most people suffer low vit d. I have been supplementing with it and vit c.
Ive actually just bought the vit b supplement you have suggested along with the vit b12 boost spray. I purchased these from amazon yesterday .
Thank you
So you will need to see endocrinologist
You have hashimoto’s, rock bottom vitamins and rock bottom Ft3 and Ft4
Clearly needing treatment
50mcg is only a starter dose levothyroxine
How much vitamin D are you supplementing?
How long at this dose.?
Suggest you test vitamin D
My gp wont do anymore. He says i dont need treatment. Im using 1000iu vid d. Its only been about 2 weeks ive been taking this dose. Alsi omega 3 capsules not sure if they will help anyway but its worth a try
Hashimoto's frequently affects the gut and leads to low stomach acid and then low vitamin levels
Low vitamin levels affect Thyroid hormone working
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
You can buy easy test kit online to do at home
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.
Trying strictly gluten free diet...getting all four vitamins optimal
Still likely to need levothyroxine
Looking at previous posts....you are in Scotland...?
there’s recommended endocrinologist in Edinburgh on list from Dionne
Teva doesn’t agree with thousands of people
You needed to try different brand
Many people find Levothyroxine brands are not interchangeable.
Once you find a brand that suits you, best to make sure to only get that one at each prescription.
Watch out for brand change when dose is increased or at repeat prescription.
Many patients do NOT get on well with Teva brand of Levothyroxine. Though it is the only one for lactose intolerant patients. Teva is the only brand that makes 75mcg tablet. So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half
healthunlocked.com/thyroidu...
Teva poll
healthunlocked.com/thyroidu...
No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.
Some like calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away
(Time gap doesn't apply to Vitamin D mouth spray)
I did comment on that post about teva but again when i went to my gp he said hes never heard of it. The way things are currently with the world i wont be reffered to anyone. He said my levels are fine and we will check them again in 3 months
My GP said he’d never heard of reaction to Levo from fillers and binders. They are clueless - Loads do. He was unconcerned about all my swollen Lymphs and chest pains, numbness. I saw a different GP and she was fortunately x
I wasn't a fan of the Levothryroxine from Teva either. I now source Eythyrox from Switzerland which I have no problems with - not ideal though especially in the current situation (I fortunately have enough for another 6 months). Whilst generic are in theory the same the reality is that many use different fillers so they are not always exactly the same (the active ingredient should be the same though) so you are well within your rights to ask to try a different brand.
I can also totally vouch for the gluten free diet - I saw a huge impact from going gluten free. It can be hard at first (especially at the moment as some supermarkets are out of stock of GF products) but you do get used to it. You can also try doing the elimination diet if you really want to see what food impacts you (I have a Hashi's friend for e.g. who has no problems with gluten but can't do dairy).
I love dairy unfortunately , especially cheddar lol. That would be so hard to give up lol. Ive ordered quiet a few different vitamins so im hoping they will at least help a bit
You can get Dairy free cheeses and they’re not bad at all x
Like Treepie says ‘Its your symptoms that count. What are your symptoms ?
Really important to help your Thyroid last as long as possible by taking vitamins x
Well unfortunately the lump sensation has come back, its not as bad as it used to be but its there. And my hair breaking. I do feel the cold at times but apart from that im ok. I dont feel unwell with it. Ive ordered a b complex vitamin, take vit c and d so fingers crossed it all helps x
I would also take Selenium. I think you said youre also taking Omega3? I have just received Zinc Balance Jarrows Formula has little bit of copper too. Zinc is very important to convert T4 to T3 and good for hair and nails. Hypothyroidism causes low Zinc ( like I am). I would also take Magnesium and a probiotic x
What is selenium??
Also bought the better you vit b12 spray as heard lots of good things about it x
Shame that lump feeling is back. Wonder what it is. Mine is stil a lot better on NDT. I would take a vit B complex like Slowdragon recommends.
Selenium is a powerful antioxidant thst plays a major role in Thyroid function like Zinc x
Ive never heard of it. Yes i bought the b complex as recommended by slow dragon and greygoose x
Is it hashis you have michelle? X
Yes x
Bit confused now as to what to take?? Dont want to take too much of different vits. X
Hashi’s causes low stomach acid and poor nutrient uptake. So I would if I were you x
Thank you for the links
Blood Test advice required please 
Pituitary? Advice please! 
Dose changes advice please 
Advice on results please
