You kind people at Health Unlocked have been guiding me for a while now and with your help I hope I’ve at last got my metrics in a reasonably good condition These are my latest blood-test results can you please confirm my optimism and/or recommend any further action?
Ferritin 146 u/gl (30 400)
Vitamin B12 122 pmol/L(>37.5)
Vitamin D125 nmol/L(50-175)
TSH2.92 miU/L(0.27-4.2)
Free T33.61 pmol/L(3.1-6.8)
Free Thyroxine18.9 pmol/L(12-22)
One question I do have regards the high Thyroid Peroxidase Antibodies. What do these antibodies signify and what, if anything, is to be done please?
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Well, your TSH is still too high. And, that's because you're a poor converter and your FT3 is pretty low.
The high TPO antibodies mean that you have Hashi's - aka Autoimmune Thyroiditis. And, there's nothing much you can do about it. You could try a gluten-free diet, which might relief certain symptoms. But, Hashi's is for life, I'm afraid.
Your thyroid produces (inactive) T4 which need to convert into the active T3 needed in every cell of your body. Most people have their free T4 and free T3 in balance (ie roughly the same way through range). But your free T4 is 69% through range and free T3 is only 13.8% through range. You are likely to feel properly well only when free T3 is a good 2/3 through range.
Two options: either increase levo until it goes over-range to get a good enough level of free T3, or try and get T3 meds - lio. In the UK this is endo-only and not many will prescribe it - (a) because it's viciously expensive; (b) because it has a very short half-life so is tricky to measure and (c) because a surprising number of them don't believe it works - and that the thousands of us who have found it transformative are suffering from some joint delusion (!)
You can get a list of T3-friendly endos from Dionne at Thyroid UK -tukadmin@thyroiduk.org - and set up a new post asking for endo recommendations near-ish to you. You don't have to see the nearest person but must obv be reasonably convenient - and be warned, the endo doesn't have to agree to see you. You need to show you're a "poor converter" - which you do.
Aiming for both Ft4 and Ft3 at least 60% through range
These results show you are poor conversion of Ft4 to Ft3
Very common with autoimmune thyroid disease (Hashimoto’s)
Have you had coeliac blood test done yet
If not, suggest that’s next step
Assuming result is negative you can trial strictly gluten free diet
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
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
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
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.
Retest thyroid levels 8-10 weeks after going on strictly gluten free diet
Thank you Slow Dragon, what a wonderful reply! Just one question before I respond in detail; I was diagnosed with Hyperthyroidism (Graves) and my Hypothyroidism arises from the RAI therapy I had in 2016. Does that change your advice at all please?
Extremely common after RAI to need addition of small doses of T3 prescribed alongside levothyroxine
Your vitamins are good
No folate test?
What vitamin supplements are you currently taking
Many Graves patients also find strictly gluten free diet helps or is essential. (Research suggests any autoimmune disease probably starts with or causes leaky gut)
Getting coeliac blood test done BEFORE cutting gluten out
Suggest you trial this first
Meanwhile look at seeing an endocrinologist who will prescribe T3
Roughly where in the U.K. are you?
It’s difficult, but not impossible to get prescribed on NHS
Best option it to get initial trial via private consultation and prescription
Email Thyroid UK for list of recommend thyroid specialist endocrinologists who will prescribe T3
NHS and Private
tukadmin@thyroiduk.org
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
Having just " caught up " from my previous post to you -
I'm glad you've seen some improvement since restoring your core strength vitamins and minerals:
However I think the main message of mine from a year ago still stands ;
You have had RAI thyroid ablation and more than likely will need full spectrum thyroid hormone replacement to restore your T3 and T4 back into balance and to a level high enough that allows you to feel " better " :
You are not converting the T4 into T3 which is the active hormone that the body runs on :
Which is power for the course after RAI as this toxic substance has burnt out your thyroid in situ meaning you have " lost " your own T3 thyroid hormone production which accounts for around 20% of your overall wellbeing, one symptom of which will be a slowing down of your metabolism, making coversion even more challenging.
The accepted conversion ratio when on T4 only is said to be 1 / 3.50 - 4.50 - T3 / T4 : wit most people preferring to come in at around 4 or under :
So if we divide your T3 into your T4 we have 3.6 / 18.9 and that works out at around 5.25 : So, a massive improvement on last year when your conversion ratio came in at around 6.60 but having had RAI, I doubt you'll be able to do " much better " without an additional, different prescription.
The answer is to add a little synthetic T3 thyroid hormone to replace that which you have lost due to having your thyroid destroyed, disabled and burnt out by the RAI .
Liothyronine - T3 is around 4 times more powerful than T4 and read the average person utilises around 50 T3 daily just to function.
I am with Graves post RAI but was refused T3 by the NHS in 2018 despite my conversion ratio being outside the accepted ratio. My TSH was low suppressed. wih my T3 at 25% whilst my T4 was at 100% and told I was overmedicated and needed a dose reduction in T4 :
Adding a little T3 to my slightly reduced T4 did the trick :
It was like light bulb being turned on in my head and brain :
I switched to Natural Desiccated Thyroid was I see it as more " like for like " as it contains all the same known thyroid hormones as that of the human gland and in my third year, self medicating and much improved.
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