I’m currently taking 100mcg of levothyroxine after being reduced from 125mcg when TSH became unrecordable in September.
TSH 0.17 mU/L (0.3-4.4)
FT4 12.7 pmol/L (9-19.1)
FT3 3.5 pmol/L (2.4-6)
Thyroid peroxidase Ab conc >1000 U/ml (<6.00)
Gradually TSH has been coming up, but T4 has remained around 12.
Any help on interpretation would be appreciated. GP has made an endo referral, thankfully to a thyroid specialist.
Thanks
Essential to test vitamin D, folate, ferritin and B12
What vitamin supplements are you currently taking
Vitamin levels frequently drop significantly if dose levothyroxine is reduced
As you have Hashimoto’s are you on strictly gluten free diet
If not request coeliac blood test BEFORE considering trial on strictly gluten free diet
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.
What were Ft4 and Ft3 results on 125mcg
Were both tests done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test
Do you always get same brand of levothyroxine at each prescription
Many people, when adequately treated will have Ft4 and Ft3 at least 60% through range
Currently your
Ft4 only 35% through range
Ft3 only 30% through range
Helpful calculator for working out percentage through range
Yes, fasting test with no meds for 24 hrs. I’ve been tested for Celiac and came back negative, but probably not been as strict with gluten as I was in the past.
Ferritin is always low in range and supplementing B12 and vit D, but not had them tested for a while. While blood cells been below range for a few years and believed to be my normal.
Always have the same Levi brand and prior to decrease results were
TSH <0.01 (0.30-4.00), FT4 16.7 (9-19.1)
I usually fight my corner and keep the Levo level unchanged, but when totally suppressed GP wanted to try a reduction. Now GP is wondering if something more than just hypo is going on.
Just testing TSH and Ft4 is completely inadequate
Ft4 nowhere near top of range at only 76% through range
Helpful calculator for working out percentage through range
Never agree to dose reduction without FULL testing including Ft3 and all four vitamins
You may well need t3 & t4! Levothyroxine plus liothyronine. But first.....Try taking your blood tests as near to midnight as possible or if you’re a very early bird, at around 4-5am. The levothyroxine may be suppressing your tsh either by cumulative excess total t4 or a big dose too near the blood test. There could be a more complex aetiology but probably it’s all about dose and timing of replacement thyroid hormones. If you’re taking 100mcg levothyroxine in one dose it’s almost certainly too much at once despite what the doctors may say, you could do well to try splitting it into 3, bedtime, waking & midday. Do that for a few weeks, re-test, well away from any dose, see what the levels are then, you may be surprised!.....
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