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Confusing results

Piedo profile image
9 Replies

I m totally confused at blood results

Had medichecks blood rest at beginning of July results were

TSH. 0.019 (0.27 - 4.2 )

T4 22.8 ( 12 - 22 )

T3. 4.65. (3.1- 6.8)

I. Had been feeling very anxious hence doing blood test Dr suggested dropping thyroxine to 75 down from 100

I have been on 100 since having thyroid removed in 2012

Had a blood test at hospital eventually managed to get early morning test

So conditions same as medichecks test

Results on 27 July are

TSH. 0.05 (0.05- 5.00 )

T4 14.3 (9 - 20 )

T3 3.8 ( 2.5 - 5.7)

Ferritin 81 (20- 275)

B12. 501 (180. -914 )

Folate 5.9 (2.7 - 34.0)

I have tried adding T3 1/4 Of 25 tablet to 75 thyroxine this week but it has made me feel awful horrible feeling in chest and nauseous

Shall I go back to 100 thyroxine .even though I didn’t t feel great on it I did at least feel stable

The GP has put no further action comment after my results

I can t see how my T4 would drop that quickly in 3weeks dropping from 100 to 75 of thyroxine

Your comments would be appreciated

Piedo

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9 Replies
Nanaedake profile image
Nanaedake

Do you have a vitamin D blood test result? Has calcium been checked recently? Do you have those test results?

Piedo profile image
Piedo in reply to Nanaedake

No vit d wasn t done Nor calcium

I have been taking vit d supplement 2000 plus K2

For a long time I stopped taking them three weeks before the blood tests

Piedo

Hibs1 profile image
Hibs1 in reply to Piedo

You don't need to stop vitamin d or k2 before blood test and 2,000 d a day is barely child's dose. You also need magnesium

Nanaedake profile image
Nanaedake in reply to Piedo

Agree with comments by Hibs1. And you do need to check vit D levels. Calcium deficiency does not always show up in blood tests because your body will rob bones of calcium to ensure enough is circulating in blood. It will eventually lead to problems.

medicalnewstoday.com/articl...

Note that this article mentions depression as possibly caused by calcium deficiency. I had similar symptoms to those you describe until my vit D levels reached around 100nmol and I was prescribed calcium as I've had most of my thyroid removed. We also lose C cells that release calcitonin and some of us lose or have damaged parathyroid glands so vit D and calcium may be critical. Problems may appear right away or emerge later on.

You need to get good advice, discuss with GP or consultant surgeon or ask for referral to thyroid specialist, not standard endocrinologist. Research who to get referred to.

Ask for a DEXA scan to check bone density, blood tests for vit D and calcium but bear in mind that low calcium may not be apparent in blood tests.

I take magnesium, K2-MK7 to maximise calcium efficiency and utilisation of vitamin D. I take vit C to support collagen and eat prunes daily for the boron content.

I had similar symptoms to the ones you describe until I did all this and like you, symptoms didn't emerge right away.

It wasn't helped by the fact that doctors didn't know what was normal after thyroidectomy and didn't have a clue about vitamin levels, calcium or vitamin D. I learned a lot from this forum about vitamin levels. The advice here is mainly aimed at people with autoimmune thyroid disease as that is the most common thyroid condition.

My experience is that with thyroidectomy there are additional issues around calcium utilisation but there doesn't seem to be enough relevant research. Some research seems to say that loss of C cells has no impact but if that is the case, then why do we have them? Some research says that a person can function perfectly well with 1 parathyroid gland but it begs the question why we've usually got 4? I've found that doctors generally think thyroidectomy is no big deal and no consequences but my experience is that is not the case.

However, if treated correctly you should be symptom free. This means attending to all vitamin levels. Keeping gut function really good and looking after bone and cardiovascular health. Other people might have better suggestions.

pennyannie profile image
pennyannie

Piedo

A fully function working thyroid would be supporting you on a daily basis with approximately 100 T4 - Levothyroxine + 10 T3 - Liothyronine.

The body runs on T3, and hypothyroid symptoms suffered are caused by low T3 and I read the average person uses about 50 T3 daily, just to function. Conversely a very high over range T3 would be indicative of hyperthyroidism.

Personally I just think it makes common sense that after a medical intervention of either a thyroidectomy or RAI to remove, disabled the thyroid, both these vital hormones should be on the patient's prescription for if, and probably when, they will both be required to maintain T3 and T4 in balance and at a level of wellness acceptable to the patient.

Some people can get by on T4 only, some people at some point in time simply stop converting the T4 into T3 and some some people simply need both these essential hormones dosed and monitored independently to bring both hormones up and into the upper quadrant of both the T3 and T4 ranges.

The conversion ratio of T4 into T3 when on Levothyroxine only is 1 / 3.5-4.50 with most people preferring to be at the 1 / 4 or lower end of this range.

Your conversion can be compromised if your vitamins and minerals are not maintained at optimal levels but considering you have " lost " this small proportion of natural T3 you have, in reality been down regulated by about 20% of your overall wellbeing, and yes, overtime this will pull you down even further.

A TSH blood test once on any form of thyroid hormone replacement is not a reliable measure of anything especially since you haven't a thyroid gland, and must not be used in isolation to monitor and adjust thyroid hormone medication.

I notice you are trying to introduce T3 - no thyroid hormone works well if your ferritin, folate, B12 and vitamin D are not maintained at optimal levels - I need my ferritin at around 100 for good conversion, it's all trial and error, but getting your core strength strong and solid stands you in good stead for which ever way you want to take your medication forward.

SlowDragon profile image
SlowDragonAdministrator

What was reason for thyroidectomy?

Essential to test all four vitamins at least annually ..They all need to be optimal

Folate is low

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...

Vitamin D may be low too

vitamindtest.org.uk

Have you ever tried strictly gluten free diet?

Clearly you have very poor conversion. Getting all four vitamins OPTIMAL first

But adding in T3 Extremely slowly.....1/8th tablet twice a day ....after week or so increase to 1/4 of tablet twice a day .....hold at this for 6-8 weeks before retesting

Piedo profile image
Piedo in reply to SlowDragon

Thank you slowdragon

I had my thyroid removed 8 years ago because of multinodular goitre that had been growing slowly sine the birth of my son 22years earlier

I was very naive about treatment and was never told what my blood levels were

My father had died of thyroid cancer so dr was concerned when mine grew and affected my swallowing My thyroid once removed was not cancerous

Like everyone else I was told just remove thyroid and take thyroxine and you will be fine , not my experience

I already take vit d k2 b12/

So will add b complex to the mix

I have always stopped taking supplements before testing

I had good GP who has been my doctor 35 years and always listened to me unfortunately he has now retired and I am left a mercy of phone consultations Drs who I have never met all they see are my results is suppressed TSH

I intend to put my thyroxine back up to 100

I will ignore the medichecks Results as there was such a discrepancy between these and hospital blood test .

Thank you all for your comments

Piedo

SlowDragon profile image
SlowDragonAdministrator in reply to Piedo

With Thyroidectomy multi nodular goitre.....you may benefit from strictly gluten free diet too

Perhaps consider in 6-8 weeks after adding vitamin B complex

You do need to stop vitamin B complex a week before any blood tests

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common.

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)

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

While still eating high gluten diet ask GP for coeliac blood test first or buy test online for under £20, just to rule it out first

Assuming test is negative you can immediately go on strictly gluten free diet

(If test is positive you will need to remain on high gluten diet until endoscopy, maximum 6 weeks wait officially)

Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse

chriskresser.com/the-gluten...

amymyersmd.com/2018/04/3-re...

thyroidpharmacist.com/artic...

drknews.com/changing-your-d...

restartmed.com/hashimotos-g...

Non Coeliac Gluten sensitivity (NCGS) and autoimmune disease

ncbi.nlm.nih.gov/pubmed/296...

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

ncbi.nlm.nih.gov/pubmed/300...

The obtained results suggest that the gluten-free diet may bring clinical benefits to women with autoimmune thyroid disease

nuclmed.gr/wp/wp-content/up...

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

restartmed.com/hashimotos-g...

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.

Why gluten intolerance can upset cortisol levels

kalishinstitute.com/blog/gl...

Nanaedake profile image
Nanaedake in reply to Piedo

This article explains the importance of magnesium for vitamin D usage. It might be even more important for people without a thyroid.

sciencedaily.com/releases/2...

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