Monitor My Health Results

[kittywatvans]

Hello all, I've had the results back which I'll attach here. My TSH is low but normal, my T4 is low and my T3 is low. There's a warning on one of my cholesterol levels which I need to look at as I don't really know what it is (low for good cholesterol). No reference range for VitD but they say it's OK. Wondering if it is a bit low, though.

[kittywatvans]

Vit D

Results

[kittywatvans in reply to kittywatvans]

I did the test first thing without eating. In not sure if that makes a difference. My blood sugar is all over the place and I had gestational diabetes.

Results

[kittywatvans in reply to kittywatvans]

I don't know what changes to make so I'll do some research.

Cholesterol result

[SlowDragon Administrator in reply to kittywatvans]

Vitamin D GP will often only prescribe to bring vitamin D levels to 50nmol.

Some CCG areas will prescribe to bring levels to 75nmol or even 80nmol

leedsformulary.nhs.uk/docs/...

GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)

mm.wirral.nhs.uk/document_u...

But improving to around 80nmol or 100nmol by self supplementing may be better

pubmed.ncbi.nlm.nih.gov/218...

vitamindsociety.org/pdf/Vit...

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

Test twice yearly via NHS private testing service when supplementing

vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function. There’s a version made that also contains vitamin K2 Mk7

amazon.co.uk/BetterYou-Dlux...

It’s trial and error what dose we need, with hashimoto’s we frequently need higher dose than average

Calculator for working out dose you may need to bring level to 40ng/ml = 100nmol

grassrootshealth.net/projec...

Vitamin D and thyroid disease

grassrootshealth.net/blog/t...

Government recommends everyone supplement October to April

gov.uk/government/news/phe-...

Web links about taking important cofactors - magnesium and Vit K2-MK7

Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

2 good videos on magnesium

healthunlocked.com/thyroidu...

Vitamin D and Covid

Notice how much vitamin D many of these medics are taking

vitamind4all.org/letter.pdf

[Jazzw]

Goodness, how are you still upright?

Your doctor was very very very wrong to reduce your Levo dosage. You’re very undermedicated and your doctor should be taken outside and shot!

Fuller reply to follow…

[kittywatvans in reply to Jazzw]

Well, at the moment, I'm not, as I've got a stomach bug and have been in bed all day. Ghastly!!!

[Jazzw in reply to kittywatvans]

You poor thing.

[kittywatvans]

The note with the thyroid result says this, which I gone the doctor doesn't put too much store by, given the rest of the figures.

Thyroid note

[Jazzw in reply to kittywatvans]

That’s just a standard reply. I wouldn’t read anything into that at all. The laboratory doctors mainly follow the same mantra as all the other doctors. But in a patient being treated for hypothyroidism, TSH is not the most important test.

[Jazzw]

So…

You were on 150mcg Levo and 20mcg liothyronine. Your Endo has said there’s no chance of a raise in T3. Your GP doesn’t understand that even a smallish dosage of T3 suppresses TSH and therefore using TSH to determine your correct dosage is hopeless.

And they’re even trying to switch your B12 jabs to tablets—when it’s very clear you’ve got gut absorption issues? I’m so so sorry Kittywatvans. Your doctors are collectively completely incompetent.

You need more medication—probably both Levo and liothyronine.

Is there any other GP in the practice you could see?

[Jazzw]

Vit D could probably do with being a bit higher. Your HBA1C is actually ok (phew, eh? )

And the cholesterol levels—well, raised cholesterol is a classic sign of undertreated hypothyroidism. Doctors used to know this. They don’t any more. Treat the hypothyroidism, watch the cholesterol sort itself out.

Edited to add—I’ve just opened the cholesterol result properly. You don’t have raised cholesterol (yet…). But not treating your hypothyroidism properly will probably lead to it eventually.

Can I ask how old you are? If you’d rather not say, that’s fine.

[kittywatvans in reply to Jazzw]

Hello, yes, I'm 42. My dad is on statins and has been for years, and has a stent and pacemaker. I don't know if the cholesterol thing is hereditary.

My good cholesterol is low amd I've looked that up, but the only thing I can change is to try and get more exercise. I don't eat meat, little dairy and never smoked.

[Jazzw in reply to kittywatvans]

Honestly, I think cholesterol is the least of your worries right now! Don’t worry about it. Cholesterol is not the problem here. (And actually, probably wouldn’t really be a problem if it was high… The thing about cholesterol being a big problem is 99% wrong.)

I know you said in your previous post that you’ve tried to get your doctors to understand that your suppressed TSH is not a concern and that it’s FT4 and FT3 they should be looking at.

I would ask them what they plan to do to get your FT4 and FT3 levels into the normal range. You can’t go on like this. They’re failing you. Your pituitary-hypothalamic axis is broken—probably has been for a long time because you said you were diagnosed with a below range FT4 and a TSH of 4-ish? So they can’t use TSH—which is a hormone produced by the pituitary to stimulate the thyroid—because the mechanism is broken. It isn’t working. If reducing your dosage isn’t making your pituitary produce enough TSH, then nothing will! The answer is to instead give you more levothyroxine and preferably more liothyronine as well.

[tattybogle]

Hypothyroidism causes raised cholesterol. See link in this post to an article in GPOnline written for NHS Doctors by specialist registrar's in Endocrinology and cardiology.

healthunlocked.com/thyroidu....

[tattybogle in reply to tattybogle]

thyroidpatients.ca/2019/01/... The above link may help with the ' low TSH when on thyroid hormone replacement doesn't mean over treatment' argument you need to have with the muppet that insists on lowering your dose. Also have a good look around the rest of the thyroid patients canada site .... i seem to remember there is a better page explaining the disjoint between TSH and fT4/3 levels once we are taking thyroid hormones , somewhere on there but i've forgotten which one it was . sorry there's loads of them.

Also this post may possibly be some use to you , healthunlocked.com/thyroidu...

[kittywatvans in reply to tattybogle]

Thank you!

[Jazzw in reply to tattybogle]

@kittywatvans Maybe it would work to talk the doctor through your understanding of how it works (as if you were the clueless one, not them).

So…

“Doctor, as I understand it, if I had a normal thyroid it would produce thyroid hormones in response to a signal from my pituitary gland—thyroid stimulating hormone or TSH. In a healthy person, whenever TSH is produced the thyroid kicks out thyroid hormones in response and when there’s enough in my blood stream the signal is switched off.

“I don’t think my thyroid can do that any more. My TSH is low, so that means hardly any signal—maybe no signal at all!—is being sent to my thyroid and therefore it isn’t making any thyroid hormones. The only reason why I have any hormones on board is because I’m taking Levo and liothyronine.

“But I can’t be taking enough because my levels of T4 and T3 aren’t even at the bottom of the reference range. And my TSH isn’t rising even though you’ve reduced my dose. I can see why you think it should but it hasn’t. That must mean that feedback mechanism isn’t working for me, right? Meanwhile, I haven’t got enough thyroid hormones and I’m feeling very poorly. What are you going to do to help me?”

[tattybogle in reply to Jazzw]

I agree .. kittywatvans that's the '6 million dollar question' isn't it .... "if TSH is ALWAYS a very accurate measure of thyroid hormone levels , then why can't Kittywatvans TSH see that she has such abominably low levels of T4 and T3 ?? "... These blood results are clear evidence that there are instances where TSH does not give a true reflection of thyroid hormone levels .. and in those instances you have to include fT4 and fT3 results and symptoms as part of the decision making process for deciding dose.

So i don't think you need a 'paper' to prove it .. these results prove it by themselves .

[Jazzw in reply to tattybogle]

It always astonishes me that doctors don’t get it. It’s really quite easy to understand.

[tattybogle in reply to Jazzw]

Yes indeed ,if they just did full TSH /fT4/fT3 testing more often, it would be obvious that sometimes it just doesn't add up to what 'the book' says it should , and they'd have to think about things for a second. It's all to easy to believe 'TSH is always right' if you never do anything else to check it against.

But even with 'only TSH' to look at, it is still sometimes obvious that they are missing something important and that therefore you can't always use TSH to adjust dose by ... for example, at diagnosis my TSH was 6.8 .

then on 50mcg Levo it was 2.9 ,

on 100mcg Levo it was 2.5

and on 150 mcg Levo it was 2.7 .... so Doctor , do tell ... based on TSH ... what was my correct dose ???? or perhaps he'd think it shouldn't matter whether i took 50 or 150 since my TSH was in range for all of them ... Duh !

[SlowDragon Administrator]

These results are on 150mcg levothyroxine and 20mcg T3

Was test done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

Last 5mcg dose T3 approx 8-12 hours before test

Your already on gluten free diet

Have you considered trialing strictly dairy or lactose free diet

You would need Lactose free levothyroxine or lactose free liquid levothyroxine

Clearly you are under medicated

Approx how much do you weigh in kilo

If dose levothyroxine is already significantly more than 1.6mcg per kilo of your weight ….suggests likely lactose intolerant

What vitamin supplements are you currently taking

You need B12, folate and ferritin levels tested

Vitamin D is far too low

Are you currently taking any vitamin D

Aiming to improve to at least around 100nmol

[kittywatvans in reply to SlowDragon]

I'm overweight 70kg. I did try to be vegan for a while, but it turned out I'm allergic to soya, so I went back to having small amounts of dairy. My mum isn't good with lactose though. I could try that.

Yes test was early, before breakfast. About 7.30/8am. And no levo taken before. I struggled to cut the t3 but managed two halves. I've asked about liquid levo to see if that would help.

I'll look at the other tests next.

[SlowDragon Administrator in reply to kittywatvans]

So if you don’t eat much red meat or vegetarian likely low B12 and iron and ferritin

If vegetarian it’s essential to regularly supplement B12 and regularly test full iron panel test for anaemia

Nether levothyroxine or T3 will work well unless all four vitamins are OPTIMAL

Vitamin D at least around 80nmol and around 100nmol maybe better

Folate and ferritin at least half way through range

Serum B12 at least over 500

Active B12 at least over 70:

[SlowDragon Administrator in reply to kittywatvans]

No thyroid patients should ever eat soya

[kittywatvans in reply to SlowDragon]

That's interesting, it gives me mouth ulcers which is what gluten does as well.

[Jazzw in reply to kittywatvans]

Lactose intolerance is something your doctor could arrange to have tested. nhs.uk/conditions/lactose-i...

Might be worth asking for it.

[JAmanda]

Looks like central hypothyroidism - you’ll need to speak to your Doc or preferably Endo for medication here.

[SlowDragon Administrator in reply to JAmanda]

She’s on liothyronine, so TSH is bound to be suppressed

[JAmanda in reply to SlowDragon]

Sorry misread it and didn’t know she was on medication.

[kittywatvans]

You're all so helpful, thank you. I've got some prep work to do before I talk to the quacks again.