Medichecks

[NinaB]

I had my Medichecks results TSH <0.01 Free T4 22.8. Told my GP so had bloods done. TSH <0.01 and Free T4 14.2. Only two weeks between. Who do I believe?

[SlowDragon Administrator]

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

Both tests done taking same dose and brand of levothyroxine

There’s nothing on your profile

Do you have Hashimoto’s?

What vitamin supplements are you currently taking

Are you on strictly gluten free diet or dairy free diet

Obviously just testing TSH and Ft4 is completely inadequate

[NinaB in reply to SlowDragon]

Hi

Same dose and brand. Took medication the morning of the test. Both done lunchtime.

No idea if I have Hashimotos.

No strict diet and no vitamins.

My T3 was normal at Medichecks. Not done by GP.

[SlowDragon Administrator in reply to NinaB]

What was Ft3 result on Medichecks

you need to test for thyroid antibodies and vitamins

90% of primary hypothyroidism is autoimmune thyroid disease diagnosed by high thyroid antibodies

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested.

Also EXTREMELY important to test vitamin D, folate, ferritin and B12 at least annually

Low vitamin levels are extremely common, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)

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 all relevant vitamins

List of private testing options

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

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

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

bluehorizonbloodtests.co.uk...

Thriva Thyroid plus antibodies and vitamins By DIY fingerpick test

thriva.co/tests/thyroid-test

Thriva also offer just vitamin testing

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

Last dose levothyroxine should be 24 hours before test, not 5 hours

[NinaB in reply to SlowDragon]

T3 4.3

[SlowDragon Administrator in reply to NinaB]

Ft3 Far too low

Ft3 is only 33% through range

Helpful calculator for working out percentage through range

chorobytarczycy.eu/kalkulator

Likely low vitamin levels/ autoimmune thyroid disease (Hashimoto’s )

[NinaB in reply to SlowDragon]

So what do I do? I’m struggling with palpitations and exertional breathlessness. I’ve had a suppressed TSH for around ten years and I do want it in the normal range. Very concerned about my Cardiovascular health and bones.

[SlowDragon Administrator in reply to NinaB]

Breathlessness is frequently low iron/ferritin

Essential to test vitamin D, folate, ferritin and B12 at least annually

Request GP test these

On levothyroxine we MUST Have GOOD Vitamin Levels

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

Serum B12 at least over 500

Active B12 at least over 70

Folate and ferritin at least half way through range

Are you vegetarian or vegan

What vitamin supplements are you currently taking?

Vast majority of primary hypothyroidism is autoimmune thyroid disease (Hashimoto’s)

High percentage of Hashimoto’s patients are gluten intolerant NOT coeliac

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

Before considering trial on gluten free diet get coeliac blood test done FIRST just to rule it out

Request GP do coeliac blood test

Or test privately

lloydspharmacy.com/products...

If you test positive for coeliac, will need to remain on gluten rich diet until endoscopy (officially 6 weeks wait)

If 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.

[NinaB in reply to SlowDragon]

Thank You 🙏

[tattybogle in reply to NinaB]

"So what do I do? I’m struggling with palpitations and exertional breathlessness. I’ve had a suppressed TSH for around ten years and I do want it in the normal range. Very concerned about my Cardiovascular health and bones."

I did a lot of reading about low TSH /risks, as mine had been 0.05ish for over a decade.

I found a large, long term study showing the 'risks' for TSH 0.04 to 0.4 were actually no greater than the risks for TSH 'in range' (0.4 -4)

The risks did increase for TSH below 0.04 , but most of them were still less than risks for TSH over 4 ... and the recent NHS guidelines say they don't need to treat unless TSH is above 10 .. so they are clearly not so worried about the risks of TSH over 4 .

The link to that study is duplicated in my replies to the following posts, but i'll include links to them all ,as they all have some interesting/reassuring discussion on the subject of low TSH/Risk.

healthunlocked.com/thyroidu... tsh-and-bone-density?

healthunlocked.com/thyroidu... suppressed-tsh-dangerous-wheres-the-evidence?

healthunlocked.com/thyroidu... tsh-and-the-more-mature

healthunlocked.com/thyroidu... risks-of-suppressed-tsh-analysis?

healthunlocked.com/thyroidu... dangers-of-suppressed-tsh?

If you wished to you could try a very slightly reduced dose of Levo to see if that brought TSH back up to above 0.04 if that reduces your concern re. low TSH.

You may find that only a 12.5mcg reduction was enough to do this, and it could be that your dose has now become slightly too much for you and it could be possible that this is causing the breathlessness on exertion ?

I reduced from 125 to 112.5mcg and TSH came up from 0.04 to 0.09 and even though at first i didn't feel as good on the lower dose , after 6 months i realised i was seeping better and some unexplained pains had gone away .. The GP then wanted to reduce by a further 12,5mcg , which i tried, but that left me feeling much worse so he agreed i go back to 112,5mcg.

Interestingly ,since then i started splitting my single daily dose of levo into 2 smaller doses (50 at 7am and 62.5 at 11pm, still 4 hrs away from food, quite useful actually as it stop you snacking in the evening) ..... anyway 6 months later my TSH had risen to 1.9... it's too soon to say if it's a 'one off'/something else .... or if avoiding a big 'all in one go' dump of T4 has allowed TSH to rise a bit .. but you could try that as an experiment too.

[NinaB in reply to tattybogle]

That was what I was wondering. I’ll chat with my GP. I’d do it myself but I only have unscored 100mcg tablets. Thanks 🙏

[tattybogle in reply to NinaB]

are you on 200mcg now ?

[NinaB in reply to tattybogle]

Yes I am

[tattybogle in reply to NinaB]

200 x7= 1400mcg /week

187.5 x7= 1312.5mcg/week

(200 x 6 days ) + (100 x1day ) = 1300mcg /week ... so you could perhaps try that if you don't want to play with the GP .

Could also do 100 am and 100 pm 6 days and just do 100 in a.m on 7 th day.

Check my maths though... just heard some horrible news and trying to distract myself but head could be all over the place.

[NinaB in reply to tattybogle]

What a good idea. I will do that. How long is it before I’d expect a TSH response?

[tattybogle in reply to NinaB]

No idea really , but my gut feeling is that big dose changes move it quickly (6 weeks)and tiny dose changes might move it much more slowly. It was at least 6 month after i started splitting my dose that i had next lot of bloods ,so don't know what it was doing in the meantime.

But the 12.5mcg reduction showed slightly increased TSH from ( 0.04 to 0.09 )when bloods done after 3 months.

[tattybogle in reply to tattybogle]

edit .. above should say "realised i was SLEEPING better" . lol

[SeasideSusie Remembering]

NinaB

Medichecks: Free T4 22.8 (range 12-22)

GP: Free T4 14.2 - what is the range for your GP test? If the range is different then the result is based on the GP range so you can't compare the result with the Medichecks one, you have to work out the percentage through range to compare them.

Calculator: chorobytarczycy.eu/kalkulator

Tests have to be done under the exact same conditions to compare them. We always advise:

* Test at the same time, preferably no later than 9am

* Nothing to eat or drink except water before the test

* Last dose of Levo 24 hours before test

[NinaB in reply to SeasideSusie]

GP range is 7-17

Same conditions but took Levo about five hours before both tests and did eat and drink.

[SeasideSusie Remembering in reply to NinaB]

Medichecks: Free T4 22.8 (range 12-22)

GP: Free T4 14.2 (7-17)

So Medichecks result is 108% of range and GP result is 72% through range.

(The link works for me on my PC. If you are on a phone or other mobile device then I don't know if it will work.)

The fact that they were done two weeks apart makes a difference, nothing is static. It is quite a big difference but anything could have caused the discrepancy.

Taking Levo before the test gives a false high FT4, you should take your last dose 24 hours before the test to get a measure of your normal circulating hormone.

The reason for an early morning test is because TSH is highest early morning and lowers throughout the day. Many doctors adjust dose by only looking at TSH so you don't want it showing too low if you are not wanting a dose reduction. Similarly, certain foods and drinks can affect TSH which is why we say drink water only before the test.

[NinaB in reply to SeasideSusie]

Calculator link not working

[humanbean in reply to NinaB]

chorobytarczycy.eu/kalkulator

Does that work? Sometimes two people can both paste the same link and one will work, the other won't. It's worth a try.

[NinaB]

I am Vegan and take just Vitamin D

[helvella Administrator Thyroid UK in reply to NinaB]

Where do you get your B12 from?

Unless you supplement somehow, you will be low in B12.