I had some medichecks tests done last year and although my TSH was 1.7 and t4, t3 etc were all within range my thyroid peroxidase antibodies were 88 ( elevated) I had the rests all redone this year and my tsh is now 2.5 and my antibodies are 155 but again t4, t3 all within range. I know that 20% of people have these antibodies and don't have hashimotos but I can't ignore the symptoms! I just want to feel well again 🙁
My symptoms are cold all the time, low mood, gaining weight and find it impossible to lose, I am tired ALL the time (my son sleeps 7-7 so its not because of him!) I have to nap every day after my lunch. I have also lost the outer 1/3 of my eyebrows.
My doctor is very dismissive. Any advice or discussion very much welcome. Thank you.
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owl_trousers
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Yes, raised TPO antibodies suggest Hashi's but unfortunately you need an over range TSH for a diagnosis. To get the highest possible TSH we advise the following :
*Do you do your thyroid tests no later than 9am, this is because TSH is highest early morning and lowers throughout the day.
* Nothing to eat or drink other than water before the test, this is because eating can lower TSH and coffee and other caffeine containing drinks can affect TSH.
* If you take a B Complex or Biotin supplement then leave it off for 7 days before the test, this is because if the lab uses biotin in the testing procedure it will give false results.
Thank you for this! The test was done at 9am and on an empty stomach. No other supplements, although I did find out my b12 and vitD were very low (now supplementing) I was wondering if I should try a gluten free diet to try and ease some of my symptoms? From what I've read a GP is unlikely to help until my TSH is out of range (10+ !)
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
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.
An enlightened GP should diagnose autoimmune thyroid disease (Hashimoto's) when TSH goes over range with raised antibodies. This information is in Dr Toft's article he wrote in Pulse magazine, in answer to Question 2. I don't have a link to quote you the relevant bit as I'm not on my PC but you can email Dionne at ThyroidUK and ask for a copy of the article:
tukadmin@thyroiduk.org
owl_trousers
Edited to add what the article says, and it's question 2, not 6 as I originally said so I've edited that now.
Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (the magazine for doctors):
Question 2:
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 two or three months in case the abormality represents a resolving thyroiditisis.
But if it persists then antibodies to thyroid peroxidase should be measured. If these are positive - indicative of underlying autoimmune 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 be come 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 restore serum TSH to the lower part of it's reference range. Levothyroxine in a dose of 75-100mcg daily will usually be enough.
If there are no thyroid peroxidase antibodies, levothyroxine should not be started unless serum TSH is consistently greater than 10mU/l. A serum TSh of less than 10mU/l in the absence of antithyroid peroxidase antibodies may simply be that patient's normal TSH concentration.
Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (the magazine for doctors):
Question 2:
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 two or three months in case the abormality represents a resolving thyroiditisis.
But if it persists then antibodies to thyroid peroxidase should be measured. If these are positive - indicative of underlying autoimmune 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 be come 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 restore serum TSH to the lower part of it's reference range. Levothyroxine in a dose of 75-100mcg daily will usually be enough.
If there are no thyroid peroxidase antibodies, levothyroxine should not be started unless serum TSH is consistently greater than 10mU/l. A serum TSh of less than 10mU/l in the absence of antithyroid peroxidase antibodies may simply be that patient's normal TSH concentration.
Also in your previous post here healthunlocked.com/thyroidu... tattybogle quoted the NICE guidance which clearly states that a trial of levo should be considered in your circumstances.
Yes, I was similar - think my TPO antibodies were 74, TSH 1 and everything else in range, but I had all the hypo symptoms.
I worked through Isabella Wentz's hasimotos protocol, and all the symptoms basically went away though. A few digestive issues linger, but brain fog, fatigue, memory issues, weight issues, hair loss, it's all still under control. Antibodies have been within range for about 2 years too. I highly recommend the book, and I can let you know the names of the supplement brands I took.
I'd also love to know the supplements please as I have seen Isabella a few times on YouTube. I too have thyroid antibodies above range, a TSH of 3.7 BUT my t3 and t4 are in range. Consultant at hospital won't diagnose me. I've felt ill for years since a teenager (im now 29) needing naps everyday and functioning not well when awake. I definitely feel a tiny bit better since going gluten free. I'm currently looking into b1 deficiency. I eat lots of veggies and try low sugar, no alcohol or smoking, so feel like my lifestyle is better than a lot of people yet I'm so poorly. I hope you find a solution as I really feel for you x
It was the Hashimotos Protocol it's a 12 week programme of diet and supplements - a bit hardcore. I haven't read her other books to compare against, but think they're very similar.
I should disclaimer that you will still have hashimotos after this, I just consider it managed . My partner is coeliac, and on a gluten free diet his antibodies are 0, but that doesn't mean he doesn't have coeliac disease any more. It's the same with this.
Free T3 and Free T4 are "in range"? Where in range?
It can make a difference. For example, if the lab's range for Free T3 is 2.0 - 4.4 (pg / ml in the case of my lab), and your result is 2.0, that is in range, but it is at the very bottom and you can feel pretty ill.
There is a calculator you can use to determine the percent through range. Ignore the Polish and just fill in the numbers for result, bottom of range, and top of range for both FT4 and FT3, then click on the button that is labeled "Oblicz"
The percents will be displayed below. Most hypothyroid patients need their free (unbound) thyroid hormones to be in the upper third of the range (i.e. >66%) and some even need it to be in the top quadrant (>75%) for most of their symptoms to be relieved.
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