Wondering if someone can help with my results again. I can't get an endo appointment for 2 weeks. The first picture is my results 8 weeks ago (with TSH at 0.9) and the second is my new results.
At the time of the first test I was on 100 of levo, now I'm still on 100 5 days but on 125 2 days a week. I think my T3 and T4 is in a better place but TSH is showing low. In saying that I feel well, much better than ever before so should I be bothered about that?
I also see a slight reduction in antibodies. I eat a good balanced diet, on advice of endo not strict gluten free but very low gluten and very low sugar. This hasn't changed since last test. The only difference is I've upped vit d from 10ug to 50ug- could that be the reason? Might it continue to reduce? Anything else I should consider?
I'm due to start stims for my next round of ivf in 2 weeks and will be increasing to 125 of levo every day as last time it went up from 2.2 to 4.5 during treatment, just want to review how I am before I do that.
Any advice appreciated.
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river242
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Your TSH getting low in range or under-range is pretty irrelevant once you are on thyroid meds - your actual thyroid hormones are much more important, and yours have improved a lot with that small increase in meds. I know a LOT of doctors are obsessed with TSH and try and scare us if it goes low, but that's because they (sadly) fail to understand the pretty major difference of a low TSH and in-range hormones because you are on thyroid meds and a low TSH and wildly over-range hormones when someone isn't on medication. You are only over-medicated if free T3 goes over-range - but if you are TTC or pregnant it's important your TSH doesn't go high (over 2.5)
And your high antibodies simply show that, like 90%+ of hypos, the reason you are hypo is Hashimoto's or Hashi's. This is nothing to worry about: it's very common but can't be cured. Your antibodies will go up and down as they feel like - a bit like an irregular tide - and there's nothing you can do. If they measure low, you aren't "improving" or "getting better" - they will simply bounce back higher later on.
greygoose does a great summary of Hashi's if you aren't too familiar with it. The one thing I would suggest is that many people find going (strictly) gluten-free, even if not coeliac, and/or dairy-free can improve how they feel.
Thank you so much. My gut instinct is that I'm in a much better place so I'm just going to go with that.
I haven't cut out dairy yet as fertility consultant wants me to have a lot of protein and without dairy milk I really struggle to hit that. I'll need to look into other ways I can increase it.
You don't have to cut out dairy if it agrees with you - it doesn't agree with everyone. And, if it doesn't bother you, then you probably won't feel any better for cutting it out.
On the other hand, you do need to be 100% gluten-free for at least three months to feel any benefit.
OK, so Hashi's is an autoimmune disease, where the immune system attacks and slowly destroys the thyroid. It is diagnosed by testing Thyroid Peroxidase (TPO) antibodies and Thyroglobulin (Tg) antibodies.
Contrary to popular belief, it is not the TPO/Tg antibodies themselves that attack the thyroid:
When lymphocytes infiltrate the thyroid gland, mistakenly taking it for a foreign bacteria invader, they damage the thyroid gland and release thyroid peroxidase &/or thyroglobulin into the blood stream. These don't belong outside of the thyroid gland so antibodies are developed to mop them up.
The antibodies are a result of the attack on the thyroid gland, the antibodies don't cause the attack.
After every immune system attack on the thyroid, the dying cells release their stock of thyroid hormone into the blood stream, causing the levels of the Frees to shoot up - FT4 to around 30 something, FT3 around 11/12 - and the TSH therefore drops to suppressed.
There is no knowing how long these high levels will persist, but eventually, they will drop by themselves as the excess hormone is used up or excreted, and not only will you become hypo again, but slightly more hypo than before, because there is now less thyroid to make hormone.
(NB: A Hashi's 'hyper' swing is not true hyperthyroidism in that your thyroid is over-producing thyroid hormone. It's physically impossible to 'go hyper' if you are basically hypo. The thyroid cannot regenerate itself to the point of over production of hormones - or even normal production. Very few doctors appear to know that.)
Therefore, it's very important that your doctor does not reduce your prescription, because you’re going to need it again! If you start to feel over-medicated at that point - some do, some don't - the best thing is to stop levo for a few days, then, when you feel hypo again, start taking it again. It's very important to know one's body, and how it reacts.
There is no cure for Hashi's - which is probably one of the reasons that doctors ignore it - apart from the fact that they know nothing about it, of course!
However, between the 'hyper' swing, and the descent back into hypothyroidism, there can be a phase - quite a long one, sometimes - of normality, where the person is neither hypo nor 'hyper'. This is where people sometimes start talking of having 'cured' their Hashi's, by whatever means. But, it doesn't last. Eventually, you will go hypo again.
But, there are things the patient can try for him/herself to help them feel a bit better:
a) adopt a 100% gluten-free diet. Hashi's people are often sensitive to gluten, even if they don't have Coeliac disease, so stopping it can make them feel much better. Worth a try. Some say that going gluten-free will reduce antibodies – I’ve never seen conclusive proof of that, but, you should be aware that even if you were to get rid of the antibodies completely, you would still have Hashi's, because the antibodies are not the disease. It is not the TPO/Tg antibodies that do the attacking.
b) take selenium. This is not only reputed to reduce antibodies, but can also help with conversion of T4 to T3 - something that Hashi's people often find difficult.
c) the best way to even out the swings from hypo to 'hyper' (often called Hashi's Flares, but that doesn't really sum up the way it works) is to keep the TSH suppressed. This is difficult because doctors are terrified of a suppressed TSH, for various false reasons, and because they don't understand the workings of Hashi's. But, TSH - Thyroid Stimulating Hormone (a pituitary hormone) - tries to stimulate the thyroid to make more hormone, which also stimulates the immune system to attack. So, the less gland activity there is, the less immune system activity there will be, meaning less attacks, gland destruction slowed down and less swinging from hypo to hyper and back.
Thank you. This is really helpful and interesting. I actually feel well now which is probably the most important thing. Having had a miscarriage and a failed ivf in the last year I'm just conscious of eliminating this as a variable and doing everything I can.
Hashi's is variable by nature, and there's not a lot you can do about that. You certainly can't get rid of it, it's for life - or until your thyroid is completely destroyed.
Good advice from greygoose & great your thyroid antibodies are reducing. Vit D is a good immune booster so could easily have been the reason for antibody reduction.
Studies on the effect of elevated thyroid antibodies in pregnancy are all fairly old, probably because not a lot regarding functional medicine has evolved in the management of autoimmune disease but there are some studies showing that thyroid hormone levels will influence pregnancy hormones and the response can be altered with elevated thyroid antibodies due to the immense immune system changes that take place during pregnancy.
A good read is "Your Healthy Pregnancy With Thyroid Disease" by Dana Trentini and Mary Shomon, and view websites such as ‘hypothyroidmom’ The general consensus appears to be to keep antibodies as low as possible through means such as eliminating cross-reactive foods, avoiding sugar spikes, supplementing selenium, fish oils, Vit D etc, that helps calm an over active immune response and reduces the chance of attacks on thyroid peroxidase (TPO) & thyroglobulin (TG).
TSH must be kept low to prevent any interference with ovulation and reduce the risk of elevation during the first trimester. Also the high oestradiol levels can stimulate TSH, although hCG will actually stimulate the gland.
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