Thyroid

[Amyjay74]

I have been well for the last 9 yrs or so and now started to feel unwell..

Here are my blood results, Dr just wants to test again in 6 months..

Thoughts and advice pls..

Ty..x

[shaws Administrator]

When we've been diagnosed and take thyroid hormone replacements, the aim is to bring TSH to around1 or lower with Free T4 and Free T3 in the upper part of the ranges.

Your TSH is rising, so I believe you need an increase in your dose.

[Amyjay74 in reply to shaws]

I'm not on any medication, my Dr doesn't think it's needed yet..I will call tomorrow to insist on it.I'm feeling really crap..

[shaws Administrator in reply to Amyjay74]

Doctors have been told not to diagnose a patient with hypothyroidism until the TSH reaches 10. I think more emphasis should be put upon the clinical symptoms the person may have developed.

Was your blood draw at the very earliest, and fasting (you can drink water) and if you had already been diagnosed and taking thyroid hormones, you take them after the blood test - not before.

[Amyjay74 in reply to shaws]

Blood tests were done in the eve, no fasting...Thank you for your info..

On phone to Dr this morning x

[SlowDragon Administrator in reply to Amyjay74]

See guidelines I gave you

After 2 thyroid tests, 6 weeks apart

If both tests have TSH over 5 and high thyroid antibodies and symptoms you should be prescribed levothyroxine

[SlowDragon Administrator]

With TSH over 5 and high thyroid antibodies you should have bloods retested in 6 weeks (not 6 months)

Assuming second test shows TSH over 5 you should be prescribed levothyroxine

Standard starter dose of levothyroxine is 50mcg

Bloods should be retested 6-8 weeks after each dose increase (or brand change in levothyroxine)

It will take 6-12 months to slowly increase dose levothyroxine up until adequately treated

See flow chart on top of page 2 here

gp-update.co.uk/Latest-Upda...

Have you had coeliac blood test done yet

Coeliac should be tested for at diagnosis of autoimmune thyroid disease

Essential to regularly retest vitamin D, folate, ferritin and B12 too

When were these last tested

What vitamin supplements are you currently taking

[Amyjay74 in reply to SlowDragon]

I haven't had them tested for yrs, just started taking vit d...Have not been tested for coeliac..Should my Dr test that or is it private testing?

[SlowDragon Administrator in reply to Amyjay74]

Assuming you aren’t already on strictly gluten free diet?

Yes high thyroid antibodies confirms autoimmune thyroid disease

nice.org.uk/guidance/ng20/c...

1.1.1 Offer serological testing for coeliac disease to:

people with any of the following:

persistent unexplained abdominal or gastrointestinal symptoms

faltering growth

prolonged fatigue

unexpected weight loss

severe or persistent mouth ulcers

unexplained iron, vitamin B12 or folate deficiency

type 1 diabetes, at diagnosis

autoimmune thyroid disease, at diagnosis

irritable bowel syndrome (in adults)

first‑degree relatives of people with coeliac disease.

[SlowDragon Administrator in reply to Amyjay74]

Make new appointment

Request testing for coeliac

Plus testing of Vitamin D, folate, ferritin and B12 levels

Come back with new post once you get results

[SlowDragon Administrator]

pubmed.ncbi.nlm.nih.gov/286...

Vitamin D deficiency is frequent in Hashimoto's thyroiditis and treatment of patients with this condition with Vitamin D may slow down the course of development of hypothyroidism and also decrease cardiovascular risks in these patients. Vitamin D measurement and replacement may be critical in these patients.

pubmed.ncbi.nlm.nih.gov/273...

Vitamin D insufficiency was associated with AITD and HT, especially overt hypothyroidism. Low serum vitamin D levels were independently associated with high serum TSH levels.

pubmed.ncbi.nlm.nih.gov/300...

The thyroid hormone status would play a role in the maintenance of vitamin D sufficiency, and its immunomodulatory role would influence the presence of autoimmune thyroid disease. The positive correlation between free T4 and vitamin D concentrations suggests that adequate levothyroxine replacement in HT would be an essential factor in maintaining vitamin D at sufficient levels.

ncbi.nlm.nih.gov/pmc/articl...

Our results indicated that patients with hypothyroidism suffered from hypovitaminosis D with hypocalcaemia that is significantly associated with the degree and severity of the hypothyroidism. That encourages the advisability of vit D supplementation and recommends the screening for Vitamin D deficiency and serum calcium levels for all hypothyroid patients.

Same applies to low B12 - extremely common in hypothyroid patients

All patients who are hypothyroid should have B12 tested

ncbi.nlm.nih.gov/pubmed/186...

There is a high (approx 40%) prevalence of B12 deficiency in hypothyroid patients. Traditional symptoms are not a good guide to determining presence of B12 deficiency. Screening for vitamin B12 levels should be undertaken in all hypothyroid patients, irrespective of their thyroid antibody status. Replacement of B12 leads to improvement in symptoms,

ncbi.nlm.nih.gov/pubmed/169...

Patients with AITD have a high prevalence of B12 deficiency and particularly of pernicious anemia. The evaluation of B12 deficiency can be simplified by measuring fasting serum gastrin and, if elevated, referring the patient for gastroscopy.

Folate supplements can help lower homocysteine

ncbi.nlm.nih.gov/pmc/articl...

Levothyroxine can decrease serum homocysteine level partly; still its combination with folic acid empowers the effect. Combination therapy declines serum homocysteine level more successfully.

Low ferritin frequent in hypothyroidism

endocrineweb.com/profession...