Dec 2019 10AM
TSH 4.27 (0.3-5.0)
T4 10.2 (12-20)
T3 3.6 (3.1-6.8)
B12 390 (200-960)
Ferritin 96 (20-350)
Folate 6.3 (3.0-18.0)
2nd May 2020 1pm
TSH 3.43 (0.3-5.0)
T4 11.5 (12-20)
T3 4.0 (3.1-6.8)
TPO anti-B 18IU/ml (<100)
Tomorrow I have 9AM bloods for “steroids and inflammatory takers”
🤷♀️
Could anybody enlighten me please?
I am so new to all this
Sarah
Previous post
healthunlocked.com/thyroidu...
Your high TPO antibodies confirms that you have autoimmune thyroid disease and need to be started on levothyroxine
Ft4 is BELOW range
Essential to test vitamin D,
GP should also do coeliac blood test
Standard starter dose of levothyroxine is 50mcg (unless over 65 years old).
Bloods should be retested 6-8 weeks after each dose increase in levothyroxine
The aim of Levothyroxine is to increase the dose slowly in 25mcg steps upwards until TSH is under 2 (many patients 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 note what foods to avoid (eg recommended to avoid calcium rich foods at least four hours from taking Levo)
All four vitamins need to be regularly tested and frequently need supplementing to maintain optimal levels
Levothyroxine is an extremely fussy hormone and should always be taken on an empty stomach and then nothing apart from water for at least an hour after
Many people take Levothyroxine soon after waking, but it may be more convenient and perhaps more effective taken at bedtime
verywellhealth.com/best-tim...
markvanderpump.co.uk/blog/p...
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. Teva contains mannitol as a filler, which seems to be possible cause of problems. 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
Teva and Aristo are the only lactose free tablets
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 iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away
(Time gap doesn't apply to Vitamin D mouth spray)
Folate and B12 are on low side
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...
Do you have any Low B12 symptoms
b12deficiency.info/signs-an...
Yes it looks like I have symptoms of B12 deficiency 🤦♀️.
Blimey this is all pretty confusing
Thank you for your help
So ask GP for testing for Pernicious Anaemia BEFORE Starting any B vitamins
👍
Are you vegitarian or vegan,?
Morning I’m a meat eater and have a good diet
Good ...just checking.......
we see hundreds of vegetarians or vegans on here...often not supplementing anything and they are surprised they have low B12/iron levels
I'm pretty sure she does not have PA as her B12 numbers are good. However, B12 assay levels have a poor correlation with symptoms so I would suggest supplementing with methylcobalamin and seeing if it helps.
Thank you SlowDragon.
Really appreciate your help
I think I’ve written TPO result incorrectly 🤦♀️
TPO 18. IU/ml ( <100)
Does that mean it’s high?
Could you advise me how to approach my GP as she seems to think my thyroid levels are ok?
Thank you
So TPO is actually negative ...so not necessarily Hashimtos
You need to test TG antibodies
You will need to get full Thyroid testing privately as NHS refuses to test TG antibodies if TPO antibodies are negative
If TG antibodies are negative
20% of Hashimoto's patients never have raised antibodies
healthunlocked.com/thyroidu...
Ft4 and Ft3 are low ....so need to find out why
What sort of age are you?
Menopause?
I’m 55 and use Estrogen gel. I reduced the amount I use in the New Year as I read that HRT can affect your thyroid.
(Your 'T4' and 'T3' figures are actually 'free T4' (fT4) and 'free T3 (fT3)'. Most T3 and T4 is bound to proteins, only small fractions are not bound i.e. 'free'. It is the free hormones that are available for use and so they measure fT3 and fT4. T3 is the active form that binds to receptors. T4 has to be converted to T3 before it is much use.
I don't know anything about “steroids and inflammatory takers” but it's clear you are hypothyroid. In most patients as the thyroid begins to fail it produces less T4. The body responds by secreting a lot more TSH. TSH usually goes well above its upper limit (5.0) before fT4 goes low. This is why TSH is often a very good marker for primary hypothyroidism (a failing thyroid gland), These high levels of TSH also stimulate the thyroid to produce proportionally more T3 and stimulates the conversion of more T4 to T3. This usually keeps fT3 around mid-interval which keeps the patient reasonably well.
In your case your pituitary is producing less TSH than would be expected. As a consequence your fT4 has gone low before TSH goes high and the diagnosis is missed. Importantly as a result of this low TSH (low for your fT3, fT4) you get less fT3, it should be around 5.0.
If the pituitary fails you get a condition called 'central hypothyroidism' or 'secondary hypothyroidism'. This really describes a condition where TSH is close to zero and usually other pituitary hormones are affected. You do not have this but your TSH is too low. I call this 'subnormal TSH secretion' to distinguish it from true secondary hypothyroidism. The consequence is usually quite considerable hypothryoidism as a consequence of both fT3 and fT4 being low normal.
The problem is that often all three hormones (TSH, fT3, fT4) are within their reference intervals and consequently doctors say the patient doesn't have a thyroid problem. This is wrong because you must look at all three hormones as a single system. Fortunately, your fT4 is low at 11.5. When you see your doctor point out that fT4 is low and consequently your TSH should be high. This shows that your pituitary is not performing well. If they say this may be normal for you tell them it is not and give them a list of your symptoms and how they affect your life.
You will have a battle on your hands but you are definitely hypothyroid. I suspect in the long term you may need some liothyronine to get well, this is really difficult to get prescribed so cross that bridge if and when you come to it. I would try to get a trial of levothyroxine, more than 25 mcg which is too little to notice a difference.
Thank you very much for your help. I will speak to Dr next week after the results of tomorrow’s bloods. She mentioned pituitary/ cortisol problems last week which is why she ordered the blood test.
I will keep researching on this site which is so informative
That sounds good. Sometimes the 'axis' becomes down-regulated, the pituitary secretes less than it should. It isn't a physical problem, it can happen if the thyroid has a period of over activity that deadens the pituitary response.
Essentially you TSH is not adequate so they should monitor you by looking at fT3 and fT4 and your signs and symptoms.
Thank you 🙏
I’m going to speak to GP who has treated me for 20yrs for PTSD ( long story) I have a good relationship but she had said on the last 2 occasions that TSH is ok. I’m going to have to tread carefully. Are there any NICE guidelines about when to treat hypothyroidism?
Severe illness and depression can cause a low TSH that leads to low fT3, fT4. I suspect PTSD can also have this effect.
NICE guidelines were created recently nice.org.uk/guidance/ng145 . To be honest they are not that good and I can't find any details on how to diagnose. There is also a NICE Clinical Knowledge Summary, these are set up to help GPs, see cks.nice.org.uk/hypothyroid... . In the section on Diagnosis cks.nice.org.uk/hypothyroid... it says 'Suspect a diagnosis of secondary hypothyroidism if clinical features are suggestive and TSH levels are inappropriately low (may be normal), but FT4 is below the normal reference range.'. Notice the bit that says TSH may be normal. Usually secondary hypothyroidism is a result of pituitary damage and accompanied by other hormone deficiences but this guidance covers milder forms where just TSH is inappropriately low. You could print off the CKS webpage and highlight the text I've put in italics. This will be easy for your GP to read.
Thank you I will do that!
I suspect that years of adrenaline/cortisol may have messed up my HPT/HPA axis. These symptoms are completely different however and have been occurring since Nov.
My PTSD is controlled with Pregabalin/Setraline/Zopiclone.
Menopause controlled by HRT
Dr may not want to add another drug.
Also because there may be a crossover with some symptoms she may be looking at all options 🤷♀️
Thanks again. Very informative and helpful group 👍
Links about drug interactions
pubmed.ncbi.nlm.nih.gov/957...
ncbi.nlm.nih.gov/pmc/articl...
I have printed the 1st link & will give it to Dr's.
"inflammatory takers" - I suspect that should probably read "inflammatory markers" if that helps. Probably a test such as ESR or CRP, which are both markers of inflammation.
Below range FT4 and low in range FT3 suggest underactive thyroid, but TPO looks as though it is negative at 18 IU/Ml sp maybe not autoimmune. Your TSH is not very high considering under range FT4, so might be a pituitary or hypothalamus problem, which GPs are not equipped to deal with or understand - needs an endo. Point out under range FT4 as GPs don't like to treat until TSH is more than double the top of the reference range
Thank you everyone you have been brilliant with your knowledge 👍
I have been researching the affect of Pregabalin/HRT on the HPA and HPT axis and there are various studies that show that both affect the pituitary gland and therefore the thyroid 🤷♀️........I would never have looked at this link without the info you have all given
Thank you 🙏
latest test results
Fluctuating results for thyroid am I going mad?
Full test results from thriva - but what now?? How do I start feeling healthy, energetic and start losing excess weight? 
Results going up and down
