Thyroid results

[river242]

Looking for some help in understanding my results. Been ttc for 3 years now and found out 2 years ago I was hypothyroidism, TSH was 7.5. Started on 50 of levo, TSH went to 4 then I had a miscarriage and levels back up at 8. Increased levo to 75 and levels went down to 2 before I started ivf, they were back up at 5 after the treatment failed. Basically it's never been stable. GP finally agreed to increase levo to 100 but wouldn't do full panel. I had these done privately last week. I think TSH, t3 and 4 look OK but what's the implications of the antibodies being so high? Thank you.

[SeasideSusie Remembering]

Hi river242 and welcome to the thyroid forum.

what's the implications of the antibodies being so high?

Your raised antibodies confirm that you are positive for autoimmune thyroid disease aka Hashimoto's which is where the thyroid is attacked and gradually destroyed.

Fluctuations in symptoms and test results are common with Hashi's. When the immune system attacks the thyroid it releases excess hormone into the blood, this will then show a low TSH and high FT4/FT3 and you may have symptoms of "false hyper", this is not true hyperthyroidism but a transient period due to the excess thyroid hormone, the antibodies come along, clean up the mess then eventually things settle down. Sometimes it might be necessary to alter your dose of Levo during these "hyper" episodes, maybe reduce dose a bit, but don't allow alteration of your prescription because once it's been reduced it will be hard to get it raised again. Just maybe reduce temporarily and when you feel the hyper period is over and you may start feeling a little hypo then put dose back up again.

Most doctors dismiss antibodies as being of no importance and know little or nothing about Hashi's and how it affects the patient, test results and symptoms. You need to read, learn, understand and help yourself where Hashi's is concerned.

Some members have found that adopting a strict gluten free diet can help, although there is no guarantee.

Gluten contains gliadin (a protein) which is thought to trigger autoimmune attacks so eliminating gluten can help reduce these attacks.

You don't need to be gluten sensitive or have Coeliac disease for a gluten free diet to help.

Gluten/thyroid connection: chriskresser.com/the-gluten...

stopthethyroidmadness.com/h...

stopthethyroidmadness.com/h...

hypothyroidmom.com/hashimot...

thyroiduk.org.uk/tuk/about_...

Supplementing with selenium l-selenomethionine 200mcg daily is said to help reduce the antibodies, as can keeping TSH suppressed.

Hashi's and gut absorption problems tend to go hand in hand and can very often result in low nutrient levels or deficiencies. It's essential to test Vit D, B12, Folate and Ferritin and address any problems. You are welcome to post these results, including reference ranges (plus units of measurement for Vit D and B12), for comment and suggestions for supplementing where necessary.

The aim of a treated Hypo patient on Levo only, generally, is for TSH to be 1 or below with FT4 and FT3 in the upper part of their reference ranges if that is where you feel well.

Your current results show that your TSH is in a good place, your FT4 is only 27% through range and your FT3 is 48% through range. Your FT4 is on the low side and you may benefit from an increase in your Levo at this time.

Always advised here to get the most accurate measure of your normal circulating hormone levels, when having thyroid tests:

* Blood draw no later than 9am. This is because TSH is highest early morning and lowers throughout the day. If looking for a diagnosis of hypothyroidism, an increase in dose of Levo or to avoid a reduction then we need the highest possible TSH

* Nothing to eat or drink except water before the blood draw. This is because eating can lower TSH and coffee can affect TSH.

* If taking thyroid hormone replacement, last dose of Levo should be 24 hours before blood draw, if taking NDT or T3 then last dose should be 8-12 hours before blood draw. Adjust timing the day before if necessary. This avoids measuring hormone levels at their peak after ingestion of hormone replacement. Take your thyroid meds after the blood draw. Taking your dose too close to the blood draw will give false high results, leaving any longer gap will give false low results.

* If you take Biotin or a B Complex containing Biotin (B7), leave this off for 7 days before any blood test. This is because if Biotin is used in the testing procedure it can give false results (most labs use biotin).

These are patient to patient tips which we don't discuss with phlebotomists or doctors.

Also, take your Levo on an empty stomach, one hour before or two hours after food, with a glass of water only, no tea, coffee, milk, etc, and water only for an hour either side, as absorption will be affected. Take any other medication and supplements 2 hours away from Levo, some need 4 hours (iron, calcium, magnesium, Vit D, oestrogen).

Presumably you know that when TTC and for a successful pregnancy TSH should be below 2.5 so it's important to check levels regularly at this time.

[river242 in reply to SeasideSusie]

Thanks. This is all really helpful. I'm considering making an appointment with a private endo just to see what they think about levo doses. It's been a real struggle with the GP to even get to where I am.

[SlowDragon Administrator]

You must get vitamin D, folate, ferritin and B12 tested

Vitamin levels are frequently low with Hashimoto’s

What vitamin supplements are you currently taking

Your current results show that your TSH is in a good place, your FT4 is only 27% through range and your FT3 is 48% through range. Your FT4 is on the low side and you may benefit from an increase in your Levo at this time.

I would agree with Seasidesusie re levothyroxine dose

Absolutely strictly gluten free diet often helps or is absolutely essential for many with Hashimoto’s it’s always worth trying

Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels

Low vitamin levels affect Thyroid hormone working

Poor gut function 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 coeliac 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.

hypothyroidmom.com/how-to-l...

Eliminate Gluten. Even if you don’t have Hashimoto’s. Even if you have “no adverse reactions”. Eliminate gluten. There are no universal rules except this one.

[river242 in reply to SlowDragon]

Thank you. I'll look into the gluten free and vitamin testing. I take 10ug of vit D, 2.6ug of vit B12 and 5mg of folic acid. I take 55ug of selenium and 250ug of 150ug of iodine too.

[SlowDragon Administrator in reply to river242]

Iodine is very controversial, especially with autoimmune thyroid disease

There’s likely high enough levels iodine in levothyroxine

What’s your diet like, are you vegetarian or vegan?

Vegan’s can sometimes be low in iodine

But should always test BEFORE supplementing

SeasideSusie had details on best iodine test

10ug vitamin D may be too little

Vitamins should be tested at least annually

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .

Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins

List of private testing options

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Thriva Thyroid plus antibodies and vitamins By DIY fingerpick test

thriva.co/tests/thyroid-test

Thriva also offer just vitamin testing

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code

thyroiduk.org/getting-a-dia...

monitormyhealth.org.uk/

NHS easy postal kit vitamin D test £29 via

vitamindtest.org.uk

[river242 in reply to SlowDragon]

and no not vegan diet, mainly poultry and fish with red meat once a week.

[SeasideSusie Remembering in reply to river242]

River242

If the fish you eat includes haddock and cod then you are getting a good amount of iodine from those, also scampi is a good source as is milk and yogurt.

bda.uk.com/resource/iodine....

The RDA of iodine is 150mcg. You get 65mcg from 100mcg Levo (not as an added ingredient but through the process of deiodinisation) then whatever you get from your diet so taking 150mcg in a supplement might be inappropriate, especially as it's not recommended when Hashi's is present.

The best iodine test is said to be the non-loading urine test which you can order from Genova Diagnostics with ThyroidUK as your "practioner".

thyroiduk.org/help-and-supp...

Urine Iodine Test:

Specimen requirements: Urine

Cost: £71.00

Order Code: END25

Turnaround time: 5 - 10 days

Iodine is an essential trace element, vital for healthy thyroid function. Adequate levels are required to enable the production of T3 and T4 thyroid hormones, whilst also being required in other areas of health.

Deficiencies can lead to impaired heat and energy production, mental function and slow metabolism. Urine iodine is one of the best measures of iodine status. This test is not performed as a loading test, but can be used to establish existing levels or to monitor iodine supplementation.

[river242 in reply to SeasideSusie]

Thanks. It's within a pre pregnancy vitamin rather than something I'm taking specifically so I may have to go through everything in it and consider what I need. I've booked to see an endo in 2 weeks, first appointment I could get.

[river242]

The vitamins are just what the ivf clinic put me on for improving egg quality. I'll need to check tomorrow what tests they did if any. They also put me on DHEA so I'll need to check the endo consultants thoughts on that- I know my levels were low.

I've followed all that for thyroid testing so at least I've done that part right. Thank you.