Relevant blood test

[MeganChar1]

Hi I have Hashimotos and I am currently waiting for results from the advanced thyroid function medichecks test which includes full thyroid bloods (apart from Rt3) and vitamins (vit d, Ferrtin, b12 etc). Is there any other tests worth getting for conditions or deficiencies which can be linked to Hashimotos? I recently had a miscarriage and will be trying again in a few months but I want to minimise any risks of this happening again due to thyroid related issues.

[SlowDragon Administrator]

How much levothyroxine are you currently taking

Do you always get same brand of levothyroxine at each prescription

As you have Hashimoto’s are you already on gluten free diet

If not, get coeliac blood test done BEFORE trialing strictly gluten free diet for minimum 3-6 months. Likely to help or be essential

What vitamin supplements are you currently taking?

Come back with new post once you get test results

[MeganChar1 in reply to SlowDragon]

Hi I’m on 75mg levothyroxine but suspect I may need an increase as noticing symptoms more. That was upped from 50mg in December when I was pregnant but think the increase came too late and I miscarried. Are there any other autoimmune conditions I should test for other than coeliacs? Not currently taking any supplements as waiting to see if I have any deficiencies from the blood test.

[SlowDragon Administrator in reply to MeganChar1]

Unless extremely petite 75mcg is likely to be too small a dose

Before considering TTC thyroid levels need to be stable

verywellhealth.com/infertil...

Pregnancy guidelines

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

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

IMPORTANT See pages 7&8 on when dose levothyroxine should be increased

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

thyroidpharmacist.com/artic...

[SlowDragon Administrator in reply to MeganChar1]

How long have you been on 75mcg

Which brand of levothyroxine are you currently taking

Do you always get same brand

guidelines on dose levothyroxine by weight

Even if we frequently 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 eventually on, or near full replacement dose

NICE guidelines on full replacement dose

nice.org.uk/guidance/ng145/...

1.3.6

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.

Also here

cks.nice.org.uk/topics/hypo...

gp-update.co.uk/Latest-Upda...

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.

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...

[humanbean]

Although not essential, some "nice-to-have" extra tests are :

Zinc

Copper

Selenium

Iodine

I've only ever had the first two of those tests done (just the once). Hypothyroid patients usually tend to have low zinc and high copper. Supplementing zinc can raise zinc level and reduce copper levels. But there are some people on the forum who have reported the opposite - low copper and high zinc. So making assumptions isn't a good idea.

As for selenium, I'm not sure, but I'm assuming it is a standard blood test.

Iodine should be tested as a non-loading test in urine.

None of the above tests can be described as "cheap"!

It has been assumed forever that the UK population has plenty of iodine and deficiency is very rare. But this is no longer true.

independentnurse.co.uk/clin...

1) Vegetarians and vegans get very little iodine from their diets because they don't usually eat animal-derived cheese and milk.

2) Salt rarely has iodine added to it, as happens in other parts of the world. Iodized salt can be bought but it doesn't seem to be very common here.

3) The reason people used to assume iodine was not a problem in the UK is that people drank a lot of cow milk and other dairy products, and cows' udders were washed with iodine before milking. Some inevitably got into the milk.