Advice please

[Catfur]

Hi,

I am 39 yr old female who had a hemithyroidectomy at the end of September 2020 for what turned out to be a benign nodule. I am doing ok but in the last month I have noticed that I am losing a lot more hair than normal. It isn’t that thick in the first place.

Over the years I have always suspected a thyroid issue as I feel I have a lot of the symptoms, plus some family members are hypothyroid (two aunts and grandmother). However I had tests at the GP and was always told they are normal.

I did get a test last year as my previous GP wasn’t great ( I have now changed GPs) and again more recently with Medichecks.

9/12/2019

11.30 am not fasting

TSH 1.67 range 0.27-4.2

FT3 5.57 range 3.1-6.8

FT4 14.1 range 12-22

Thyroglobulin antibodies 11.4 range <115

Thyroid peroxidase antibodies <9 range <34

Ferritin 42.2 range 13-150

Folate 5.68 range >3.89

Vit B12 active 89.7 range >37.5

Vit D 15.7 range 50-175

7/12/2020

9.30am no breakfast but not 12 hrs fasting

TSH 4.2 range 0.27-4.2

FT3 4.66 range 3.1-6.8

FT4 13.7 range 12-22

Thyroglobulin antibodies 10 range <115

Thyroid peroxidase antibodies <9 range <34

Ferritin 36 range 13-150

Folate 7.48 range >3.89

Vit B12 active 96.5 range >37.5

Vit D 49.7 range 50-175

Since the first test I have been supplementing with vitD and my levels have improved but still need work.

I have also been reading much of this information available on this forum and am much better informed about testing. I don’t think I will be offered treatment with these results.

I have made an appointment at my GP to discuss the hair loss and most recent thyroid tests. They won’t routinely retest thyroid till 6 months post op.

I am wondering are my symptoms related to the thyroid results? Would I get such hair loss with only slightly raised/ within normal limits results?

Will my results (tsh) normalise again given some time after surgery. Is this normal to have raised levels after partial thyroid removal?

My ferritin is in the lower end which I’ve read can cause hair loss. Is that more to blame than my thyroid?

I am just trying to work all these results and any advice would be gratefully received.

[jrbarnes]

Hi there, I had a hemi after years of symptoms. Two years after the surgery my TSH crept up to 5 and I developed symptoms I didn't have before the surgery. It looks like the hemi pushed you into an overt hypo state. I had to go on Levothyroxine for life.

[Catfur in reply to jrbarnes]

Hi thank you for replying. I’m still new to this and learning.

When you say overt hypo state do you mean from my thyroid results? I don’t think my GP will treat me when I am still within normal limits.

[jrbarnes in reply to Catfur]

Hi there, Doctors will label you as having sub clinical or overt hypothyroidism depending on where your TSH falls in the reference range. The higher the number, the more hypo. With your symptoms prior to the surgery, a nodule, and now removal of half your thyroid and a rising TSH you may need Levothyroxine. I went on it to avoid anymore growths or surgeries.

[Catfur in reply to jrbarnes]

Hi, thanks that makes more sense. I suppose I was thinking of it just in terms of the reference ranges and I would sit at the top TSH 4.2. Hopefully my GP takes everything else into consideration.

[pennyannie]

Hello Catfur and welcome to the forum :

Generally speaking when a TSH rises above 3 you are hypothyroid - most countries start medication when TSH reaches 5 though current UK guidelines state not to prescribe until the TSH reaches over 10 : ridiculous and cruel for many patients - but there you go :

Considering you have had surgery you might find you will be prescribed T4 - Levothyroxine which is the only medication we have in the UK to treat hypothyroidism.

Your TSH is at the top of the range and needs to come down to around 2 or lower :

It will come down with a prescription for Levothyroxine - T4 :

Your T4 is just under 20% through the range and needs to come up into the top quarter :

Taking T4 should then increase your T3 which is currently at around 40% and we generally feel better when both T3 and T4 are balanced and ideally in the top quadrant of the range

It is the T3 level that gives you symptoms - too little T3 and you experience symptoms of hypothyroidism - conversely too high a level of T3 and you may experience symptoms of hyperthyroidism.

T4 is a prohormone that needs to be converted by your body into T3 - the active hormone that the body runs on, which is about 4 times more powerful than T4 with the average person utilising about 50 T3 a day, just to function.

Your ability to convert the T4 into T3 can be compromised by several things, but in the first instance optimal vitamins and minerals of ferritin, folate, B12 and vitamin D is something you will probably need to do for yourself., as it is very common to be low in nutrients when hypothyroid and your metabolism slowed.

The thyroid is a major gland, the body's engine and conductor of the body's orchestra.

The thyroid controls your physical, mental, emotional, psychological and spiritual well being, your inner central heating system and your metabolism.

I'm with Graves post RAI ablation back in 2005 and I now aim to maintain my ferritin at around 100 : B12 active at around 70 + folate at around 20 and vitamin D at around 100.

I know from experience that this is where these vitamins and minerals need to be for me to optimise my conversion of T4 into T3.

Just for reference : A fully functioning working thyroid would be supporting you on a daily basis with approximately 100 T4 + 10 T3 - there is a synthetic T3 medication - Liothyronine.

Should you wish to read up around everything thyroid the Thyroid uk website are the charity who support this amazing forum and the website contains everything you my need in order to take your first steps back to better health.

P.S. Doctors are not obliged to accept Medichecks blood test results and may rerun everything / some of it again, on the NHS - however you do have these results from 2019 and if, you were feeling better then, than you do now, at least you have a TSH, T3 and T4 level that you could use as a bench mark to try and dose back up to with Levothyroxine - T4 ?

Your T3 in 2019 was around 70% through the range ?

[Catfur in reply to pennyannie]

Hi pennyannie,

Thanks for taking the time to provide such a comprehensive answer. I have found this forum which is really informative and also been reading around various websites further. There is so much info out there and at this moment in time I have been trying to understand it, as well as how it might apply to me.

I have been supplementing vit D and it has improved but needs further work. I am looking into how to improve my ferritin and folate especially.

I guess I was thinking maybe my Thyroid levels were not normal for me as I had had surgery and perhaps they will settle down.

I have had tests done via the NHS before my surgery and was told they were normal. At the time I didn’t think to ask for a copy.

I have been in touch with my GP today and they are going to arrange for blood tests but did not specify for what. I will ask when I go next week what they are testing.

[pennyannie in reply to Catfur]

Yes, well, ideally you have all the results you need - but from Medichecks :

Your doctor may accept these - but then again may not, and ideally you need all the same tests on the NHS.

The NHS work to ranges and the truth is some ranges are too wide to be of any value. Should your results fall into the range somewhere the NHS consider you " normal " and don't need a prescription for anything and that you are good to go :

I experienced this, as have many thousands of us : when my ferritin was at 22 and just 9 digits within a range of 150 , so yes, I was " normal and in the range " but so much better when I supplemented and built my ferritin up to well over half way through the range.

It stands to reason really if you think about it, as to be " normal " we now need to keep ourselves " optimal " to enable the thyroid hormone replacement to work

I don't think many doctors realise how important these are to us, and again with TSH, T3 and T4 if you " fall anywhere in the range " the assumption is you are normal " - it's a fine balance between T3 and T4 - but as I said, you do have a blood test result from early 2019 and this might be worth trying to work to if you felt relatively well then.

If you read through a few detailed posts on the vitamins and minerals subsection you'll read what is recommended. I still supplement to maintain all of these and maintain my ferritin with a weekly tub of Asda frozen chicken livers.

There is also a book recommended on the Thyroid uk website, which I purchased and helped me get a handle on things. Written by a doctor who has hypothyroidism Barry Durrant - Peatfield writes in an easy to understand manner in Your Thyroid and How To Keep It Healthy "

P.S. I take daily Ingennus Super B Complex : Doctors Best Vitamin D together with Healthy Origins K2 : and now just weekly 1 tub of the chicken livers :

[SlowDragon Administrator]

Suggest you work on improving low vitamin levels

Vitamin D result on 9/12/2020 - is that a typo at 15.7

Aiming for vitamin D at least around 80nmol and around 100nmol maybe better

Folate and ferritin halfway through range

Active B12 around 100

[Catfur in reply to SlowDragon]

Hi SlowDragon,

Thanks for replying.

Yes my vit D was 15.7 in 2019 but is now 49.7 in most recent bloods. I have been supplementing vitD and B12 so they have improved but I have more work to do.

I am trying to work out the best way to improve my ferritin as well.

[Lora7again]

Your low Ferritin could be contributing to your hair loss and it needs to be over 80 for hair growth.

[Catfur in reply to Lora7again]

Hi Lora7again,

Thanks for your reply.

I wondered that about my ferritin. I didn’t have the hair loss issues in 2019 when it was 42.2 but now it is 36 I do. Both levels I believe are quite low.

I wondered if it was to do with ferritin, thyroid or maybe both?

I am going to try and improve my ferritin levels and hope that resolved some of the hair loss.

[Lora7again in reply to Catfur]

I ate pate twice a week and took Spatone to bring my levels up. When I was first diagnosed over 10 years ago my vitamin D was 7 and I think it needs to be about a 100. I have been trying to bring mine up but I have only managed to get it to 64 so I am taking the BetterYou vitamin D spray once a day which is easily absorbed on your tongue.

[Catfur in reply to Lora7again]

I’ve just bought some pate and supplements so hopefully I can increase my levels!

[pennyannie in reply to Catfur]

Hey there again:

If you think about the frozen chicken livers from Asda -

they are clean and mild - and once defrosted flash fry in a little olive oil and then whizz down into your own pate - with a little mayo if looking too dry - keep in a jam jar in the fridge and a spoonful each day helps this medicine go down.

[Catfur in reply to pennyannie]

Ooh yes that’s a good idea, I’ll have to try that!

[Lora7again]

Mine is based on Medichecks Ferritin test which is ug/L