I am looking for more advice please, as asked for another thyroid function test due to putting on a few pounds, despite increasing excercise.
Just had my recent bloods back and two, nearly three results are 'out of reference range'.
T4 -22.6 (12-22)
TSH -4.4 (0.27-4.2)
T3 -3.3 (3.1-6.8)
I am on a dosage of 75 Levothyroxine and have Hashimoto's. I am taking Vitamin D, and supplimenting B12 as my last reading was 376 (180-914). My Ferritin and Folate are also near to the bottom of the range. I think that the TSH has lowered as previously it was 5.8, due to taking the B12. I have no recent results for Ferritin, B12, or Folate.
I have been asked to call the doctor as my results are 'borderline'.
I do not really know what to discuss as we all know that I need T3 supplimenting, yet the doctor will only want or will only be able to up my Levo to 100, which of course will increase my T4 ( it did last time), and not tackle the problem of the T3 due to it being just within tolerance. I have previously been to an Endocrinologist who was no help what so ever.
Any ideas apart from a referral please?
Once again thanks for any help.
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We should leave 24 hours between last dose of Levo and blood draw, this is because we get a false high FT4 if we take it too close to the test. Taking last dose 24 hours before gives normal circulating amount of hormone.
Coffee can affect TSH.
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.
I am taking Vitamin D, and supplimenting B12 as my last reading was 376 (180-914). My Ferritin and Folate are also near to the bottom of the range. I think that the TSH has lowered as previously it was 5.8, due to taking the B12. I have no recent results for Ferritin, B12, or Folate.
How much Vit D do you take and do you also take it's important cofactors - magnesium and Vit K2-MK7?
When taking Vit D supplement we should test twice a year to ensure we stay within the range recommended by the Vit D Council/Vit D Society - 100-150nmol/L. Too much Vit D will get stored and lead to toxicity, too little and it wont help raise or maintain your level.
Do you take anything for the low ferritin and folate?
When were your last vitamin tests done?
By the way, if you take B12 you should always take a B Complex as well, this keeps all the B vitamins in balance.
No take nothing for the Folate or Ferritin, also nothing with the B12. These vitamin tests done in February, for some reason no vitamin D results at this time. The last vitamin D result I have was 73.9 in April 2019.
Would you advise staying on the 75 dosage, and supplementing with Ferritin and Folate and B complex to go with the B12.?
Your Vit D test is too old, you really need to retest. Come back with new result.
Can't comment on Ferritin and Folate without up to date results/ranges. Ferritin is tricky because low Ferritin can suggest iron deficiency or iron deficiency anaemia, but it could just be low Ferritin without iron deficiency or anaemia. So when Ferritin is low it's a good idea to also do a full blood count and an iron panel.
Definitely need a B Complex when taking B12.
To be honest, I'd get all new tests for vitamins and base supplements on results.
Need to do thyroid test under advised conditions to get accurate results before come ting on whether dose needs changing.
I did have a full blood count in February, but it came back as normal, my Haemoglobin was -Haemoglobin concentration (Xa96v) 137 g/L [120 - 150], does this help?
So just 7.74% through range. I'd get an iron panel done to see if you have iron deficiency. Fast for 12 hours beforehand, water only to drink. No high iron foods or iron supplements in the week before the test.
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)
Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse
If you found gluten free diet reduced symptoms, then you need to stay on it
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.
Thank you. I am not sure that the gluten free diet worked totally for me, I had other problems that went un-diagnosed for several months, finally sorted now.
Would you advise staying on the 75 dosage, and supplementing with Ferritin and Folate and B complex to go with the B12.?
Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption
This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.
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