Iodine slightly deficient and low Cortisol

[Catou142]

Hello,

I am still trying to find the root cause of my subclinical hypothyroidism.

last blood test 01-12-20:

TSH 7.36 [0.27 - 4.2]

FT4: 11.7 [11.4 - 21.4]

FT3 so far normal (tested privately 14th oct. 5.5 pmol/L)

serum ferritin 79 [11-307]

vit D 109

serum B12 641 [180 - 914]

serum folate 12 [3 - 20]

fasting glucose 4.5 [3 - 6]

HA1c 26 nmol/mol [ <42 non diabetic range]

Cholesterols and Liver all good

NOW for the 'not normal' (Medichecks tests)

12-01-21 - 24 hr cortisol:

Free Cortisol 24h: 41 [55-138]

20-01-21 - Iodine Urine Test :

Creatinine Urine: 1.03g/L (normal)

Iodine - urine: 64 ug/L

Iodine - creatinine: 62ug/g

<25 Severe deficiency

25-49 Moderate deficiency

50-99 Mild deficiency

>100 No deficiency

What can I do about my low cortisol and iodine levels? I would love 2 months holidays by the sea on my own ideally! Realistically, I just want to lower my TSH, raise my FT4/3 and feel better.

We eat cod/haddock/prawns at least 2x a week. I am gluten, dairy and oats free but eat nuts and loads of vegetables. I don't have a lot of salt because of my tinnitus...but when I season my food, it's good quality sea salt.

Thank you for any advice you might give me. I still don't take Levo at the moment, even though I've been prescribed it. I tried it twice now and didn't like how I felt on it.

I think my adrenals need looking after first...

I actually sent off another finger prick sample this morning. Blue Horizon premium silver which will give me early morning cortisol and also magnesium (I take 2g / day as a supplement at the moment). Do I need to talk to my GP about the low cortisol or are they just going to brush it off as insignificant and tell me to reduce stress?

[SlowDragon Ambassador]

Most likely your cortisol is low BECAUSE You are hypothyroid

[Catou142 in reply to SlowDragon]

Thank you for this. What can I do? Do you treat adrenals or thyroid first? I thought it was the adrenals. I have been hypothyroid for a long time now...I suffered from burn out in 2009 (took me 3 years to recover). At the time, my TSH went to 4.49 by GP didn't mention it as it was 'normal' I guess.

I think my adrenals are worn out. I am under a lot of stress. Then there's the problem with the iodine...Do I have enough for my thyroid hormones to function properly?

[SlowDragon Ambassador in reply to Catou142]

No you probably don’t, levothyroxine is made of iodine....it will have all you need

Hashimoto’s doesn’t want excess iodine

Best option is to start on levothyroxine slowly.

Which brand of levothyroxine have you tried.

Common to feel worse before you feel better

At moment adrenals are working flat out trying to compensate for lack of thyroid hormones

[Catou142 in reply to SlowDragon]

OK, thank you for this! I have a box of 25mcg Wockhardt. I was not feeling great on those last time, although I only took 4 tablets and was taking them with my breakfast (1 banana and a cereal bar - no coffee - I'm caffeine free anyway). After 4 days of those, I felt so tired, pulsatile, much louder tinnitus, head felt like an engine...I just wanted to cry.

I had experienced similar side effects + really bad stomach upset before with the Activis ones when I was taking them 1 hr before breakfast, on an empty stomach. Do you think 25mcg is not enough? Should I try to correct my iodine levels first and see if my thyroid responds well to that?

[SlowDragon Ambassador in reply to Catou142]

No don’t mess with iodine.

As soon as we start on levothyroxine any vitamin deficiencies often get noticeably worse ....before getting better

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

Suggest you try taking it at bedtime

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

Many people find Levothyroxine brands are not interchangeable.

Most easily available (and often most easily tolerated) are Mercury Pharma or Accord

Note Accord is also boxed as Almus via Boots, and Northstar 50mcg and 100mcg via Lloyds ....but beware 25mcg Northstar is Teva

List of different brands available in U.K.

thyroiduk.org/medications-f...

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

But for some people (usually if lactose intolerant, Teva is by far the best option)

Teva, Aristo and Glenmark are the only lactose free tablets

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.

[Catou142 in reply to SlowDragon]

Thank you for this. What do I do about my iodine insufficiency? I don't have dairy but I do eat fish 2 or 3 times a week. Do I need this every day? Could the iodine deficiency have caused the high TSH? I've had such a bad time on the levo, I would actually dread taking it again!

[SlowDragon Ambassador in reply to Catou142]

SeasideSusie has info on best iodine test

Most are extremely unreliable

drknews.com/iodine-and-hash...

thyroidpharmacist.com/artic...

Your thyroid is packing up....you need replacement thyroid hormones

If you are lactose intolerant and on lactose free diet you will need lactose free levothyroxine

[Catou142 in reply to SlowDragon]

wow, I found the article from Dr. Wentz very interesting and surprising. So, taking less iodine would be better...'Dr. Christianson has designed a diet plan that aims to provide between 57-107 mcg of iodine per day, and reports that within the first 28 days, people should start seeing an improvement in thyroid function, and most see the full benefits in three to six months.' (Wentz) I am going to wait for my latest Blue Horizons results now.

[greygoose in reply to Catou142]

Well, that could be logical, because too much iodine is antithyroid. BUT, without knowing how much iodine these people were consuming to begin with, it's rather difficult to judge.

But, have you not considered that your iodine could be low due to you being hypo, rather than the other way round. Most hypos have low nutrient levels, due to low stomach acid, but iodine is rarely tested. If it were routinely tested, we might find that all hypos have low iodine. But, that doesn't mean they need their iodine levels raised.

But prevention is better than cure and as long as the antibodies are there, it’s potentially not just hypothyroidism, but other autoimmune problems.

Does that mean that you have Hashi's? If you do, then it's a bit late for prevention. And, there's no way you can get rid of the antibodies. And, even if you did, you would still have Hashi's. And, getting rid of the Hashi's antibodies wouldn't stop you developping other autoimmune problems, because the Hashi's antibodies have nothing to do with other autoimmune problems.

But, none of that has anything to do with your iodine being low - although, excess iodine can trigger Hashi's, low iodine won't cause it.

[Catou142 in reply to greygoose]

Yes, with regards to my iodine levels being low because my TSH is 7.5, which one comes first? Iodine or hypothyroidism? Considering I have removed salt and other salty foods from my diet since 2008, I would say I have not had a lot of iodine in my diet and it's only recently that I am eating more fish. Considering all my other vitamins and minerals are good, it would be unusual for just Iodine to be slightly low, because of some possible gut malabsorption problem. Maybe the test was not that accurate...I am finding a lot of articles on the incidences of hypo and hyper in either high or low iodine areas of the world. Here's just one quote from one scientific article: 'The iodine intake of an area seems to be of major importance for the pattern of thyroid disorders observed.' And yes, my antibodies are around 300 (TPO and TGa). My TPOs were around 1000 in January 2020 and consistently remained at 300 since gluten removal, so, a move in the right direction, but still not brilliant...

[greygoose in reply to Catou142]

My TPOs were around 1000 in January 2020 and consistently remained at 300 since gluten removal, so, a move in the right direction, but still not brilliant...

No, not a move in the right direction. Totally irrelevant. The level of your antibodies has no bearing on your disease. It is not an indecation of the severity or Hashi's. Antibodies fluctuate all the time, and tend to reduce as the thyroid is slowly destroyed - less thyroid tissue means less immune system attacks, which means less antibodies coming along to clean up after the attack. But, you still have Hashi's, and your thyroid will still be slowly destroyed. And raising your iodine won't stop that - in fact, it might hasten the thyroid's demise.

Low iodine might cause hypothyroidism, but it doesn't cause Hashi's. And, Hashi's is the cause of your hypothyroidism.

Besides, your iodine isn't low enough to cause hypothyroidism. Start taking levo and it will soon rise. 100 mcg levo contains about 65 mcg iodine which is recycled in the body.

[Jazzw]

Being completely honest, I’m always a little sceptical about the idea one can even find a “root cause” for hypothyroidism. I think one can waste a lot of time hunting for a magical solution, all the while getting progressively run down because of the knock on effects of not treating the symptoms.

Hypothyroidism leads to poor gut absorption leads to deficiencies in vitamin and minerals leads to all sorts of secondary effects, from tinnitus to plantar fasciitis.

All sorts of things can cause hypothyroidism, most commonly the development of autoimmune thyroiditis (which often has a hereditary factor), environmental factors, many of which we didn’t know we needed to avoid and it’s too late now, or congenital issues, like the underdevelopment of a thyroid gland or reduced pituitary function. Or injury caused by a blow to the head or sudden and dramatic blood loss.

Even if you find the cause, the chances are you won’t be able to do anything about it. If levothyroxine made you feel worse, it’s probably due to nutritional deficiencies or not being prescribed enough levothyroxine to make things better not worse.

Of those who advocate finding out a “root cause”, I’ve noticed most have something to sell: a book, purchase of their specially formulated vitamins... And that makes me angry, because optimising thyroid hormone replacement is generally the fastest way of getting better.

I wish you luck, I really do. I hope you find something that helps. But for most, hypothyroidism is a one way trip and even if you do manage to stave off further deterioration for now, the chances are high that sooner rather than later you’ll need to take thyroid hormone replacement.

[helvella Administrator in reply to Jazzw]

Investigating and finding that the cause of your broken arm was having a drink then going out for a run in slippery shoes, on an icy pavement, and not looking where you are going, doesn't alter the treatment.

At best, it suggests what you might do differently in order not to break your arm again. Which is not really relevant to a "broken" thyroid.

There just might be some value in considering vitamin D and bone density.

[Catou142 in reply to helvella]

I totally understand what you’re saying. But prevention is better than cure and as long as the antibodies are there, it’s potentially not just hypothyroidism, but other autoimmune problems. Slipping in ice, yes, I know what the cause is. I repair my bone and it never happens again. There are a lot charlatans selling their books and potions...I know. But I’ll keep looking for a while. My general health has actually improved since last year, except for my thyroid, which has not worsened at least! Better weight (17kgs lost!), better fitness (I walk min 1hr each day) cholesterol and diabetes good, vits all good. I had no clue about any of this last year. It’s a journey.

[Catou142 in reply to Jazzw]

Thank you very much for this. I completely agree with you. I guess I’m the sort of person who just likes to sort problems put and when I cannot, it’s frustrating. I might just have to accept now, and ask to be given a higher dose. There is hypothyroidism at all in my family. Could be congenital, not accidental. I think nutritionally i feel really good. If it wasn’t for the tinnitus and the brain fog, I’m actually feeling ‘not that bad’, although if I’ve had this since 1999, I guess this feeling grew on me. If only I could find a good GP or specialist I can trust.

[SlowDragon Ambassador]

Extremely common to find it difficult to tolerate higher starting dose than 50mcg

Some people struggle to even tolerate 50mcg initially

[Catou142]

Sorry...brain fog at work: there is NO hypothyroidism at all in my family. I've asked my mum and she has no antibodies or thyroid problems on her blood test results.

At least, no hypo that anyone knew about when they died in old age of strokes or heart attacks...I come from a family of mostly farmers in France and always heard that women were very hardworking and strong...not really any stories which could indicate hypothyroidism

[SlowDragon Ambassador]

Generally the faster you can get dose up the better....hence new guidelines recommend starting on higher doses

Obviously many people have been extremely hypothyroid for a long time before they finally get diagnosed

Far too many people get left under medicated too long on 50mcg or 75mcg