Advice on Blood Tests + Levo dose

[Beeper1]

Hi All,

Following 2 unsuccessful IVF rounds last year one of which I think may have been unsuccessful due to my thyroid levels being too high, I went to see a private Endocrinologist. He asked me to stop all medication for a month so he could accurately see what my thyroid levels were.

After confirming I was hypothyroid, he upped my medication from 75mi of levothyroxine to 100mi. After 6 weeks of the increased dose, I retested my bloods with Medichecks and the results are below. (I had a blood test with the GP where T3 + T4 were requested, but the results came back without the T3 + T4 results). TheEndocrinologist also said my raised antibodies were nothing to be worried about.

I forwarded the results to my GP, who has said that I am overmedicated, and has asked me to take 100mi Levothyroxine Monday - Friday, and 75mi on Saturday & Sunday. I'm not sure that it works that way. Is it dangerous to be slightly overmedicated?

I am about to start another round of IVF in a few weeks. During the last cycle, I asked to test the TSH every time I added a new medication though the cycle, and I could see the levels did go up as a result of the IVF meds.

Any advice is gratefully received.

Medichecks Advanced Thyroid Function Blood Test

Inflammation

CRP HS 2.77 mg/L (Range: < 5)

Iron Status

Ferritin 74.80 ug/L (Range: 13 - 150)

Vitamins

Folate - Serum 19.67 ug/L (Range: > 3.89)

Vitamin B12 - Active 78.200 pmol/L (Range: > 37.5)

Vitamin D 74.90 nmol/L (Range: 50 - 175)

Thyroid Hormones

TSH X 0.07 mIU/L (Range: 0.27 - 4.2)

Free T3 4.95 pmol/L (Range: 3.1 - 6.8)

Free Thyroxine 19.200 pmol/L (Range: 12 - 22)

Autoimmunity

Thyroglobulin Antibodies X 177.000 kIU/L (Range: < 115)

Thyroid Peroxidase Antibodies X 71.00 kIU/L (Range: < 34)

[SlowDragon Administrator]

Was this test done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

Your only over medicated if Ft3 is over range

Your Ft4 is only 72% through range

Ft3 only 50% through range

Helpful calculator for working out percentage through range

chorobytarczycy.eu/kalkulator

Like many Hashimoto’s patients you have poor conversion of Ft4 to Ft3

You don’t want to reduce levothyroxine unless endocrinologist is going to prescribe small doses of T3 alongside levothyroxine. Which is unlikely.

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,

"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l.

Most patients will feel well in that circumstance.

But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."

(That’s Ft3 at 58% minimum through range)

You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctor



please email Dionne at

[e-mail]

[Beeper1 in reply to SlowDragon]

Thanks so much for your reply. Yes, as per your guidance last year, test was done first thing in the morning pre eating/drinking, and last dose of levo was 24 hours before the test. That's now drilled into me 🙂 I will stay on the 100mi for now, and forward the article to my doctor.

[SlowDragon Administrator in reply to Beeper1]

Do you always get same brand levothyroxine

Which brand

If looking to get T3 prescribed, testing Dio2 gene can be helpful....assuming you test positive

[Beeper1 in reply to SlowDragon]

I have been taking the North Star brand for the 100mi, but the pharmacist has also given me a packet of Mercury Pharma. I may look into the T3 at a later stage, but I don't have the brain space right now in between working out what to do with the IVF.

[SlowDragon Administrator]

Pregnancy guidelines

thyroiduk.org/having-a-baby-2/

gp-update.co.uk/files/docs/...

Important See pages 7&8

btf-thyroid.org/Handlers/Do...

thyroidpharmacist.com/artic...

[Beeper1 in reply to SlowDragon]

Thank you!

[SlowDragon Administrator]

high antibodies confirms cause of your hypothyroidism is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).

About 90% of primary hypothyroidism is autoimmune thyroid disease

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 with Hashimoto’s 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

healthcheckshop.co.uk/store...?

Assuming test is negative you can immediately go on strictly gluten free diet

(If test is positive you will need to remain on high gluten diet until endoscopy, maximum 6 weeks wait officially)

Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse

chriskresser.com/the-gluten...

amymyersmd.com/2018/04/3-re...

thyroidpharmacist.com/artic...

drknews.com/changing-your-d...

restartmed.com/hashimotos-g...

Non Coeliac Gluten sensitivity (NCGS) and autoimmune disease

ncbi.nlm.nih.gov/pubmed/296...

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

ncbi.nlm.nih.gov/pubmed/300...

The obtained results suggest that the gluten-free diet may bring clinical benefits to women with autoimmune thyroid disease

nuclmed.gr/wp/wp-content/up...

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

restartmed.com/hashimotos-g...

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.

[Beeper1 in reply to SlowDragon]

Thank you.

[Jazzw]

I’m not sure what makes me feel more sad—the fact that the private so-called “endocrinologist” took you off all thyroid hormone replacement for a month (a ridiculous thing to do—it could have made you very ill and you’re probably still feeling the repercussions), or that your GP has absolutely no idea what they’re doing regarding your levothyroxine dosage.

Perhaps both.

But I’m glad you’ve found us and really hope that your next round of IVF is successful xx

[Beeper1 in reply to Jazzw]

Thanks Jazzw. I'm super thankful to have found this golden resource. I've found out so much more than I ever would have from a doctor.