Low mood: Hi, Thank you for taking the time to... - Thyroid UK

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Low mood

Dudedolf profile image
12 Replies

Hi,

Thank you for taking the time to read this message and also thank you for providing so much useful information. I am writing on behalf of my wife, who has hypothyroidism.

As others have mentioned, some days are good others not so good.

We took a blood test and the results are as follows:

Active b12: 124 pmol/L (normal 37.5-188)

Ferritin: 35ug/L (13-44 normal, 44-150 optimal)

Folate: 32.2nmol/L (30-60.8 optimal)

FT3: 3.9pmol/L (3.1-5 optimal)

TSH: 3.02mIU/L (0.27-1 normal, 1-2.5 optimal, 2.5-4.2 normal)

TgAB: 15kU/L (0-115 normal)

TPOAb: 56.2kIU/L (34-200 high)

T4: 108nmol/L (66-181 normal)

FT4: 16.8pmol/L (12-17 optimal, 17-22 normal)

Vit D: 73nmol/L (50-75 normal, 75-120 optimal, 120-175 normal)

All the results came back in the normal/sufficient/optimal range. So we are at a loss as to what could be causing these high and low points.

To add to this, my wife is also peri-menopausal.

Any ideas or suggestions would be appreciated.

Thank you

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Dudedolf profile image
Dudedolf
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humanbean profile image
humanbean

We really need the reference ranges for the test results you've given. You can edit your post by clicking on "More" at the bottom of your post, then click on Edit, make your changes, then click on "Post".

Dudedolf profile image
Dudedolf in reply to humanbean

Thank you, updates have been made. Hopefully that is what you were after. Thanks

humanbean profile image
humanbean in reply to Dudedolf

That's perfect, thanks.

Lora7again profile image
Lora7again

How much Levothyroxine is she taking? Most people feel better when their TSH is 1 or lower and their T4 and T3 are in the upper third of the range.

Dudedolf profile image
Dudedolf in reply to Lora7again

Thanks for coming back, it is 75micrograms of levithyroxine

Lora7again profile image
Lora7again in reply to Dudedolf

I think she needs an increase of 25mcg and then a blood test 6-8 weeks afterwards to see if her levels have improved.

SeasideSusie profile image
SeasideSusieRemembering

Dudedolf

Presumably this is a Medichecks or Thriva test (as Humanbean has mentioned, we always need reference ranges with results as these vary from lab to lab).

EDITED TO ADD:

OK, so it's a Thriva test. please ignore their "optimal" and "normal" ranges. They report these in a very confusing way. Go the the downloadable pdf for a list of test results and alongside them will be the proper ranges, like this:

healthunlocked.com/thyroidu...

As your wife is diagnosed with hypothyroidism, how much Levo does she take, assuming she is on Levo only?

The aim of a treated Hypo patient on Levo only, generally, is for TSH to be 1 or below with FT4 and FT3 in the upper part of their ranges, if that is where the patient feels well.

Her TSH is far too high at 3.02 and her FT4 is 48% through range with FT3 just 21.62% through range, assuming FT4 range is 12-22 and FT3 range is 3.1-6.8

She needs an increase in her Levo, 25mcg now, retest in 6-8 weeks.

Always advised here, when having thyroid tests:

* Blood draw no later than 9am. This is because TSH is highest early morning and lowers throughout the day. If looking for a diagnosis of hypothyroidism, an increase in dose of Levo or to avoid a reduction then we need the highest possible TSH

* Nothing to eat or drink except water before the blood draw. This is because eating can lower TSH and coffee can affect TSH.

* Last dose of Levo 24 hours before the test, take that day's dose after the blood draw. This is because if you take your Levo before the blood draw the test will measure the dose just taken and show a false high. If you leave longer than 24 hours the result will show a false low.

* 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 phlebotomists or doctors.

TPOAb: 56.2kIU/L

Assuming the range for this is <34 then her antibodies are raised and this suggests autoimmune thyroid disease, known to patients as Hashimoto's. This is where the immune system attacks and gradually destroys the thyroid.

Fluctuations in symptoms and test results are common with Hashi's.

Most doctors dismiss antibodies as being of no importance and know little or nothing about Hashi's and how it affects the patient, test results and symptoms. You need to read, learn, understand and help yourself where Hashi's is concerned.

Some members have found that adopting a strict gluten free diet can help, although there is no guarantee.

Gluten contains gliadin (a protein) which is thought to trigger autoimmune attacks so eliminating gluten can help reduce these attacks.

You don't need to be gluten sensitive or have Coeliac disease for a gluten free diet to help.

Gluten/thyroid connection: chriskresser.com/the-gluten...

stopthethyroidmadness.com/h...

stopthethyroidmadness.com/h...

hypothyroidmom.com/hashimot...

thyroiduk.org.uk/tuk/about_...

Supplementing with selenium l-selenomethionine 200mcg daily is said to help reduce the antibodies, as can keeping TSH suppressed.

Active B12 is good.

Folate is fine.

Ferritin is low, the recommended level is half way through range, so around 82 with their range if it's 13-150.

She can help raise her level by eating liver regularly, maximum 200g per week due to it's high Vit A content, also liver pate, black pudding, and including lots of iron rich foods in her diet

apjcn.nhri.org.tw/server/in...

Don't consider taking an iron supplement unless you do an iron panel, if you already have a decent level of serum iron and a good saturation percentage then taking iron tablets can push your iron level even higher, too much iron is as bad as too little.

Vit D is recommended to be 100-150nmol/L according to the Vit D Council/Vit D Society. Your wife might want to improve her level, in that case taking 3,000iu D3 daily should help. Retest after 3 months.

Once she's reached the recommended level then she'll need a maintenance dose to keep it there, which may be 2000iu daily, maybe more or less, maybe less in summer than winter, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. She can do this with a private fingerprick blood spot test with an NHS lab which offers this test to the general public:

vitamindtest.org.uk/

Doctors don't know, because they're not taught much about nutrients, but there are important cofactors needed when taking D3 as recommended by the Vit D Council.

D3 aids absorption of calcium from food and Vit K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems such as hardening of the arteries, kidney stones, etc.

D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds if taking D3 as tablets/capsules/softgels, no necessity if using an oral spray.

Magnesium helps D3 to work. We need Magnesium so that the body utilises D3, it's required to convert Vit D into it's active form. So it's important we ensure we take magnesium when supplementing with D3.

Magnesium comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds if taking magnesium as tablets/capsules, no necessity if using topical forms of magnesium.

naturalnews.com/046401_magn...

drjockers.com/best-magnesiu...

afibbers.org/magnesium.html

Don't start all supplements at once. Start with one, give it a week or two and if no adverse reaction then add the next one. Again, wait a week or two and if no adverse reaction add the next one. Continue like this. If you do have any adverse reaction then you will know what caused it.

Dudedolf profile image
Dudedolf

Thank you all for all the information, I will read and digest. Appreciated 😊

humanbean profile image
humanbean

Active b12: 124 pmol/L (normal 37.5-188)

This is very good. Optimal is usually classed as above 100 pmol/L for Active B12.

Ferritin: 35ug/L (13-44 normal, 44-150 optimal)

On this forum people usually aim for a ferritin of mid-range to a bit more - say, 80 - 130. You might find this link of interest :

dailyiron.net/

If increasing high iron foods in the diet doesn't help then it is possible to buy prescription strength iron supplements without a prescription - you only need the permission of a pharmacist. Supplementing iron isn't without risk - see this post on the subject and also read all the replies :

healthunlocked.com/thyroidu...

You might find the following replies I've made to others on the subject of some interest.

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

If your wife decides to supplement make sure she gets a full iron panel done first, puts results in a new post, and asks for feedback.

Folate: 32.2nmol/L (30-60.8 optimal)

On this forum we usually recommend a folate level in the upper half of the standard reference range. You've been given an optimal range already, rather than a standard reference range and so I'm not sure what to say.

humanbean profile image
humanbean

FT3: 3.9pmol/L (3.1-5 optimal)

TSH: 3.02mIU/L (0.27-1 normal, 1-2.5 optimal, 2.5-4.2 normal)

TgAB: 15kU/L (0-115 normal)

TPOAb: 56.2kIU/L (34-200 high)

T4: 108nmol/L (66-181 normal)

FT4: 16.8pmol/L (12-17 optimal, 17-22 normal)

The reference ranges with the references to optimal are not helpful to me. For example, I would never classify a Free T3 of 3.1 pmol/L as optimal. To me it is far too low. If you had the standard reference ranges then people tend to feel at their best when Free T3 is very roughly 50% - 70% of the way through the range - for some people it could be substantially higher. For Free T4 optimal is roughly 60% - 80% of the way through the range. These suggested levels are assuming the patient is taking Levo only. If people are taking combinations of Levo and T3, or NDT, or T3 only then optimal levels could be quite different.

A TSH of 3.02 is far too high and suggests under-medication. For many of us on this forum a TSH below 1 is necessary to have a hope of feeling well.

You might find this link of interest :

healthunlocked.com/thyroidu...

The levels of TPOAb and TgAb are not currently suggesting that your wife has autoimmune thyroid disease (aka Hashimoto's Thyroiditis), but if she has had positive antibodies in the past then she has Hashi's. It isn't something that goes away, even if it fluctuates in and out of range.

humanbean profile image
humanbean

Vit D: 73nmol/L (50-75 normal, 75-120 optimal, 120-175 normal)

To calculate the dose of vitamin D3 required to raise or maintain an optimal level of vitamin D, see this calculator :

grassrootshealth.net/projec...

Please note that vitamin D requires a couple of co-factors to go with it - magnesium and vitamin K2.

SeasideSusie has written on these often, and you can see her replies to others on this link :

healthunlocked.com/user/sea...

SlowDragon profile image
SlowDragonAdministrator

Extremely low Ft3 will be causing symptoms

75mcg is only one step up from starter dose

As others have already said, improving vitamin levels and getting 25mcg dose increase in levothyroxine are first steps

Does she always get same brand of levothyroxine

Which brand?

Many people find Levothyroxine brands are not interchangeable.

Many patients do NOT get on well with Teva brand of Levothyroxine. Teva contains mannitol as a filler, which seems to be possible cause of problems. Teva is the only brand that makes 75mcg tablet. So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half

Is she currently taking Teva?

Teva, Aristo and Glenmark are the only lactose free tablets

dropbox.com/s/6h3h0qi4eqwi6...

Teva poll

healthunlocked.com/thyroidu...

Once you find a brand that suits you, best to make sure to only get that one at each prescription.

Watch out for brand change when dose is increased or at repeat prescription.

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

Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).

Levothyroxine is an extremely fussy hormone and should always be taken on an empty stomach and then nothing apart from water for at least an hour after

Many people take Levothyroxine soon after waking, but it may be more convenient and perhaps more effective taken at bedtime

verywellhealth.com/best-tim...

No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.

Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away

(Time gap doesn't apply to Vitamin D mouth spray)

If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal

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