Blood test results, am I fine?

[FindMeInTheForest]

Hypothyroidism treated with 75mcg Levothyroxine.

Blood sample taken in morning before medication, 24hrs since last dose.

If someone could take a look at the results & let me know if they look ok it would be much appreciated.

Many thanks.

[SeasideSusie Remembering]

FindMeInTheForest

How do you feel?

Many Hypo patients feel best when TSH is 1 or below with FT4 and FT3 in the upper part of their ranges. Your FT4 is 34% through range and FT3 is 24% through range so there is plenty of room to increase. However, if you feel well you could leave things as they are.

[FindMeInTheForest in reply to SeasideSusie]

Thanks SeasideSusie, that's helpful. I don't feel amazing, I get very fatigued & have body aches (which have been suggested are probably fibromyalgia, but I'm not keen on that suggestion).

When increasing, would it usually be done in 25mcg increments?

Presumably if I increase & feel better i'd need to get the ok from a GP to prescribe more in my repeats? (sighs & rolls eyes at thought of contacting GP surgery).. x

[SeasideSusie Remembering in reply to FindMeInTheForest]

FindMeInTheForest

With your current FT4 and FT3 levels an increase of 25mcg would be about right, it's when you get higher up in the ranges that smaller increases make more sense so that you don't go over your sweet spot.

Do you have enough tablets to be able to increase yourself without running out before your next prescription is due? Some surgeries are very strict in only giving 28 days' worth at a time and not allowing a new prescription to be issued until X days before your current box finishes. You might be risking your doctor's wrath if you go ahead and increase yourself without discussing with him first and getting agreement to increase, but only you know your doctor.

What may help persuade your doctor to agree to an increase is the following:

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (the professional publication for doctors):

"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l. In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance. But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l. This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l).*"

*He confirmed, during a talk he gave to The Thyroid Trust, that this applies to Free T3 as well as Total T3 and this is when on Levo only. You can hear this at 1 hour 19 mins to 1 hour 21 minutes in this video of that talk youtu.be/HYhYAVyKzhw(Not working as expected?)

You can obtain a copy of this article from ThyroidUK:

[e-mail]

print it and highlight Question 6 to show your GP.

[FindMeInTheForest]

Thank you so much 🙏🏻

[SlowDragon Administrator]

As you have PCOS ……Presumably you have autoimmune thyroid disease also called Hashimoto’s …..even though antibodies are negative

Have you had ultrasound scan of thyroid

20% of Hashimoto's patients never have raised antibodies

healthunlocked.com/thyroidu...

Paul Robson on atrophied thyroid - especially if no TPO antibodies

paulrobinsonthyroid.com/cou...

Extremely important to have optimal vitamin levels too as this helps reduce symptoms and improve how levothyroxine works

When were vitamin D, folate, ferritin and B12 last tested

What vitamin supplements are you currently taking

[FindMeInTheForest in reply to SlowDragon]

Hello SlowDragon, What is the link from autoimmune thyroid disease to PCOS?

I've never had an ultrasound done on my thyroid, can I request for that to be done?

Vits were last tested over a year ago. I meant to order the advanced thyroid test from Medichecks but somehow ended up with just the thyroid+antibodies test.

I'm taking 3000iu Vit D daily plus a multivitamin with omega.

Thanks SO much for your input on this.

[SlowDragon Administrator in reply to FindMeInTheForest]

PCOS and autoimmune thyroid disease (hashimoto’s)

verywellhealth.com/things-w...

pcosdiva.com/2015/08/got-pc...

endocrineweb.com/news/thyro...

frontiersin.org/articles/10...

[FindMeInTheForest in reply to SlowDragon]

Very interesting that they are commonly found together. I've made an appointment to speak with a GP in 2weeks about upping my Levothyroxine dose and will also ask for an ultrasound of my thyroid gland.

Does knowing that it's Hashimotos as opposed to clinically underactive make a difference to the treatment?

Thanks

[SlowDragon Administrator in reply to FindMeInTheForest]

To you …yes

To GP …no not really

Technically it’s Hashimoto's (with goitre) or Ord’s thyroiditis (no goitre). Both variants are autoimmune and more commonly just called Hashimoto’s

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 a further 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

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. Can take many months for brain fog to lift.

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.

[FindMeInTheForest in reply to SlowDragon]

SlowDragon this is just so helpful, thank you. Your time and knowledge on this is greatly appreciated.

I will do the Coeliac test.

I forgot to mention before that I use something called Sunshine Salt, which I buy from Dr Myhill. It has many key vitamins and minerals and I use it instead of salt in my cooking.

[SlowDragon Administrator in reply to FindMeInTheForest]

As you likely have Hashimoto’s….and on levothyroxine, you might not want extra iodine in this salt

Iodine is controversial

pubmed.ncbi.nlm.nih.gov/970...

thyroidpharmacist.com/artic...

Are you ALSO taking separate multivitamin

Multivitamins are never recommended on here…..as these usually contain iodine too

Autoimmune thyroid patients should only ever take iodine if tested and deficient.

Iodine use to be used to treat hyperthyroidism

Suggest you get vitamin D, folate, B12 and ferritin levels tested

Some Hashimoto’s patients have high ferritin…..if that includes you, you don’t want to be taking iron supplements

Also suggest you test iodine levels

SeasideSusie has details of best iodine test

[GiaM in reply to SlowDragon]

Wow I had no idea about this...I have PCOS and a recent underactive thyroid diagnosis, I'm reading the links you posted its really interesting stuff. I also have raised intracranial pressure which is linked to PCOS so I'd be interested to research a little further and see if this is also connected with thyroid issues. I suspect mine is Hashimotos as most of my female relatives have thyroid issues, of course Dr will only test TSH!

[SlowDragon Administrator in reply to GiaM]

GP should always test thyroid antibodies once

Though NHS only tests TG antibodies if TPO antibodies are high

Significant minority of Hashimoto’s patients only have high TG antibodies and struggle to get diagnosed

[GiaM in reply to SlowDragon]

Unfortunately my GP only tests TSH and just once tested free T4 . I just had my blood test yesterday since being told to stop taking levo to see if my TSH goes up again, so will mention this when I speak to the GP about the results failing that I may have to do it privately

[FindMeInTheForest in reply to GiaM]

I know GaiM, it's great to have the connection confirmed.I've always suspected a connection, since the thyroid and ovaries are both key parts of the endocrine system, but I haven't been assertive enough to seek that confirmation.

I'm going to pursue getting an answer on Hashimotos as that seems more and more likely, the more I read. Also, my dad had a chunk of his thyroid gland removed a few years ago. He is not interested and has no clue if he had Hashimotos or not, which isn't very helpful but I will do some digging.

[tattybogle]

To minimise hassle with the doc , if they are one who won't increase dose 'because your results are fine', (and it's much harder to use references to argue for an increase if your TSH is already below 2) ..... it might be less hassle to increase yourself for 6 weeks ,then tell em what you've done and ask for a blood test. which they will find it hard to refuse under those circumstances . (it's even handier if you happen to be coming up to your annual review date , then you don't even have to tell them what you did in order to get a blood test because 'one is due' ) anyway, tell the phlebotomist at the time of the blood draw ... 'i've been taking 'x' for the last 6 weeks because i was feeling slow'.

Once GP gets the results from the blood test .. assuming TSH (fT4 if done) are still in range .... they will have no grounds to ask you reduce .. so if you feel better on the new dose they'll have to increase your prescription.

I've always done it this way ...I never did get on very well with the idea of 'ask first' .... it just gives people the opportunity to say 'no'.

Obviously you need enough tablets to do it for 6 weeks. and back when i was doing this they used to prescribe 3 months at a time. so it was easy.

..... mind you there's more than one way to skin a rabbit... you could always ' accidentally leave some on holiday' and have to ask for some 'replacements cos you've got none left' .... they can't really say no to that either.

Just depends whether you prefer to be upfront . or not.

[FindMeInTheForest in reply to tattybogle]

Very helpful, thanks tattybogle! I get my prescriptions 3 monthly so I'm away to count how many weeks' worth I have left and calculate if it will work out ok.

[tattybogle in reply to FindMeInTheForest]

Also worth noting .. 12.5mcg increases/decreases can be more effective than you'd think.i now only adjust my dose up or down by 12.5 mcg's /day ( or even less),

If you don't have the right size tablets to get the dose you want to try , then do the maths for a full weeks worth , and then divide that up as equally as you can through the week.

it doesn't matter if you take 75 one day and 100 the next,, as long as it adds up to the right amount for the week .. but do try to keep the differences between one day and the next as small as possible because some people can feel the difference each day, which doesn't help if you are also trying to figure out if a new dose is an improvement in how you feel or not.

Eg , if you wanted to increase from 75 to 87.5mcg . then either split a 25 in half each day to add to the 75... or take 75 one day and 100 the next.

Just for information:

Even if we only have 100mcg tablets , we can still make pretty fine adjustments eg.

100mcg a day = 7 days 100mcg

86mcg a day = 5 days 100mcg/2 days 50mcg (half a tablet (600mcg divided by 7 =86))

114 mcg a day = 5 days 100mcg /2 days 150mcg (800mcg divided by 7 =114)