What is happening now!

[Bichonbetty]

I have Hashimotos and Coeliac rash and was recently dx with MGUS last year...now I have macrocytosis......does anyone know what this is all about???? my folate and B12 are ok. I have been told that I do not have MM, which is great, but I still don't understand this new blood condition.

Betty

[SlowDragon Administrator]

How much levothyroxine are you currently taking

What were most recent thyroid results

Please add actual results and ranges on vitamin D, folate, ferritin and B12

mayoclinic.org/macrocytosis...

[Bichonbetty in reply to SlowDragon]

Thanks for your reply, Slow Dragon, I just found your reply.My Ferritin levels were 103, Thyroid results: Free T4, 16.9 ,TSH: 2.42, Free T3: 3.5 ,Vit D: 103. Vit B12: 521, Folate: 29.1

I recently had a bone scan: Left FNT- 2.39, Left femur total 1.46, and Left femur 2.41. Apparently this is down on results from 2002, which was classed as Osteopenia.

I have a few other things going on, skin wise, but the doctors don't seem to think they are connected.....

Lichen sclerosus et atrophicus, Oral ( with ulcers in mouth as well as lichenoid reactions) and VulvaVaginal Lichen Planus. I have IBS-D and Diverticular disease in the whole colon, and allergies to fish and seas foods. I also carry an Epi-pen.

[SlowDragon Administrator in reply to Bichonbetty]

Please add ranges on these results (figures in brackets after each result)

On levothyroxine TSH should be under 2

Many people will have TSH well under one

How much levothyroxine are you currently taking

Do you always get same brand

Most important results is Ft3, should be at least 50-60% through range

Ft3 looks low, obviously need ranges to be certain

As coeliac you are likely to need addition of small doses of T3 prescribed alongside levothyroxine

Osteoporosis can be due to low ft3

[Bichonbetty in reply to SlowDragon]

Thanks for your help....here are the ranges for Thyroid results: Free T4 : 16.9 (9.0-25.0) pmol/L

TSH: 2.42 (0.40-4.00) mIU/L

Free T3: 3.5 (3.5-6.5)

I am on 75mcg of Eutroxsig by Aspen Pharma Aust. and have been on that for a few years.

[SlowDragon Administrator in reply to Bichonbetty]

Was this test done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

Clearly under medicated

Ft4 is only 49% through range

Ft3 0% through range

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,

"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l.

Most patients will feel well in that circumstance.

But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."

(That’s Ft3 at 58% minimum through range)

You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctor



please email Dionne at

[e-mail]

gponline.com/endocrinology-...

Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L.

academic.oup.com/jcem/artic...

Interestingly, patients with a serum TSH below the reference range, but not suppressed (0.04–0.4 mU/liter), had no increased risk of cardiovascular disease, dysrhythmias, or fractures.

It is unfortunate that we did not have access to serum free T4 concentrations in these patients to ascertain whether they were above or within the laboratory reference range.

However, our data indicate that it may be safe for patients to be on a dose of T4 that results in a low serum TSH concentration, as long as it is not suppressed at less than 0.03 mU/liter.

Many patients report that they prefer such T4 doses (9, 10). Figure 2 indicates that the best outcomes appear to be associated with having a TSH within the lower end of the reference range.

[SlowDragon Administrator in reply to Bichonbetty]

Presumably you are absolutely strictly gluten free 100% of the time