New in the Hasi crew. Need some advice.

[TomPlatz]

Hi guys! seems I ve joined the Hasi crew.....

Let me explain and get some advice from you.

Everything began 2 months ago . All of a sudden , my TSH level was tested at 4.8 in December 2020.

Some other interesting stuff from the blood test results from December 2020.

25-ΟΗ-vitamin D 29,14 ng/ml

Ferritine 137 ng/ml

b12 958 pg/ml

folic acid 3,1 ng/ml ( with normal range of 2,1- 34)

There was a thought that some asthma-allergy and appendicitis medication I took during November and December 2020 ,could affect TSH, so we agreed on checking them again in one month

I checked them back, one month later, in January 2021

b12 551 pg/ml

ferritine 106,51 ng/ml

iron (Fe) 48 mg/dl (with normal range 70-180)

folic acid 4,5 ng/ml

TSH was 4.2

anti tg 4,19

anti tpo 0,18

free t4 1,06

I talked with 2 endocrinologists . They checked both my ultrasound and the blood tests , and claimed I have Hasimoto . They suggested I should have another blood test. The first endo suggested I should not take any pill yet and just repeat this whole testing thing in 6 months. The other endo, is waiting for the new blood test results I have just downloaded .

If I had to bet , I would say he will suggest the same thing.

February 2021

TSH 3,1

anti tg 4.8

anti tpo 0,44

I am waiting for their final diagnosis.

In addition to all that. both the endocrinologists didnt mention anything about my very low levels of folic...

Iron is very low too, however my ferritine levels are ok.

At this point I have to mention that I have experienced most of the symptoms of Hasimoto in my daily life for the past year.

Some info about me.I train hard ( although its been very hard to follow my program lately, due to sudden tiredness) for the last 15 years, I am 1.80, 78 kg, around 15-18 % bf.and supplement with whey iso, creatine, zync, D3 ,omega3 ( all from myprotein).

I follow a complete diet (not your typical gym bro diet) I dont have any food allergies or problems ( as far as I know).

I was feeling pretty crap for the last 1 year so that was the reason for me to check my hormones,

My mother has hypo, and I first checked my thyroid a few years ago when my hair thinned (8 years ago). My thyroid blood testing was always fine. till this year!

I also checked my testo and things dont look very great too... Maybe is my thyroid to blame?

January 2021

LH 3,61 mUI/mL 0,8-7,6

FSH 2,74 mUI/mL 0,7-11,1

PRL 14,17 ng/mL 3,46-19,4

Ε2 < 24 pg/ml 11-44

PRG < 0,5 ng/mL 0,2-0,75

Testo 4,00 ng/ml 1,56-8,77

DHEA-141,9 μg/dL 139,7-484,4

February 2021

LH 2,72 mUI/mL 0,8-7,6

FSH 2,86 mUI/mL 0,7-11,1

Testo 4,41 ng/ml 1,56-8,77

COR 6,8 μg/dL 3,7-19,4

DHEA 146,6 μg/dL 139,7-484,4

SHBG 26,9 nmol/L 13-71

Any advice or suggestions would be very well appreciated.

[PurpleNails Administrator]

Please can you add ranges for FT4 and antibody <limit

FT4 is a storage hormone, you need FT3 tested too. Do you have private testing options?

If ultrasound scan shows confirms Hashis your thyroid will inevitably decline further. Ask your endocrinologist at what stage they do treat? Why must you be left to get more unwell before commencing treatment?

In the UK there are NHS guidelines for sub clinical hypothyroid? Are you in UK or elsewhere?

[TomPlatz in reply to PurpleNails]

I live in Creta, Greece ...unfortunately... The limits are :

tsh range is 0,25-3,43

anti tg is <4,11

anti tpo <5,61

free T4 0,7-1m94

The first endo told me my TSH must reach 10 range to get treatment since its not the best thing in the world to get a pill. He even argued that many docs subscribe thyroid treatments just to get you attached /depended to them...

The second endo sounded more concerned , but I would bet he wont give me treatment. (maybe selenium).Just wait and check again in 6 months.

what d you suggest me doing?

[PurpleNails Administrator in reply to TomPlatz]

tsh range is (0.25-3.43) 4.2 now 3.1

anti tg is (<4.11) 4.19 now 4.8

anti tpo (<5.61) 0.18 now 0.44

free T4 (0.7-1.94) 1.06.

TSH of 10 (same in UK) is proof of overt hypothyroidism. I’m not surprised you found a second endo after the first one said patient were dependant on replacement hormone...

Your TSH did improved slightly. Your FT4 is in range which is why they deem treatment unnecessary. anti Tg borderline. TPO negative. Not everyone with Hashis has antibodies & they fluctuate.

Is your vitamin D at deficient levels? Cofactors Magnesium important as is K2 which directs calcium to teeth and bones & away from arteries.

You don’t have a range on your B12 but by most ranges this is a good level?

Keep vit d, b12, ferritin and folate at optimal levels. This will help your thyroid function & conversion of FT4 to FT3.

Supplements to be careful with are iron, calcium and iodine, but the ones you are using don't have them. Zinc can affect the ratio of copper these need to balanced. Do you test?

Selenium is said to be good for thyroid function, check the label for most absorbable forms, selenium l-selenomethionine and yeast bound selenium, avoid selenite and selenate.

Many with Hashis see improvement with gluten free diet.

See if you can find a lab which will test TSH, FT4 & FT3. FT3 is the active hormone this is low you will have hypo symptoms. I would want to test earlier than in 6 months.

When you retest try to keep to the same circumstances & conditions. For example get an early morning blood draw, fast before (only drinking water) this will show highest TSH and lowest FT4 and this way your result over time will be consistent.

Biotin (B7) if taken needs to be stopped 7 days before any blood test as they can skew the results on some test (affects the testing process).

[TomPlatz in reply to PurpleNails]

You ve been very helpful with all the info!

Ferritin range ng/ml 21,81-274,66

Vitamin B12 range pg/ml 189-883

folic acid range ng/ml 2,7-34

D3 range Deficiency<10

insufficiency 10-30

Sufficient 30-100

As you can see, Iron is super low ( 48 mg/dl with normal range 70-180) however ferritin is ok, no great ( 106,51 ng/ml with normal range 21,81-274,66)

and Hgb is just ok too (HGB 14,3 g/dl with range 14-18)

Folic acid is very low too, (3,1 with range ng/ml 2,7-34).

Neither of the 2 doctors did mention anything about those issues.

Excuse me if I didnt fully understand your point.

''I’m not surprised you found a second endo after the first one said patient were dependant on replacement hormone...''

You mean that its better to not take thyroxine or other thyroid pill/therapy ., at least for now, am i right?

''Supplements to be careful with are iron, calcium and iodine''

So its better not to take any iron supplement , although my iron levels are super low?

Regaridng iodine .

Is using salt in my food ok?

Its very interesting that I didnt use salt in my diet ( except for the products that already contain iodine for instance bread , cheese etc).

I started using sea salt 1 -1.5 years ago and noticed a change (for the better) in my energy levels.

I find it impossible to believe that adding some sea salt - after so many years of being afraid of salt ( foolishly) - negatively effected my thyroid!

I even added whole wheat , bread ,rye flour etc during 2020 and my diet has become more balanced and enjoyable. Bread was another product I deprived myself of, due to stupid gym bro diets....

Regarding Calcium, i do love dairy but havent noticed any issues,

''Zinc can affect the ratio of copper these need to balanced. Do you test?''

I didnt test either for Zinc or copper. I supplemented with Zinc because I ve read it helps with Testosterone and hormones as a whole.

D3 level is borderline sufficient. ( i do supplement).

B12 was 958 pg/ml in December ( its puzzled my alot since I dont supplement with B12...) and 551 pg/ml in January .

To be honest I was thinking of supplementing myself with Selenium (although the second endo told me that he doesnt believe in selenium) , k2 (mk7) and folic acid.

I bought Magnesium Citrate a few months ago, but havent used it. Maybe its time.

I was thinking of supplementing with Iron too , however I can not make a conclusion whether its ok for people with Hasimoto or not.

In addition to that, the first Endo suggested I buy a Lamberts muti A-Z, However i checked that it has biotin and iodine in it.

[PurpleNails Administrator in reply to TomPlatz]

I see you are very deficient on vit D you’ll likely need loading doses. Possibly an iron panel to check for anaemia as showing low iron. Iron supplements only when deficient but I don’t know enough to say at what levels.

I think you need better advice on vitamins than I can offer. Perhaps start a new post focusing of vitamin advice?

If you explain you have diagnosis of Hashis but TSH and FT4 within range so have not been offered levo but that you need help with low vitamins, it will flag member with vitamin knowledge. Put you country in post or in your profile or you may get a long list of UK private testing companies and NHS guidelines on sub clinical hypo which won’t be much use to you.

Put your result and (range) together in same line, it will be easier for responders to interpret.

The notion your first endo had regarding hypothyroid patients being dependent on thyroid replacement is rather concerning attitude. I think having to wait until TSH reaches 10 is a disgrace. Some countries treat at 3. If your FT4 or FT3 is low replacement hormone should be offered. I don’t view it drug medication it is a necessary replacement hormone.

Dietary iodine it considered ok, its additional supplements which are not recommended. If you feel better using sea salt it I’d be inclined to stay the same.

Calcium has abundant sources in diet and excess not needed.

Over the counter Zinc should be fine.

Many find selenium helpful. Especially if you were to have less than optimal levels. Doctors aren’t taught about nutrients, but saying they do not believe in it seems silly.

I was using Magnesium Citrate and I recently switch to a glycinate which is the most bioavailabile form, but I think I’m going to switch back. The citrate has been helpful for my stomach, (I won’t go into further detail)

I do take biotin, just not the week before a blood test. Multi not a good idea as the contain the cheapest, least absorbable ingredients. Usually at levels far below what would be of any help. Your endo recommendation just shows how little they know.

It’s not a good idea to start taking lots of supplements. Leave at least 2 weeks between new ones in case you have a reaction to one.

Always best to test and supplement to maintain optimal levels.