Medicheck results - Over active

[kezzabird30]

Hi Can someone please read my mums medichecks results. She has been over active thyroid for around 4 years. She is currently on 5mg Carbimazole. She has the usual symptoms, extreme tiredness, thin hair and nails. Thanks for reading x

[SlowDragon Administrator]

Sorry photo is unreadable

Can you rephotograph or crop in tighter

Or type results up

[kezzabird30 in reply to SlowDragon]

Hopefully you can read them now? Kind regards Kerry

Other results

[SlowDragon Administrator in reply to kezzabird30]

What’s her diet like

Is she vegetarian or vegan

Being hypothyroid frequently causes low stomach acid this leads to poor nutrient absorption and low vitamin levels as direct result

B12 is extremely low Any Active B12 below 70 needs further testing

She needs full testing for Pernicious Anaemia

Likely to need B12 injections

If not injections, then daily B12 supplements

Folate also very low

Vitamin D far too low as well

Aiming for vitamin D at least around 100nmol

[kezzabird30 in reply to SlowDragon]

Her diet is not great as she does not like veg. She takes Vit D 3 prescribed by the doctor. I dont think she could sustain a Gluten free diet as she is disabled so eats a lots of ready meals that she can just throw in the oven.

[SlowDragon Administrator in reply to kezzabird30]

See my reply below about her high parathyroid test result

parathyroid.com/low-vitamin...

There are two reasons for having low vitamin D. One reason for low vitamin D is not serious and simply means you need to take some vitamin D pills. The second reason for a low vitamin D is much more serious (and less common) and may indicate that you have primary hyperparathyroidism and need an operation to remove a small parathyroid tumor. These folks should not be taking vitamin D until after the parathyroid operation. If you have low vitamin D, you must understand which of these two groups you are in.

She needs vitamin D, calcium and parathyroid levels tested together NOW

[SlowDragon Administrator]

Has she definitely been confirmed as having Graves’ disease. Autoimmune HYPERTHYROID.

Graves is confirmed by high TSI or Trab antibodies

She should have been tested by GP or endocrinologist at diagnosis

Look at old blood test results

Her high thyroid antibodies suggests she might/possibly has autoimmune thyroid disease also called Hashimoto’s which is HYPOTHYROID

It is possible to have Hashimoto’s and Graves’ disease at same time

Her current thyroid results suggest she needs dose reduction in Carbimazole

Or endocrinologist can prescribe levothyroxine alongside Carbimazole

Known as “block and replace “

Ft3 and Ft4 are both on low side

Vitamin levels are terrible

What vitamin supplements is she currently taking

Many Hashimoto’s and Graves patients find it extremely beneficial to be on gluten free diet

Has she had coeliac blood test done

Is she on strictly gluten free diet?

[kezzabird30 in reply to SlowDragon]

Hi Slow Dragon

I have some of her early thyroid results that were taken at addenbrooks endo team. results as below.

I think she was originally given 20mg of carbimazole but was reduced around a year ago.

Dec 2017

Parathyroid 8.2 (1.6 - 6.9)

TSH 0.01 (0.27 - 4.20)

FT4 23.6 (11.00 - 22.00)

TPO 306 (^34)

Oct 2019

TSH 2.26 (0.35 - 5.580)

FT4 13.6 (10.5 - 21.0)

FT3 4.4 (3.5 - 6.5 )

[kezzabird30]

I just found TSI results from Oct 2019 0.53 (<0.56iu/L)

[SlowDragon Administrator in reply to kezzabird30]

So her results never showed she had Graves’ disease

TSI results from Oct 2019 0.53 (<0.56iu/L)

Result is negative (just)

When did she start Carbimazole?

Dec 2017

TSH 0.01 (0.27 - 4.20)

FT4 23.6 (11.00 - 22.00)

TPO 306 (^34)

These results strongly suggest Hashimoto’s NOT Graves’ disease

We see many early stage Hashimoto’s patients misdiagnosed as Graves patients

Carbimazole is not correct treatment for Hashimoto’s patients

Hashimoto’s frequently starts with transient hyperthyroid results and symptoms before becoming increasingly hypothyroid

After this test she should have had vitamin D, folate, ferritin and B12 tested

Plus thyroid ultrasound scan

Hashimoto’s can be confirmed by ultrasound

As already mentioned, possibly had Graves and Hashimoto’s

This is more complex and managed by endocrinologist…..usually with “block (Carbimazole) and replace (levothyroxine)

Parathyroid 8.2 (1.6 - 6.9)

Was vitamin D, calcium and parathyroid tested together after this high parathyroid result

High parathyroid can be due to vitamin D deficiency

Oct 2019

TSH 2.26 (0.35 - 5.580)

FT4 13.6 (10.5 - 21.0)

FT3 4.4 (3.5 - 6.5 )

These results show hypothyroid…..if on Carbimazole, dose presumably was reduced

Suggest you insist on thyroid ultrasound scan

Retest TSI or Trab antibodies for Graves’ disease

Improving low vitamin levels absolutely essential

Strictly gluten free diet likely to help as well

Get parathyroid, vitamin D and calcium levels tested together

If she has high parathyroid levels she Must NOT supplement vitamin D

parathyroid.com/low-vitamin...

There are two reasons for having low vitamin D. One reason for low vitamin D is not serious and simply means you need to take some vitamin D pills. The second reason for a low vitamin D is much more serious (and less common) and may indicate that you have primary hyperparathyroidism and need an operation to remove a small parathyroid tumor. These folks should not be taking vitamin D until after the parathyroid operation. If you have low vitamin D, you must understand which of these two groups you are in.

[kezzabird30 in reply to SlowDragon]

Thank you slow dragon. lots to take in there but will have a proper read and see if I can get her a scan. Thank you for taking the time to reply

[SlowDragon Administrator]

Will flag a few other members to comment

PurpleNails

greygoose

SeasideSusie

bantam12 re parathyroid issue

[SeasideSusie Remembering]

My first thought would have been Hashimoto's as well. Agree with retesting Graves antibodies.

[PurpleNails Administrator]

TSH 0.75 (0.27-4.2)FT4 15.7 (12 - 22)

FT3 4.2 (3.1 - 6.8)

The current results (if I’m reading correctly?) show FT4 37% & FT3 29% through range.

You could either stop carbimazole altogether and retest in 4 weeks to see if levels rise or drop. Or reduce dose and monitor.

5mg carbimazole is considered lowest dose as it’s the lowest manufactured but you can reduce by either splitting a pill or taking every other day.

The antibody results do not suggest Graves as although TSI are present the level does not exceed the positive level limit. The TPO & TGab suggest under active autoimmune thyroiditis (Hashimotos). This often starts with elevated hyper so the levels need to be closely monitored as you may find these levels drop.

Has there been any calcium results? Usually If there have been 2x over-range calcium readings this usually prompts calcium, phosphate, PHT (parathyroid hormone) & vitamin D be tested together. It can be a marker for parathyroid issues.

The parathyroid is located near thyroid but had a completely separate function (controlling calcium).

Does she take any other medications. Propranolol is often prescribed in conjunction with carbimazole and this can affect PTH lowering it.

[kezzabird30]

Hi Purple nails. many thanks for your reply. Mum is on a right cocktail of drugs for nerve damage in her spine. She did have calcium issues before covid and was being seen by addenbrooks, but since then, they cancelled her appointment and now she cannot be seen. None of the drugs she is on is propranolol though. I think she needs to take your advise, stop the carbimazole and restest. i have sent an email to her doctor on her behalf and have asked that they give her a further blood test to check the things that Slow dragon mentioned, I am awaiting a response. I will check her results again from addenbrooks and see where wer were last at with the calcium and Parathyroid. thanks again for your response

[PurpleNails Administrator in reply to kezzabird30]

It’s seems wrong to me all these hospital specialists postpone appointments and don’t follow up. I had a referral cancelled and was told to refer once “covid over”. I told the GP and they didn’t believe me she said they’re not allowed to do that. But they had, it taken months to get another referral & now on wait list. No appointment available.

There’s nothing to prevent blood tests & monitoring remotely. Before covid this is how was I was reviewed every 6 weeks. I don’t draw blood easily so do have to go to hospital for tests but then I’m telephoned. At start of 1st lock down the specialist wrote to me and said as I was “more or less stable” I could be left for 10 weeks. Last check was 12 weeks. Seems to get further apart each time!