Over range TSH, below range FT4, raised antibodies, this is autoimmune thyroid disease (known to patients as Hashimoto's) and your GP should start you on Levo. If he is reluctant, show him the following:
Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (the magazine for doctors) in answer to Question 2:
Question 2 asks:
I often see patients who have an elevated TSH but normal T4. How should I be managing them?
Answer:
The combination of a normal serum T4 and raised serum TSH is known as subclinical hypothyroidism. If measured, serum T3 will also be normal. Repeat thyroid function tests in 2 or 3 months in case the abnormality represents a resolving thyroiditis.
But if it persists then antibodies to thyroid peroxidase should be measured. If these are positive - indicative of underlying autoimmune thyroid disease - the patient should be considered to have the mildest form of hypothyroidism.
In the absence of symptoms, some would simply recommend annual thyroid function tests until serum TSH is over 10mU/l or symptoms such as tiredness and weight gain develop. But a more pragmatic approach is to recognise that the thyroid failure is likely to become worse and try to nip things in the bud rather than risk loss to follow up.
Treatment should be started with levothyroxine in a dose sufficient to restored serum TSH to the lower part of it's reference range. Levothyroxine in a dose of 75-100mcg daily will usually be enough.
You can obtain a copy of the article by emailing Dionne at
tukadmin@thyroiduk.org
print it and highlight question 2 to show your doctor.
Even though your FT4 is below range, rather the normal as mentioned in this article, it's still autoimmune thyroid disease so you should be started on Levo.
Normal starting dose is 50mcg unless it's a child, someone with a heart condition or elderly when it's 25mcg. Retesting should be carried out 6 weeks after starting Levo, an increase in dose if necessary followed by retesting6-8 weeks later. Repeat until levels are where they need to be for you to feel well.
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When doing thyroid tests, we advise:
* Book the first appointment of the morning, or with private tests at home no later than 9am. This is because TSH is highest early morning and lowers throughout the day. If we are looking for a diagnosis of hypothyroidism, or looking for an increase in dose or to avoid a reduction then we need TSH to be as high as possible.
* Fast overnight - have your evening meal/supper as normal the night before but delay breakfast on the day of the test and drink water only until after the blood draw. Eating may lower TSH, caffeine containing drinks affect TSH.
* If taking thyroid hormone replacement, last dose of Levo should be 24 hours before blood draw, if taking NDT or T3 then last dose should be 8-12 hours before blood draw. Adjust timing the day before if necessary. This avoids measuring hormone levels at their peak after ingestion of hormone replacement. Take your thyroid meds after the blood draw. Taking your dose too close to the blood draw will give false high results, leaving any longer gap will give false low results.
* If you take Biotin or a B Complex containing Biotin (B7), leave this off for 7 days before any blood test. This is because if Biotin is used in the testing procedure it can give false results (most labs use biotin).
These are patient to patient tips which we don't discuss with doctors or phlebotomists.
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Also, take your Levo on an empty stomach, one hour before or two hours after food, with a glass of water only, no tea, coffee, milk, etc, and water only for an hour either side, as absorption will be affected. Take any other medication and supplements 2 hours away from Levo, some need 4 hours.
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Fluctuations in symptoms and test results are common with Hashi's.
Most doctors dismiss antibodies as being of no importance and know little or nothing about Hashi's and how it affects the patient, test results and symptoms. You need to read, learn, understand and help yourself where Hashi's is concerned.
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.
Supplementing with selenium l-selenomethionine 200mcg daily is said to help reduce the antibodies, as can keeping TSH suppressed.
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Hashi's and gut absorption problems tend to go hand in hand and can very often result in low nutrient levels or deficiencies.
Ferritin 149 (Range 13-150)
Ferritin is recommended to be half way through range. Do you supplement?
Folate - Serum 2.59 (Range: >3.89)
This is folate deficiency and you should discuss this with your GP who should prescribe folic acid. Please come back if he wont prescribe.
Vitamin B12 - Active 76.500 (Range: >37.5)
This is just about OK, I'd want mine over 100.
Vitamin D - 58.9 (Range: 50 - 175)
The Vit D Council recommends a level of 125nmol/L and the Vit D Society recommends a level of 100-150nmol/L.
To reach the recommended level from your current level, based on the Vit D Council's suggestions you could supplement with 4,000-5,000iu D3 daily
Retest after 3 months.
Once you've reached the recommended level then you'll need a maintenance dose to keep it there, which may be 2000iu daily, maybe more or less, maybe less in summer than winter, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. You can do this with a private fingerprick blood spot test with an NHS lab which offers this test to the general public:
Doctors don't know, because they're not taught much about nutrients, but there are important cofactors needed when taking D3 as recommended by the Vit D Council.
D3 aids absorption of calcium from food and Vit K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems such as hardening of the arteries, kidney stones, etc.
D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds if taking D3 as tablets/capsules/softgels, no necessity if using an oral spray.
Magnesium helps D3 to work. We need Magnesium so that the body utilises D3, it's required to convert Vit D into it's active form. So it's important we ensure we take magnesium when supplementing with D3.
Magnesium comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds if taking magnesium as tablets/capsules, no necessity if using topical forms of magnesium.
Thank you, I will need to take a bit of time to read this properly. I don't take any medication or vitamins and do have a pretty healthy diet. I will go to the doctor and see what he says.
When you are hypo, the level of your nutrients has little to do with your diet. Even with the best diet in the world, your nutrients can still be suboptimal because hypos tend to have low stomach acid, which makes it difficult to digest food and absorb nutrients.
Does it make a difference that about 20 years ago I had an operation on my thyroid because I had a lump on it (reading up on this on the internet makes me wonder if it was in fact a goiter caused by Hashimoto?) anyway, they said that they took part of my thyroid out. Since then I have had blood test with the GP and they have always said they were normal. I have gained loads of weight over the years despite my best efforts and have always suspected that something wasn't right. Does this effect your above advise?
A goitre is not a lump on your thyroid. A goitre is a swollen thyroid - usually all of it, but could be just one side. And they wouldn't take out a thyroid just because it was swollen, unless it was pressing on your oesophagus making breathing and/or swallowing difficult.
What you probably had was a large nodule or a cyst, which can be caused by Hashi's, but not necessarily. Even people without thyroid problems can have nodules.
Pretty certain you have. The disease is slow to make itself felt. As your thyroid fails, the adrenals increase their production of cortisol to take up the slack. And, by the time you feel bad enough to go to the doctor, you've probably had it for quite a long time.
Well, you have Hashi's and you are hypo and your nutrients are too low. Has your doctor seen these results?
Usually, in the UK, they like your TSH to get to 10 before they will diagnose - i.e. they like to leave you to suffer a bit! But, if your doctor has any intelligence and the ability to think for himself, he should take the following points into consideration:
a) Your TSH is well over-range, and not far off 10 - much higher than a euthyroid TSH which is around 1.
b) Your FT4 is very much under-range, and your failing thyroid, pushed on by the high TSH, is putting all its energy into producing T3 (the active hormone), rather than T4 (the basically storage hormone) to keep you alive. But, that cannot go on forever. Eventually, the FT3 will drop, too.
c) Your antibodies are high, meaning you have what UK GP's call 'Autoimmune thyroiditis', meaning that things are going to get worse, rather than better, and the sooner you start thyroid hormone replacement, the better.
You could try pointing all that out to him, if he disagrees that you need treatment. However, not all doctors will accept private labs, believing (falsely) that they are unreliable, even though they're done in the same labs as NHS tests. So, he will probably want to do the tests himself - although he won't test FT3, and probably not antibodies, either. In any case, if this is your first test with a high TSH, the protocol states that another test is carried out six weeks after the first, to make sure you really are hypo and the first test wasn't just a fluke - many thing can affect thyroid results, like viruses - although how high antibodies can be a fluke, I just don't know.
As far as the nutrients are concerned, you're on your own. Doctors think that as long as the results are somewhere in-range, then everything has to be alright. We know better.
Your ferritin is good, so we can ignore that.
But, your folate is under-range. All your doctor will do about that - if he even notices it - is to give you folic acid for a short period of time. You'd be better off self-treating with that one.
Your B12 is also on the low-side - most hypos would like their B12 higher than that. So, I would suggest you get a good B complex, with methylcobalamin (B12) - you don't want one with cyanocobalamin - and at least 400 mcg methylfolate. That should bring both up nicely. But, if it isn't enough to raise the folate, you could take extra folate as well - not folic acid.
Your vit D is only just in-range. Your doctor might or might not prescribe vit D with that result, but it will only be 800 IU, which isn't enough. So, it might be better to get your own, at a higher dose.
Even if your doctor still refuses to take your thyroid seriously - and, remember, 'normal' only means 'in-range', it doesn't mean the results are good in any way - then don't give up testing, because as I said, things will get worse with Hashi's. And, it would still be a good idea to optimise your nutrients yourself.
Oh no! Not Holland and Barratt. You won't get the high quality supplements you need there. The best B complex is produced by Igennus. You can find that on Amazon or other on-line pharmacies, but I doubt they have it in H&B. And H&B own brands tend to be the cheapest, least bio-avalable ingredients. I get all my supplements on Amazon.
No, not H&B, and certainly not their own brand, nor supermarket or any other high street brand. Best supplements are found on the internet. Ask for recommendations.
B Complex - Thorne Basic B or Igennus Super B.
Vit D - Doctor's Best D3 softgels or some members use BetterYou oral spray but that contains a lot of excipients.
Actually, H&B do sell the Better You range of Vit D sprays and Magnesium oil & lotion but I don’t know what level of stock they might have at the moment. I get my Better You products from their own website - just google it. Also, I get my Igenus B complex directly from their own website as well . Good luck, you’ll probably have to chase the stock as everyone has jumped on the band wagon for vitamin sources due to the Covid scare
You are legally entitled to printed copies of your blood test results and ranges.
The best way to get access to current and historic blood test results is to register for online access to your medical record and blood test results
UK GP practices are supposed to offer everyone online access for blood test results. Ring and ask if this is available and apply to do so if possible, if it is you may need "enhanced access" to see blood results.
In reality many GP surgeries do not have blood test results online yet
Alternatively ring receptionist and request printed copies of results. Allow couple of days and then go and pick up.
Important to see exactly what has been tested and equally important what hasn’t been tested
I just wanted to thank you all for your help and advice yesterday. I am pleased to say that I picked up my prescription for 50mg of Levo this afternoon and all vits are ordered and will arrive in a couple of days. Hopefully this will start to turn things around and we will see some changes in the blood test in 6 weeks. Thanks again.
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