Do symptoms go if the dosage is right?

[Annib1]

Hi, I am new on this very interesting forum. I am 78 and have been on levothyroxine for years. Just now it is hard to see doctors so I have turned more towards the internet to try and sort myself out. As well as hypothyroidism I have intermittent seronegative arthritis and GERD and it is hard to sort out whether symptoms belong to the arthritis, the thyroid or my age. I have just sent off for the results of my NHS thyroid tests for the last 3 years and for the testing kit for thyroid and vitamins

[Lalatoot]

Welcome.

It is hard to work out which symptom belongs to which problem!

When your thyroid hormones are balanced and optimal for you through being on the correct dosage of hormones then your symptoms should be minimal - can't promise that they would totally go away.

Once you have blood and vitamin results post them here and we can advise.

With regards to GERD, often hypos have too low stomach acid and this can cause reflux too and symptoms similar to too much stomach acid.

[SlowDragon Administrator]

Welcome to the forum

Well done for ordering copies of your most recent results

When test thyroid levels, always test as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

Only do private test early Monday or Tuesday morning and post back via tracked postal service

Are you currently taking any vitamin supplements?

If taking any supplements that contain biotin remember to stop taking these a week before ALL blood tests

Come back with new post once you get results

[Annib1 in reply to SlowDragon]

Many thanks for your input. I now have my tests back from Thriva and they are all within normal range so I may have to look elsewhere for the reason for my increasing muscle weakness etc.Active B12 is 91 pmol/L where normal range is 37.5 to 18.8

Ferritin is 94 ug/L 44 to 150

Folate is 15 nmol/L 8.83 to 30

Triiodothyronine (FT3) is 3.9 3.1 to 5

TSH is 1.92 mIU/L 1 to 2.5

Thyroglobulin antibodies are 12.7 kU/L 0 to 115

Thyroid peroxidase antibodies is 10.7 kIU/L 0 to 34

Thyroxine (T4) is 113 nmol/L 66 to 181

Free thyroxine (FT4) is 19.6 pmol/L 17 to 22

Vitamin D is 71 nmol/L 50 to 75

My morning temperature hovers around the 36 mark

My last NHS blood tests were done in May and September last year.

May results were serum TSH 4.26 mu/L (0.27 to 4.2)

free T4 18.7 pmol/L (12 to 22)

September serum TSH 8.67 (0.27 to 4.2)

free T4 19.3 (12 to 22)

My dose of levothyroxine is 100 daily which I now take before bed having read this website as I now realise that I could be mucking up the absorption of my thyroxine by taking it with sulfasalazine and and vitamins and minerals and peptac and ompeprazole. I am trying to go gluten free as I am trying to identify the main causes of my acid reflux and bread and pastry certainly don't seem to help. My next blood tests for being on sulfasalazine are on April 8th and I have asked the surgery whether I could book a phone call with the GP to see is she would add in thyroid tests at this time to confirm the correlation with the Thriva results but I am told I cannot get a GP phone call before April 8th so the nurse will have to use her judgement. Thriva also tell me to book a discussion with the GP to discuss a QRISK score that they have identified of 22.9% so that will have to wait. GP was obviously not worried that TSH was above upper limits in last 2 tests, but she did send me to see a neurologist to look into myasthenia gravis. They found indications of muscle weakness but the medication for MG did not help so that was stopped so this is where I have got.

I would really appreciate you having a look at these results and giving an opinion.

[SlowDragon Administrator in reply to Annib1]

So gluten free diet needs to be absolutely strictly gluten free to be effective

Do you always get same brand of levothyroxine

Which brand

Are these results Thriva- ranges are as Medichecks

Suggest you download pdf of results to get easier view on ranges

Active B12 is 91 pmol/L where normal range is 37.5 to 18.8

Ferritin is 94 ug/L 44 to 150

Folate is 15 nmol/L 8.83 to 30

TSH is 1.92 mIU/L 1 to 2.5

Thyroglobulin antibodies are 12.7 kU/L 0 to 115

Thyroid peroxidase antibodies is 10.7 kIU/L 0 to 34

Thyroxine (T4) is 113 nmol/L 66 to 181

Free thyroxine (FT4) is 19.6 pmol/L (12 to 22)

Triiodothyronine (FT3) is 3.9 (3.1 to 6.8)

Vitamin D is 71 nmol/L (range 75-150)

Ft4 is 76% through range

Ft3 only 22% through range

Helpful calculator for working out percentage through range

chorobytarczycy.eu/kalkulator

So very poor conversion of Ft4 to ft3

Improving conversion by

Taking levothyroxine at bedtime

Strictly gluten free diet

Always same brand levothyroxine

Getting vitamin levels optimal

Vitamin D at least around 80nmol and around 100nmol maybe better

Suggest you retest thyroid levels in 6-8 weeks

Have you had high thyroid antibodies in past?

Ever had ultrasound scan of thyroid?

[Annib1 in reply to SlowDragon]

Thanks for this. My tablets are always Accord I think. I have never had my thyroid antibodies tested before. Nor have I had a scan of thyroid. What can that show? 60 years ago when I was at university I had a biopsy done of a lump in my throat. All I can remember is they told me it was not cancerous. How can you tell there is poor conversion of Ft4 to Ft3? Thriva sent my results to my phone and I do not know how to download a pdf file.

[SlowDragon Administrator in reply to Annib1]

Likely to need addition of small doses of T3 prescribed alongside levothyroxine

Email Thyroid UK for list of recommend thyroid specialist endocrinologists...NHS and Private

[e-mail]

The aim of levothyroxine is to increase dose upwards in 25mcg steps until TSH is under 2

When adequately treated, TSH will often be well under one.

Most important results are ALWAYS Ft3 followed by Ft4.

When adequately treated Ft4 is usually in top third of range and Ft3 at least 60% through range (regardless of how low TSH is)

Extremely important to have optimal vitamin levels too as this helps reduce symptoms and improve how levothyroxine works

So did you have thyroidectomy?

Or just nodule investigation

£150 for ultrasound scan. Can be helpful

20% of Hashimoto's patients never have raised antibodies

healthunlocked.com/thyroidu...

Paul Robson on atrophied thyroid - especially if no TPO antibodies

paulrobinsonthyroid.com/cou...

Getting coeliac blood test done BEFORE considering trial on strictly gluten free diet

[Annib1 in reply to SlowDragon]

I will find out whether I had a thyroidectomy and will ask for a coeliac blood test. But why does Thriva say my T3 results are optimal if you think they are way too low? And what are optimal vitamin levels? Many thanks for your input.

[SlowDragon Administrator in reply to Annib1]

On levothyroxine Ft3 typically needs to be at least 60% through range

[Annib1 in reply to SlowDragon]

Thanks. I am now in correspondence with my GP through econsult as I requested that thyroid tests should be added to my next regular 3 monthly blood test for sulfasalazine reactions. She emailed me to say she has added them in and that as my TSH was raised when my last thyroid tests were done in September she had added 25 mcg of Levo to my prescription list to be taken at weekends and she was sorry the message never reached me because she was away from work because of illness. So we will review after I have my tests on April 7. Hopefully I can talk to her then about getting vitamin levels checked before I embark on medicating myself with supplements.

[Annib1 in reply to Annib1]

I have been quiet for 2 weeks as waiting for NHS lab results. They would not agree to to test FT4 (or 3) until they saw results of TSH were high enough so it is going to be a slow process to get a comparison with private tests. Cannot book an appointment with GP until I can get a phone call with her once results come through later this week! Meanwhile I have been starting on vit supplements and doing some reading. I was born in India and lived there until age of 3 and drinking water had very high fluoride levels which affected my teeth. In later life I lived in Nairobi for 15 years where the fluoride levels are also dangerously high but I did not buy bottled water as I was told the fluoride only mattered if I had young children. I am now wondering whether the fluoride could have damaged my thyroid function as it seems to affect iodine levels. If so, is this reversible? Any ideas? I don’t think doctor over here would consider asking about iodine and fluoride as the levels are controlled over here.