Querying the results we have back...

[Blanco1]

Having asked for the annual blood test to check my husbands thyroid we wondered if anyone could confirm if these results are anything to worry about. I shall put the ranges in brackets? We did ask for a TG (TgAb) and Vitamin D but I cannot see this in the report we have. TSH 0.01 (0.35-4.94), T3 0.85 (0.64-1.52), T4 8.89 (4.5-12.5), FT3 2.45 (1.4-3.5), FT4 1.04 (0.71-1.85), TPO 49.79 (<6), B12 251 (200-950), folic acid 8.7 (3-17), Ferritin 142 (59-160). My husband takes Levothyroxine 150mcg, this was a fasting sample. He was taking the tablet in an evening but now we may have to change as his cholesterol is very high (we know if the thyroid isn't well controlled this can increase the cholesterol so we wanted to check the thyroid results first). Many thanks.

[SlowDragon Administrator]

Ft4 only 30% through range

Ft3 50% through range

Helpful calculator for working out percentage through range

chorobytarczycy.eu/kalkulator

So good converter, but probably not on high enough dose levothyroxine

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

NICE guidelines on full replacement dose

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.

gp-update.co.uk/Latest-Upda...

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...

B12 and folate on the 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 after breakfast

Igennus Super B is good quality and cheap vitamin B complex. Contains folate. Full dose is two tablets per day. Many/most people may only need one tablet per day. Certainly only start on one per day (or even half tablet per day for first couple of 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...

Getting vitamin D tested essential

vitamindtest.org.uk

[Blanco1 in reply to SlowDragon]

Many thanks for all that useful information having checked the information on weight it came out the dose of 140 (if I did it correctly). He feels well in himself and we understand getting the vitamin D is essential so we shall go back and ask again. We don't really understand the TPO reading having never had this done before - so this is ok and the TSH at 0.01? We think we remember reading that the Ft3 & Ft4 are more important? Again many thanks for the useful information. Sorry to bother with more questions.

[SlowDragon Administrator in reply to Blanco1]

Postal vitamin D test via nhs £29

vitamindtest.org.uk

[SlowDragon Administrator in reply to Blanco1]

Getting vitamin levels optimal helps improve test results

[greygoose]

You don't need a TgAB test. His TPO antibodies are over-range, so he has Hashi's. Doesn't matter what the TgAB are. No point in retesting the TPO antibodies, either. Antibodies fluctuate, but Hashi's doesn't go away.

[Blanco1 in reply to greygoose]

Many thanks now we need to read up on Hashi's. Thanks again

[greygoose in reply to Blanco1]

Well, here's a potted version of how it works:

OK, so Hashi's is an autoimmune disease, where the immune system attacks and slowly destroys the thyroid. It is diagnosed by testing Thyroid Peroxidase (TPO) antibodies and Thyroglobulin (Tg) antibodies.

Contrary to popular belief, it is not the TPO/Tg antibodies themselves that attack the thyroid:

"When lymphocytes infiltrate the thyroid gland, mistakenly taking it for a foreign bacteria invader, they damage the thyroid gland and release thyroid peroxidase &/or thyroglobulin into the blood stream. These don't belong outside of the thyroid gland so antibodies are developed to mop them up.

The antibodies are a result of the attack on the thyroid gland, the antibodies don't cause the attack."

thyroiduk.org.uk/tuk/about_...

After every immune system attack on the thyroid, the dying cells release their stock of thyroid hormone into the blood stream, causing the levels of the Frees to shoot up - FT4 to around 30 something, FT3 around 11/12 - and the TSH therefore drops to suppressed.

There is no knowing how long these high levels will persist, but eventually, they will drop by themselves as the excess hormone is used up or excreted, and not only will you become hypo again, but slightly more hypo than before, because there is now less thyroid to make hormone.

(NB: A Hashi's 'hyper' swing is not true hyperthyroidism in that your thyroid is over-producing thyroid hormone. It's physically impossible to 'go hyper' if you are basically hypo. The thyroid cannot regenerate itself to the point of over production of hormones - or even normal production. Very few doctors appear to know that.)

Therefore, it's very important that your doctor does not reduce your prescription, because you’re going to need it again! If you start to feel over-medicated at that point - some do, some don't - the best thing is to stop levo for a few days, then, when you feel hypo again, start taking it again. It's very important to know one's body, and how it reacts.

There is no cure for Hashi's - which is probably one of the reasons that doctors ignore it - apart from the fact that they know nothing about it, of course!

However, between the 'hyper' swing, and the descent back into hypothyroidism, there can be a phase - quite a long one, sometimes - of normality, where the person is neither hypo nor 'hyper'. This is where people sometimes start talking of having 'cured' their Hashi's, by whatever means. But, it doesn't last. Eventually, you will go hypo again.

But, there are things the patient can do for him/herself to help them feel a bit better:

a) adopt a 100% gluten-free diet. Hashi's people are often sensitive to gluten, even if they don't have Coeliac disease, so stopping it can make them feel much better. Worth a try. Some say that going gluten-free will reduce antibodies – I’ve never seen conclusive proof of that, but, you should be aware that even if you were to get rid of the antibodies completely, you would still have Hashi's, because the antibodies are not the disease. It is not the TPO/Tg antibodies that do the attacking.

b) take selenium. This is not only reputed to reduce antibodies, but can also help with conversion of T4 to T3 - something that Hashi's people often find difficult.

c) the best way to even out the swings from hypo to 'hyper' (often called Hashi's Flares, but that doesn't really sum up the way it works) is to keep the TSH suppressed. This is difficult because doctors are terrified of a suppressed TSH, for various false reasons, and because they don't understand the workings of Hashi's. But, TSH - Thyroid Stimulating Hormone (a pituitary hormone) - tries to stimulate the thyroid to make more hormone, which also stimulates the immune system to attack. So, the less gland activity there is, the less immune system activity there will be, meaning less attacks, gland destruction slowed down and less swinging from hypo to hyper and back.

[Blanco1 in reply to greygoose]

Wow - I need to digest this. Thank you so so much for all your help.

[greygoose in reply to Blanco1]

Yes, it's a lot to take in, at first. But, you'll soon get the hang of it, and end up knowing more than your GP!