Not been feeling myself since February and even being on a diet I am finding it hard to shirt the weight taken a year to lose 2.5 stone, so I always wonder what the results for my thyroid mean, as the gp just says all OK no further action required. I am on 75mg of levo for hypothyroidism.
I am also a inflammatory arthritis suffer and on DMARD sulfasaiazine, and anti inflammatory etoricoxib and pain killers. Vit D over the counter tablets.
This is the results from what I can see from my medical files.
Can someone tell me if my results are normal.?
SERUM FREE T4 LEVEL=15.0 pmol/L(12.0-22.0) normal no further action required.
SERUM THS LEVEL=1.95 mlu/L(0.27-4.2) normal no further action required.
Trust above is ok?
Any advise will be most welcome
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Results suggest that you are probably under medicated
Ft4 is only 30% through range
Most patients on just levothyroxine will need Ft4 at least 60% through range
Just testing TSH and Ft4 is completely inadequate
For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also EXTREMELY important to test vitamin D, folate, ferritin and B12
Low vitamin levels are extremely common, especially if you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies
Do you know if you have high thyroid antibodies?
Likely cause is autoimmune if you also have arthritis
Ask GP to test vitamin levels (and thyroid antibodies if not been tested yet )
Low B12 causes night sweats
Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .
Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
Is this how you do your tests?
Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins
I am speaking to the doctor tomorrow and will ask then.
I don't know if I have high thyroid antibodies, but if I do what does this mean.
When I was first tested for underactive thyroid the doctor did say the levels in the gland in the brain(sorry can't remember the term he used) where so high he thought I was also diabetic and tested for that too which I am not.
If TPO or TG thyroid antibodies are high this is usually due to Hashimoto’s (more commonly known in UK as autoimmune thyroid disease).
About 90% of all primary hypothyroidism in Uk is due to Hashimoto’s.
Low vitamin levels are particularly common with Hashimoto’s.
Gluten intolerance is often a hidden issue to.
GP’s tend to think it not particularly relevant to know if cause is autoimmune or not ......as there is no specific treatment for the autoimmune aspect
Just levothyroxine for subsequent hypothyroidism
But it’s important for you as an individual to know
A) because low vitamin levels are especially likely. Frequently necessary to supplement virtually continuously to maintain optimal vitamin levels
Important to have optimal vitamin levels for levothyroxine to work well
B)gluten intolerance is frequently a hidden issue
C)Hashimoto’s patients may also have hidden lactose intolerance if gluten intolerant. Though often lactose intolerance improves once on strictly gluten free diet
The aim of levothyroxine is to increase dose upwards until Ft4 is in top third of range and Ft3 at least half way through range (regardless of how low TSH is)
Extremely important to have optimal vitamin levels too as this helps reduce symptoms and improve how levothyroxine works
Vitamins should be tested annually as absolute minimum
Frequently necessary to test privately if GP unhelpful
Hashimoto's frequently 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.
Are you currently taking Teva brand of levothyroxine?
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
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
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
Unless very petite....you can use guidelines on dose levothyroxine by weight to push for dose increase
Even if we don’t start on full replacement dose, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until on full replacement dose
Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.
Traditionally we have tended to start patients on a low dose of levothyroxine and titrate it up over a period of months.
RCT evidence suggests that for the majority of patients this is not necessary and may waste resources.
For patients aged >60y or with ischaemic heart disease, start levothyroxine at 25–50μg daily and titrate up every 3 to 6 weeks as tolerated
For ALL other patients start at full replacement dose. For most this will equate to 1.6 μg/kg/day (approximately 100μg for a 60kg woman and 125μg for a 75kg man).
If you are starting treatment for subclinical hypothyroidism, this article advises starting at a dose close to the full treatment dose on the basis that it is difficult to assess symptom response unless a therapeutic dose has been trialled.
A small Dutch double-blind cross-over study (ArchIntMed 2010;170:1996) demonstrated that night time rather than morning dosing improved TSH suppression and free T4 measurements, but made no difference to subjective wellbeing. It is reasonable to take levothyroxine at night rather than in the morning, especially for individuals who do not eat late at night.
HiFunny the Doctor did mention that I may also have fibromyalgia, but as my hormone level came back abnormal and as I just turned 46 last month they are only willing to offer HRT at this stage, even though I have nearly all the fibromyalgia symptoms and only a few mild pre menopausal ones
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