please can I have some advise on my results from March. have been feeling pretty awful with Hypothyroid symptom, plus some new ones.Fatigue, anxiety,foggy brain,etc but for the last 9 or so months have been coughing a lot especially when swallowing. Throat seems swollen and have a gravelly voice a lot of the time.Been Hypothyroid for 4 years now but do not feel that I have made much progress.I have put on 2 stone in weight, my cholesterol is 5.9 and BMI 31.I am wondering whether or not I am converting T3 as it has always been low in range. TSH has gone down from 9 to 1.51 but am symptomatic!! I supplement with Vit D Better you 9000IU, Codliver oil 1000mg,Folic acid 400UG and probiotic 5 Billion. I take Thyroxine 75mg, Citalopram 10mg, Rabeprazole 20 mg for a hiatus hernia which gives me acid reflux.I have been researching and realise that the Rabeprazole could be responsible for me not absorbing vitamins and minerals due to low stomach acid.Also have noticed on here that Hashis can give low stomach acid too.I would really appreciate your opinions on why im feeling so bad again , im at my wits end trying to help myself and not seeing vast improvements. These are my results: Blue Horizon
March 2020
TSH 1.51 (0.27-4.2)
Total T4 105 (59-154)
FreeT4 16.0 (12-22)
Free T3 3.7 (3.1-6.8)
Thyroglobulin 198 (0-115)
Peroxidase 66.2 (0-34)
July 2019
TSH 1.72
Total T4 101.0
FreeT4 16.10
FreeT3 3.81
Reverse T3 21.0
Reverse T3 Ratio 11.81 Normal >15 Borderline 12-15 Low <12
Thyroglobulin 169
Peroxidase 60.4
Vit D 64 (50-175)
Vit B12 411 (300-569)
Serum folate 17.50 (8.83-60.8)
Ferritin 100 (13-150)
Magnesium 1.00 (0.7-1.0)
The highest my T3 has been is 4.17 over the 4 years.
Thankyou in advanced for any advice.
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Traceycrete
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Doubtful. It's probably been a lot longer than that - especially as you have Hashi's. It's something that creeps up slowly, and as the thyroid hormones decrease, the adrenals step up their cortisol production to compensate. So, by the time you feel bad enough to go to the doctors - or to have a doctor take you seriously - you've been hypo for quite a long time.
TSH has gone down from 9 to 1.51 but am symptomatic
Not surprising, because it's not the TSH that causes symptoms. It's the T3, and your FT3 is very low despite your TSH level. TSH can be a very poor indicator of thyroid status, but doctors don't understand that.
Also have noticed on here that Hashis can give low stomach acid too
It certainly can. So, taking a PPI can make matters worse, rather the better. And, the problem is that symptoms of both high and low acid are the same.
TSH 1.51 (0.27-4.2)
Still too high. Should be down to 1 or under.
FreeT4 16.0 (12-22)
Too low. Well below mid-range, should be nearer the top of the range.
Free T3 3.7 (3.1-6.8)
Much too low, scraping along the bottom of the range, and the source of all your problems. It would seem as if you are a poor converter - quite common with Hashi's - because your FT4 is 40% through the range, but your FT3 is only 16.22%, the numbers should be closer together. But, as you're under-medicated at the moment, things could improve with an increase in levo.
Thyroglobulin 198 (0-115)
Peroxidase 66.2 (0-34)
You have Hashi's. No point in retesting.
Reverse T3 21.0
Reverse T3 Ratio 11.81 Normal >15 Borderline 12-15 Low <12
Total waste of time and money. These tests don't give you any useful information because there are many, many causes of high rT3, and only one of them has anything to do with thyroid. And, your FT4 is not high enough to cause high rT3, so your high-ish rT3 has nothing to do with your thyroid. And, of course the ratio is low - what else would you expect with that low FT3? Doesn't mean a thing.
I supplement with Vit D Better you 9000IU, Codliver oil 1000mg,Folic acid 400UG and probiotic 5 Billion.
If you're taking vit D, are you taking its cofactors: magnesium and vit K2-MK7? If not, you really should be.
I see that your B12 was rather low in July 2019, so rather than taking folic acid, it would have been better to take a good B complex - one with methylcobalamin (B12), not cyanocobalamin, and methylfolate rather than folic acid - which would bring both your B12 and folate up nicely. Igennus do a good one, you can find it on Amazon.
Citalopram
If you raised your FT3 level, you probably wouldn't need citalopram. Depression is a symptom of low T3.
Thankyou Greygoose for quick reply.That seems to make sense to me about Adrenals and Cortisol may explain the anxiety attacks. Forgot to mention that the Vit D spray I take does have the K2 with it. With regards to magnesium do I still need to supplement when its quite high in range?I will try upping the Levo if I get palpitations is it something you have to persevere with or drop dose to 100 on alternate days? Didn't realise low acid has same symptoms as high, thanks for that info. I may start weaning myself off PPi again to give vits a better chance. I will source the B complex and give them a try also. Lets hope this all makes a difference other than that will have to source T3. Hopefully in 6 weeks I can get a blood draw done at my local BMI hospital, difficult with the Covid problem. Thanks again
With regards to magnesium do I still need to supplement when its quite high in range?
Magnesium blood tests are unreliable, and even a result like yours does not guarantee that you aren't deficient. Taking vit D will lower your magnesium, anyway, so always best to take some, and excess will be excreted.
I will try upping the Levo if I get palpitations is it something you have to persevere with or drop dose to 100 on alternate days?
Palpitations can also be due to under-medication, so don't lower your dose just because of them. With your FT4 result, an increase of 25 mcg daily is unlikely to raise your FT4 too far, so don't be afraid of over-medication.
You can find the Igennus B complex on Amazon.
Did an endo give you a diagnosis of Addison's? On what did s/he base that diagnosis? Not advisable to change your HC dose until you have a reliable diagnosis.
Oh, I'm so sorry! I replied on the wrong thread! Please disregard the comment about Addison's. Bit muddle-headed this afternoon. But, the other comments still stand.
It's not just for constipation. People without constipation take it - I think it's probably the most popular form of magnesium. But, it depends what you want help with:
Magnesium citrate: mild laxative, best for constipation.
Magnesium taurate: best for cardiovascular health.
Magnesium malate: best for fatigue – helps make ATP energy.
Magnesium glycinate: most bioavailable and absorbable form, non-laxative.
Magnesium chloride: for detoxing the cells and tissues, aids kidney function and can boost a sluggish metabolism.
Magnesium carbonate: good for people suffering with indigestion and acid reflux as it contains antacid properties.
Worst forms of magnesium: oxide, sulphate, glutamate and aspartate.
I was just re reading your earlier message about taking magnesium as I take Vit d and it can lower magnesium levels that’s why I ask. Didn’t realise there were that many mag supplements to choose from. Will give it some thought Thankyou.
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. Dairy is second most common.
According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps, sometimes significantly. Either due to direct 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 gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse
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
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
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.
Also ....guidelines by weight might help push for dose increase
Even if we don’t start on full replacement dose, most people need to increase dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until on full replacement dose
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.
Thankyou for your reply Slowdragon. NorthStar is the brand I always use.I will try an increase and see if that helps first. I did try that a year ago but started having palpitations so reverted back to 75mg. doctor then said try 100mg alternate days but outcome was the same. Is this something that passes after your body adjusts to new dose? I take folic acid 400UG, Vit D better you spray with K2 9000IU and a probiotic. I am not gluten free. I do think that the PPI I take for acid reflux may play a part in absortion so will try and wean off of that. Thankyou for the link to Dionne, do the Endo's prescribe on NHS or privately? Thanks again.
Strictly gluten free diet helps or is essential for high percentage of Hashimoto’s patients...you do not need any typical symptoms....acid reflux frequently improves too
Retest in 6-8 weeks after adding vitamin B complex and magnesium supplement
The ONLY way to know if gluten is a hidden issue is to try absolutely strictly gluten free diet for minimum 3-6 months
Roughly 86% per of Hashimoto’s patients find gluten free diet helps or is absolutely essential.....personally I never made progress until absolutely strictly gluten free........had absolutely zero gut symptoms (more on my profile)
Is always worth trying gluten free diet ....you might be astonished
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Bit muddle-headed this afternoon. But, the other comments still stand. 
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