Bloods and symptoms - interpretation and advice needed please. I'm new.

[ZeilaJee]

Sorry – this is going to be a bit of a history as this is the first time I’ve asked advice here but I would be very grateful for some feedback, please.

I recently saw an endocrinologist ‘whole health’ consultant for a whole health perspective on thyroid and lifestyle/diet and my bloods were taken privately (see below). All taken around 13:00hrs and last dose of Armour c65mg previous morning under the tongue, 24hrs previously, no vitamin supplements or food.

I am 65 and have been borderline low thyroid for 10-15 years, starting medication 2-3 years ago after struggling for a long time with all the symptoms and trying to manage it through diet. I do have a good diet - no gluten, very little sugar, no grains, not much dairy, lots of veg and meat and nuts. I read Stop the Thyroid Madness and other info and found a consultant who was willing to start medication with natural thyroxin. Symptoms generally receded well.

However I still lack 'get up and go', sometimes queasy in the mornings, find it difficult to get fit and stay fit, sleep is good for 2 weeks then appalling for 2 weeks. Depressive state has mostly gone though I don't have much laugh nowadays. In normal weather I feel cold and can’t warm up and generally poor thermostat. I started taking a ¼ tablet (c20mg) extra before bed in the worse periods but find sometimes my heart beat increases from normal 64bpm to 92bpm (fitbit) and feel very hot in bed, though I can't eat red meat/red wine at night as this may be the/an added cause? In the day I lack strength which stops me being active, though I feel good energy now in general. If muscle weakness occurs I then reduce the Armour to 45mg/day again for a bit until sleep is totally disrupted again. Though now I’m not sure when the ‘good’ sleep periods are in relation to the dose.

Consultant questioned why I was on Armour (T4 and T3) medication when I had never been tried on synthetic levothyroxine and after viewing bloods below proposes I should stop the natural and go on to the levo following my next GP blood tests. She said that ‘natural’ thyroxin is not natural for humans as pig thyroid (Armour) has 10x as much T3 in it as a human needs proportionally. I feel that the natural thyroxin has dealt with symptoms very well in the main, especially restoring some energy to life which is a relief, but my hair is thin and flat, dry skin, dry mouth at night) and I lead a normal life with much more energy now even though I have the exercise and erratic sleep pattern issues. I am a singer and have two nodules on my thyroid and I feel it presses into my throat at times and it affects my vocal range and I have catarrh on top of my vocal chords which is difficult to clear. I do about 7-9,000 steps/day (fitbit...) but this is summer.

I am afraid of going on the levo and not being able to get back to natural again as it was hard to find someone who would prescribe it and things are alot better than they were.

Bloods: Result Range

TSH v 0.064 (0.26-4.20 mIU/L)

Free T4 12.32 (12-22 pmol/L)

Free T3 5.0 (3.1-6.8 pmol/L)

Ferritin ^ 245.1 (13-150ug/L)

White blood cell count 6.0 (4-10.0 10*9/L)

Red blood cell count 4.11 (3.80-4.80 10*12/L)

Haemoglobin (Hb) 133 (120-150 g/L)

Haematocrit (Hct) 0.39 (0.36-0.46 L/L)

Mean cell volume (MCV) 96 (83-101 fl 0

Mean cell haemoglobin (MCH) ^ 32.4 (27.0-32.0 pg)

Red cell distribution (RDW) 12.6 (11.6-14.0 %)

Serum folate 8.13 (3.89-26.80 ng/ml)

Vitamin B12 584.1 (197-771 pg/ml)

Cortisol* 232 (am 166-507;

pm 73.8-291 nmol/L)

Total Vitamin D v 44 (75-200 nmol/L)

*The Cortisol was taken when I had been left for over an hour alone with no explanation so I was upset. There are other results too (Platelets 299 (range 150-210); Neutrophils, Lymphocyte, Monocytes, Eosinophils Basophils, Erythrocyte sedimentation rate... can supply these if relevant)). Hope all is readable I can't seem to put in the spaces and keep them.

Please can you interpret these results and tell me what you think?

Thank you.

[SeasideSusie Remembering]

ZeilaJee

That looks like a copy and paste job for your test results. The formatting has been lost, all spaces have disappeared and the figures all jumbled together. This makes it very hard on the eye and difficult for the reader to separate the result from the reference range.

It would help those who wish to respond if you could edit your post and put spaces between the results, and putting the reference ranges in brackets then makes it very clear and avoids confusion.

You can edit your post by clicking on MORE beneath it, choose EDIT, make changes then click SUBMIT.

[SlowDragon Administrator]

Welcome to the forum

Have you ever had thyroid antibodies tested?

Do you know if you have Hashimoto’s?

We usually advise that day before any test you split NDT into two doses and take last dose 8-12 hours prior to testing as early as possible in morning before eating or drinking anything other than water

Do you normally split NDT?

TSH is almost always suppressed in any dose of NDT (or T3)

Ft4 is also frequently low on NDT

Vitamin D is insufficient and needs improving

Were you supplementing at all?

Low vitamin D obviously needs improving and GP should prescribe 1600iu everyday for 6 months

Vitamin D

GP will often only prescribe to bring levels to 50nmol.

Some areas will prescribe to bring levels to 75nmol

leedsformulary.nhs.uk/docs/...

GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)

mm.wirral.nhs.uk/document_u...

NHS Guidelines on dose vitamin D required

ouh.nhs.uk/osteoporosis/use...

But with Hashimoto’s, improving to around 80nmol or 100nmol by self supplementing may be better

ncbi.nlm.nih.gov/pubmed/218...

vitamindsociety.org/pdf/Vit...

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

Test twice yearly via vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function. There’s a version made that also contains vitamin K2 Mk7

It’s trial and error what dose we need, with hashimoto’s we frequently need higher dose than average

Government recommends everyone supplement October to April

gov.uk/government/news/phe-...

Also read up on importance of magnesium and vitamin K2 Mk7 supplements when taking vitamin D

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

[ZeilaJee in reply to SlowDragon]

Thank you. Vit D ordered and I will get back to you after I've pursued the rest of your info.

[Health4I in reply to ZeilaJee]

Hi there, just a point on vitamin D...... I had severe muscle weakness and bone pains last year and whilst many blood tests were done and I was diagnosed with Hashi and given levo I was also given Vitamin D tablets (high dosage) to get my levels up as I was severely deficient. It has taken some time but I am in a different place now and so assume vitamin d tablets have worked for me (perhaps along with levo too). I am now taking Vit D daily and that was the recommendation of an endo I saw. It's possible that some of your symptoms may be resolved by insuring your VitD levels are optimal? Good luck

[ZeilaJee in reply to Health4I]

Thank you. It's interesting (and comforting) to have something to try.

[greygoose]

She said that ‘natural’ thyroxin is not natural for humans as pig thyroid (Armour) has 10x as much T3 in it as a human needs proportionally.

This is one of the old, old excuses they use to put you off taking NDT. They don't understand it, not how it works, and not how to dose it. They don't understand how to interpret the blood test results. Don't listen to her. It doesn't matter that the ratios are different. She talking about the ration of T4:T3 that the thyroid produces, but she's not taking into consideration the T3 that is produced by conversion of T4 to T3. So, if you are well on NDT, I really, really wouldn't recommend going onto T4 only, just to keep your endo in her comfort zone. She's only concerned about herself, not you.

[ZeilaJee in reply to greygoose]

Thank you Greygoose. She said that taking T3 when the thyroid was able to convert T4 to T3 by itself (ie. not failing to convert - how does one tell?) suppressed the natural conversion when taking NDT instead of encouraging the thyroid to be as normal as possible. She said the fact that there was so much excess T3 in the pork thyroid made it less than ideal for humans. She was also an NHS consultant for many years (now private) so maybe she was thinking of the drugs bill as it's very expensive. Please can you clarify ?

[helvella in reply to ZeilaJee]

Yes, a working thyroid can and will convert T4 to T3.

But it will also directly produce some T3.

And the 10% claim is wrong-headed.

She should realise that as soon as you take any thyroid hormone, your thyroid and the whole control mechanism are not working normally. If it had been working normally, and that normal was adequate, you wouldn't need any replacement in the first place.

All you can manage is the best of the non-normal state you found yourself in.

[greygoose in reply to ZeilaJee]

Wot helvella said. lol

Yes, exactly, she's making the mistake so many doctors make of comparing a euthyroid gland with a hypo gland. You just can't do that. Once your thyroid starts to fail, all the encouragement in the world won't have any effect. Her theory is totally wrong in so many ways.

The way to tell how well you are converting is to have your FT4 and your FT3 tested at the same time WHEN TAKING T4 ONLY. There is no way to tell how well you convert when taking NDT, I'm afraid.

[ZeilaJee in reply to greygoose]

If there any reason why I would be better on levo than what I'm on? I anticipate a battle to stay with NDT as I'm moving house and area.

Also - is my dosage right from what you see from the results above or is it possible to get myself going better?

Winter - even without C-19, is always going to be hard as to keep the cortisol up I have to exercise much more than I want to. I have ordered the Vit D Slow Dragon suggests. I will find out about thyroid antibodies/Hashimotos when I see the consultant again - which may be a long time ahead. I have presumed it's Hashimoto's: low thyroid nearly always Hashimoto's, isn't it?

[greygoose in reply to ZeilaJee]

That is impossible to say with any certainty, but probably not. We're all different, and what suits one person, won't suit another. Some people do very well on levo, but as they've never tried anything else, we cannot know if they'd be better on something else. As you've never tried levo, you cannot know how well you'd do on it. As you've never been on levo only, we cannot know how well you convert, and if you don't convert well, you would be much worse off on levo. Is it worth the risk?

So, if you're well on NDT, I cannot see any advantage for you in changing to NDT. It's just easier for your endo, because that's what she was taught about in med school. Personally, I wouldn't put my health at risk just to please a doctor - and it's not very professional of her to ask you to do it.

Also - is my dosage right from what you see from the results above or is it possible to get myself going better?

You could easily increase by quarter grain, yes. See if it feels better.

low thyroid nearly always Hashimoto's, isn't it?

No, not at all. There are many, many reasons for a failing thyroid. It's more often Hashi's than any other single cause, true, but if you add all the causes together, I think they would out-weigh Hashi's - if you see what I mean.

[ZeilaJee in reply to greygoose]

So I understand that a failing thyroid gets worse over time with the disease phases and ageing. With NDT, because we are not asking for the conversion to T3, as there's effectively an 'oversupply' from its porcine makeup, is the thyroid function is being helped too much and it will fail faster because it's not practising conversion?

I think it's radiation from Chenobyl that caused my thyroid to go - I was living in the risk area when it blew (lambs were put down if you remember) and there is no history of problems in my family. On increasing the dose, what symptoms of overdose should I be vigilant for?

This is very helpful. I've felt completely in the dark without this site and your feedback is very gratefully received - from all. Thank you.

[SlowDragon Administrator in reply to ZeilaJee]

With suppressed TSH, your own thyroid output is effectively switched right off

Getting full private testing will reveal if you have high thyroid antibodies

Ever had ultrasound scan of thyroid?

20% of Hashimoto's patients never have raised antibodies

healthunlocked.com/thyroidu...

Paul Robson on atrophied thyroid - especially if no TPO antibodies

paulrobinsonthyroid.com/cou...

[greygoose in reply to ZeilaJee]

It's very doubtful there is an over-supply of T3. For some people there isn't enough - there wasn't for me - and they have to add extra synthetic T3 to their NDT. But, it has no effect on the failure of the thyroid because it switches the thyroid off, so you could say it's giving the thyroid a rest, and that way it will survive longer, just not producing any hormone.

But, the point is - and it's a big one - because the thyroid is resting, should you be without your NDT or whatever, for whatever reason, the thyroid will step back up and do it's best to keep you alive. This happened to me. For a variety of reasons, I didn't have any thyroid hormone for six months, but my thyroid kept me alive. I had a TSH of about 45, and Frees under-range, but I was alive, long after my thyroid had been pronounced dead. But, of course, you could say all that about any thyroid hormone replacement, it's not just a selling point for NDT. Anymore than this rot about too much T3 is a good reason for not taking it.

Thing is, we're all different, we all have different needs. But, endos won't give us the freedom to experiment and find what exactly it is that we, as individuals, need. For them, the only treatment is levo, and get the TSH back in-range, and there job is done. But, there's so much more to it than that. And, all this endo is doing, in telling you there's too much T3 in NDT, is showing her endo-ignorance.

Whilst it's true that if you look at the T4:T3 ratio, there is more T3 to T4 in pig thyroid than in human thyroid, ratios have nothing to do with hypos. Ratios are for healthy people. We - and I have to say it - are not healthy people, ratios are irrelevant to us. We are not looking to be euthyroid, we are looking to be well. And as far as rations are concerned, that's not the same thing. A hypo needs what she needs. If that's a very high dose of T3 - and I've known doses over 300 mcg - and little to no T4, then so be it. On the other hand, some people are very happy taking just T4 and no T3. It all depends.

But, I've been waffling on and I'm not sure I'm explaining very well. But, the bottom line is, the exogenous hormone you take will have zero effect on your actual thyroid, apart from switching it off. If you have Hashi's, the disease will probably continue to take its course, of attacks on the gland, slowly destroying it. But, even there, the destruction might be slowed down by taking enough hormone to suppress the TSH and put the gland to sleep. (Another grey area where not enough research has been done!) And, there is nothing - absolutely nothing - your endo can say that justifies taking someone off NDT, when they are well on it, and putting her on levo. There is no advantage to the patient, only to the endo.

I don't really remember Chernobyl, no. I wasn't in the UK at the time. But, that is perfectly possible, as are a load of other causes. You'll probably never know for certain, and it doesn't make that much difference, anyway. There's nothing you can do to bring your thyroid back to life.

On increasing the dose, what symptoms of overdose should I be vigilant for?

Well, once again, we're all different, and everyone has their own individual set of symptoms. For me, over-medication leads to a tremor in my hands, when I hold my arms out straight in front of me. You could have a racing heart, or loose bowels, or a whole host of other symptoms - many of which can be mistaken for hypo symptoms. When is why we need to do labs, to back up the way we feel. But, I think you'll know instinctively that something isn't right. So, don't worry about that for now. For the moment, your task is to fend off the Wicked Endo that wants to take your magic potion away!

[ZeilaJee in reply to greygoose]

Thank you - your knowledge is really helpful and you have answered all my questions - for now! Accepting that one isn't superwoman - or at least normal and well woman - is very hard and I've resisted it for many years. I will do whatever I can to keep as normal/well as I can and I WILL RESIST THE WICKED ENDO! THANK YOU.

[greygoose in reply to ZeilaJee]

You're welcome.

[SlowDragon Administrator in reply to ZeilaJee]

You can’t chop and change dose

The fact you are, suggests you need to tweak dose

Some people need to add a bit of levothyroxine alongside NDT

Others do better on levothyroxine plus T3

Getting vitamin levels optimal

Suggest.....Sticking on unchanging dose NDT and get retested 6-8 weeks time

Making sure to test early morning before eating or drinking anything other than water and last 1/2 or 1/3 dose NDT 8-12 hours before test

List of private testing options

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus ultra vitamin

medichecks.com/products/thy...

Medichecks often have special offers, if order on Thursdays

Thriva Thyroid plus vitamins

thriva.co/tests/thyroid-test

Blue Horizon Thyroid Premium Gold includes vitamins

bluehorizonbloodtests.co.uk...

[ZeilaJee in reply to SlowDragon]

Thank you - I note your advice on testing and will do that.

Vitamins: I was recommended to take Centrum Performance multivitamin but it's difficult to fit it in regularly leaving enough time after thyroxin doses if they are split. I did take it split but wondered if the bad sleep was to do with the T3 taken just before bed and livening me up (heart rate, brain and can't keep still). So I now take in the morning, don't have breakfast until at least 2 hours later (or not at all) and try to remember a the multivitamin at lunch. What would you suggest?

[SlowDragon Administrator in reply to ZeilaJee]

We never ever recommend any multivitamins. Too little of what we do need. Usually have lots we definitely don’t want

Post re Multivitamins

healthunlocked.com/thyroidu...

Far better to test and only supplement what we need

You may need a good quality vitamin B complex

But only add one supplement at a time and wait at least 2 weeks to assess any changes

Many people split NDT or T3 doses through day

Many of us find a small dose T3 at bedtime improves sleep

But everyone is different, some try it and don’t get on with it

[greygoose in reply to ZeilaJee]

Vitamins: I was recommended to take Centrum Performance multivitamin

Who recommended that? Whoever it was knows nothing about nutrition. It's pretty awful. Have you looked at the ingredients?

It contains:

Calcium: very doubtful you'll need that, but you should always test before taking any because taking too much can be catastrophic. Calcium supplements are not a good thing to take anyway, because they are not well absorbed and can build up in arteries, etc. causing problems. It's rather like swallowing rocks!

Iodine: you definitely shouldn't be taking that as you're hypo, could cause all sorts of problems. Iodine deficiency is rare in the western world, and if you are taking thyroid hormone replacement, you'll be getting iodine from that. 1 grain of NDT contains about 29 mcg iodine, which is recycled in the body. Plus what you're getting from your food. It is very easy to over-dose.

Iron: taking iron at the same time as vitamins, blocks the absorption of said vitamins, so you don't benefit from any of the vitamins in the pill. And, if you take iron and calcium together, they will bind so that you can't absorb either of them. Iron should be taken at least two hours away from everything else, including food, and four hours away from thyroid hormone.

Copper: hypos are usually high in copper and low in zinc - the two should be balanced. So, taking more copper on top is not a good idea. Over-dosing on copper is not pleasant. One more thing that should be tested before taking any.

But, the worst thing about this multi is that it doesn't tell you the form of any of the ingredients. For example: B12 - is it cyanocobalamin or methylcobalamin? It's methyl you want to take, not cyano. Magnesium - there are so many forms of magnesium, but not all of them are good to take. They don't tell us which one is in the pill. Probably the cheapest - they usually are - which are also the least bio-available. So, much, much better not to take a multi-vit.

[pennyannie]

Hello ZuilaJee

There are may people who adjust their thyroid hormone replacement in the colder months, and this might solve the winter months for you.

With NDT you dose to the relief of symptoms and would think, as one ages, you might need to be looking at your initial dose with a view of increasing by another 1/4 grain and just see if you feel any better.

If you are with Hashimoto's obviously you will need to be playing close attention to your dose level and possibly adjust down when the disease is in an ' active ' phase.

With each ' phase ' the thyroid becomes more damaged and as your own thyroid production declines you will need to adjust your thyroid hormone medication accordingly to compensate.

Since a fully functioning working thyroid supports you on a daily basis with T1.T2.T3.T4 and calcitonin it does seem to me, that if the gland is failing, or non functioning, replacing with full spectrum thyroid hormone a better option.

[ZeilaJee in reply to pennyannie]

Thank you - that's really specific and helpful about dose and winter.

When you say 'adjust down' in the 'active phase', what is this? what happens and what symptoms tend to occur? (Is it the muscle weakness, feebleness, depression etc?). I would have perhaps taken more with more symptoms rather than reducing dose.

[pennyannie in reply to ZeilaJee]

Hey there,

Well, I'm not with Hashimoto's but read the nature of this particular disease is that your thyroid is attacked by anti bodies and every attack sends the thyroid a little bit haywire.

This can be referred to as a ' hyper swing or phase ' as it is transient and you will swing back once the thyroid attack is over. The ' hyper ' symptoms you may experience can be anxiousness, sweating, giddiness, a faster than normal heart beat and blood pressure, and a generally uncomfortableness within your own skin.

As though you have taken too much medication ? ( if you have ever been there ) .

I read during this phase/ swing some people drop down their dose, or skip doses depending on the severity of the symptoms experienced.

When this phase is over your thyroid returns to normal but has been damaged by the attack and will not be as functional or robust as it was before, and so you may find you need to add a little more thyroid hormone support to your existing dose.

So, I would think if the symptoms you describe, were new to you, and you were well and settled on that dose of NDT previously, these could be your symptoms of this hyper phase.

It's difficult because some symptoms of hyper and hypo cross over :

I guess the question has to be : Did taking extra NDT when in this 'hyper ' phase help or hinder you ?

It's all about trying to control and reduce the anti bodies so the attacks on your thyroid will not be so long or so strong and read your diet is an all important factor in this.

[SlowDragon Administrator]

Noticed you say you put NDT under your tongue ...rather than swallow

There’s some debate on wether NDT can be absorbed under tongue

greygoose ....what’s your view

[greygoose in reply to SlowDragon]

Oh, gosh, yes! I forgot to mention that. No, don't take it sublingually. All forms of thyroid hormone are designed to be swallowed. They need the stomach acid to 'unlock' the hormone, as it were. Thyroid hormone molecules are too large to pass through the mucus membrane, straight into the blood, which is the point of taking things sublingually, and they just stay in the mouth until swallowed. And, that's particularly bad if people think that taking it sublingually means they can drink their coffee/tea/eat immediately afterwards. NDT should be taken on an empty stomach, and hour before eating or drinking anything except water, and well away from other medication/supplements, just like levo.

[ZeilaJee in reply to greygoose]

Thank you. I'm sure I'll be back - I am grateful for your contribution and help. I will do as suggested.

[greygoose in reply to ZeilaJee]

You're welcome.