Blood test results - thoughts and advice please.

[ElephantShoes]

Hello, I am going to post my recent blood test results and would appreciate your thoughts and advice please. My last results approx 4 months ago were:

TSH

4.69 mU/L [0.35 - 5.5]

FREE T4

17.4 pmol/L [10.5 - 21.0]

Please note change to free T4 reference range.

FREE T3

3.9 pmol/L [3.5 - 6.5]

This was on 100mcg. I then upped to 100 -125mcg on alternate days. After my recent results and discussion with Dr I have upped to 125mcg daily. This was just over a week ago. I have been on holiday and unable to seek advice before now! I took Thyroxine in the morning the day before the test and fasted for about 10 hours. My Dr says the results confirm Hashimoto's. He also said not to worry about a low lymphocyte count, this is common and often fluctuates. I'm not sure why this was tested in the first place. Both my TSH and T4 seem to have gone down and my T3 stayed the same. Please advise! The main reason for wanting to get my dose right is to lose a very stubborn stone (or 2) in weight and to hopefully improve tiredness, occasional brain fog and stiffness. I don't think my symptoms are that bad though compared to what I read on here. I am on Teva too. I don't think this is having any adverse reactions but could see if I can change brand when I am due a new prescription. I am interested to know if I should also be taking supplements. I currently take Selenium with Zinc and Vit D+K2 spray. I was taking Magnesium with B vits but haven't replaced when ran out. My B12 was tested this time around. My Ferritin from before was 50.8 ug/L [10.0 - 291.0] and my Vit D 76.1 nmol/l. I haven't had Folate done but can ask when I get my next test in September/October. I really appreciate any help and advice you can give. Thank you!

[ElephantShoes]

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[ElephantShoes in reply to ElephantShoes]

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[SlowDragon Administrator]

So these tests were how long after increasing dose levothyroxine to 100mcg/125mcg on alternate days?

Bloods should be retested 6-8 weeks after increase to 125mcg daily

Might be worth trying different brands levothyroxine

High thyroid antibodies confirms autoimmune thyroid disease

Have you had coeliac blood test done yet

If not, get that done before trialing strictly gluten free diet

B12, vitamin D and ferritin all slightly on low side

[ElephantShoes]

Thank you SlowDragon . The test after increasing to 100mcg/125mcg on alternate days was actually after about 13 weeks as I delayed because of Covid jab. I do intend to get my next test after increasing to 125mcg daily in 6-8 weeks.

My Dr in his email to me said: other results are a negative test for coeliac disease and a negative anti-nuclear antibody, which, if positive would be a marker for rheumatic conditions like lupus.

So, not coeliac. Is gluten free diet recommended? Also, what do you recommend for improving B12 and ferritin? I'm not keen on liver! Thank you for your help.

[SlowDragon Administrator in reply to ElephantShoes]

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

As your coeliac result is negative can consider trialing strictly gluten free diet for 3-6 months. Likely to see benefits.

If no obvious improvement, reintroduce gluten 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.

[SlowDragon Administrator]

Low B12supplementing a good quality daily vitamin B complex, one with folate in (not folic acid) may be beneficial.

This can help keep all B vitamins in balance and will help improve B12 levels too

Difference between folate and folic acid

chriskresser.com/folate-vs-...

Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid.

thyroidpharmacist.com/artic...

B vitamins best taken after breakfast

Thorne Basic B is an option that contain folate, but is large capsule. You can tip powder out if can’t swallow capsule

Igennus Super B is good quality and cheap vitamin B complex. Contains folate. Full dose is two tablets per day. Many/most people may only need one tablet per day. Certainly only start on one per day (or even half tablet per day for first couple of weeks)

IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

Low B12 symptoms

b12deficiency.info/signs-an...

If serum B12 result below 500, (Or active B12 below 70) recommended to be taking a B12 supplement as well as a B Complex (to balance all the B vitamins) initially for first 2-4 months, then once your serum B12 is over 500 (or Active B12 level has reached 70), stop the B12 and just carry on with the B Complex.

B12 sublingual lozenges

amazon.co.uk/Jarrow-Methylc...

cytoplan.co.uk/shop-by-prod...

healthunlocked.com/thyroidu...

[SlowDragon Administrator]

Suggest you retest ferritin at next test see if it’s going up or down

Look at increasing iron rich foods in diet

Eating iron rich foods eg plenty red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption

List of iron rich foods

dailyiron.net

Links about iron and ferritin

irondisorders.org/too-littl...

davidg170.sg-host.com/wp-co...

Great in-depth article on low ferritin

oatext.com/iron-deficiency-...

drhedberg.com/ferritin-hypo...

This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.

Thyroid disease is as much about optimising vitamins as thyroid hormones

healthunlocked.com/thyroidu...

restartmed.com/hypothyroidi...

Post discussing just how long it can take to raise low ferritin

healthunlocked.com/thyroidu...

[ElephantShoes in reply to SlowDragon]

Also, SlowDragon any thoughts on a low lymphocyte count? And why T4 could drop with an increased dose? Thank you.

[ElephantShoes]

Thank you SlowDragon . Lots here to read up on. Much appreciated.