"All is normal", so they say in the medical profession....

[Molioli]

Hi everyone on this site, I'd like to introduce myself and ask for your opinion.

I'v had Type1 Diabetes over 40 years now and Graves diagnosis in 2006 (in remission after 18 months treatment with Carbimazole), so I was told that I must have predisposition to other autoimmune conditions and I should look out for them. I have... but no one (GP, endo clinic, even private prof who features on your list of practitioners) wants to even acknowledge that my results and all my hypothyroid symptoms mean another condition.....grrrr.... this must sound so familiar to you all.

So my results are (ranges in the brackets):

21 Jan 2020 4pm private clinic 23 June 2020 7am Medichecks

TPO 410.38IU/ml (0=<50) 266.34 klu/L (<34)

TGlob not tested 155 klu/l (<115)

TSH 1.33uU/mL (0.35-4.50) 1.79mIU/L (0.27-4.2)

fT3 4.9pmol/L (3.9-6.8) 4.69pmol/L (3.1-6.8)

fT4 16.3pmol/L (11.0-26.0) 13.8pmol/L (12-22)

Vit D 75nmol/L (50->200) 80.09nmol/L (50-175)

Folate Serum >20ng/mL (>3) 19.8 ug/L (3.89-20.58)

Vit B12 >2000 ng/L (197-771) active >150pmol/L (37.5-187.5)

Ferritin not tested 195ug/L (13-150)

Cortisol serum 536 nmol/L (73.8-291) pending

CRP HS not tested 0.65 mg/L (0-5)

Tiss Transglutaminase IgA 4.25 U/mL (neg<20) not tested

ESR 24 mm/hr (0-20) not tested

I have suspected under active thyroid and/or pituitary, adrenal issues for over 12 years now, have been supplementing with Vit A, Bs, C, D3+K2, E, selenium, zinc, magnesium and no end of adaptogens, diets, herbs .... and I do feel better when comparing what I was like even a year ago.

My concern is that both the cortisol and thyroid activities have done and are creating huge issues as far as control of my diabetes is concerned, so much so that I'v had to invest into blood glucose monitor in 2012 and insulin pump (2016) in the attempt to keep some sort of control and avoid continuous hypoglycemia despite 10-15 finger prick tests and 10-15 insulin injections per 24 hour periods. My HbA1c is now 6.5% and the endos are extremely happy but totally ignoring the fact that an average (HbA1c = 3 moths of glucose levels) is no measure of time in range! They are just ticking boxes and happy that I have taken my own initiative totally ignoring the diabetes complications already developing.

Please could you have a look at my results and let me know if I am right suspecting Hashi or central Hypo, especially from the point of cortisol level, it creates insulin resistance, which I cannot manage despite my latest tech apps

May we all get good endos and GPs

[Molioli]

I hope the test results will make sense, they appear differently to when I was typing.

I will re-type if a problem

Thanks

[SeasideSusie Remembering]

Molioli

TPO 410.38IU/ml (0=<50) 266.34 klu/L (<34)

TGlob not tested 155 klu/l (<115)

let me know if I am right suspecting Hashi or central Hypo,

Your raised antibodies suggest Hashi's.

Unfortunately, your TSH is not yet at a level where even with raised antibodies you'd get a diagnosis. With Primary Hypothyroidism TSH has to reach 10, with autoimmune hypothyroidism (Hashi's) an over range TSH with raised antibodies should get you a diagnosis with an enlightened doctor.

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (the magazine for doctors) in answer to Question 2:

Question 2 asks:

I often see patients who have an elevated TSH but normal T4. How should I be managing them?

Answer:

The combination of a normal serum T4 and raised serum TSH is known as subclinical hypothyroidism. If measured, serum T3 will also be normal. Repeat thyroid function tests in 2 or 3 months in case the abnormality represents a resolving thyroiditis.

But if it persists then antibodies to thyroid peroxidase should be measured. If these are positive - indicative of underlying autoimmune thyroid disease - the patient should be considered to have the mildest form of hypothyroidism.

In the absence of symptoms, some would simply recommend annual thyroid function tests until serum TSH is over 10mU/l or symptoms such as tiredness and weight gain develop. But a more pragmatic approach is to recognise that the thyroid failure is likely to become worse and try to nip things in the bud rather than risk loss to follow up.

Treatment should be started with levothyroxine in a dose sufficient to restored serum TSH to the lower part of it's reference range. Levothyroxine in a dose of 75-100mcg daily will usually be enough.

You can obtain a copy of the article by emailing Dionne at

[e-mail]

and if necessary print it to show your doctor.

[Molioli in reply to SeasideSusie]

Thank you SeasideSusie

[SlowDragon Administrator]

As you have Type one diabetes this is autoimmune,

Your high TPO antibodies confirms Hashimoto’s

Ask/insist on ultrasound scan of thyroid....despite low TSH your thyroid is failing

Or organise scan privately

Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels

Low vitamin levels affect Thyroid hormone working

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...

Strictly gluten free diet helps many with Type one diabetes too

Susan Blum book the immune system recovery plan has chapters on T1 diabetes and Hashimoto’s

[Molioli in reply to SlowDragon]

Thank you SlowDragon, I'm already gluten free-ish but not for long enough, I think, to notice the difference. I will read through you recommendations.

[SlowDragon Administrator in reply to Molioli]

Does need to be absolutely strictly gluten free to be effective

chriskresser.com/the-gluten...

Even worse, the immune response to gluten can last up to 6 months each time you eat it. This explains why it is critical to eliminate gluten completely from your diet if you have AITD. There’s no “80/20” rule when it comes to gluten. Being “mostly” gluten-free isn’t going to cut it. If you’re gluten intolerant, you have to be 100% gluten-free to prevent immune destruction of your thyroid.

No shared butter, jam cutting board etc

If toasting GF bread...use coeliac toasting bags in standard toaster or get separate GF toaster

[Molioli in reply to SlowDragon]

Thank you