Is anyone able to help with my mum’s labs please

[musicaljune]

Hello all,

She has Hashimoto’s which is well managed on glandulars and she feels well. Her thyroid labs are a little on the low side this time because she reduced her dose significantly having felt over-medicated previously but has since increased it slightly and hopes her next labs are better.

Am I right in thinking that with these results it appears she’s converting ok? Given though, that these glandulars are alleged to contain two particular hormones- which shall remain unnamed - how can we ascertain conversion?

Oct 21 at 8.30am on an empty stomach, having taken last glandulars at around 10pm

TSH 0:03 (0.35 - 5.5)

Ft4 12.8 (10.5 - 21) 21.9%

Ft3 5.5 (3.5 - 6.5) 66.67%

Iron Studies

Ferritin 73 (10 - 291) 22.42%

Serum iron level 23.6 (10 - 30.4) 66.67%

Transferrin 2.84 (2.5 - 3.8) 26.15%

% iron sat 37% (16 - 50) is it correct to say that a percentage iron saturation of 37% is 61.76% through the range?

Since these results she’s been sporadically taking liquid iron to address low ferritin, fully aware that being too high is dangerous and without really understanding what the other iron study numbers mean. Can anyone help to interpret these please? To my untrained eye iron saturation and serum iron look reasonable but transferrin and ferritin look poor.

Nutrients

B12 661 (211 - 911) 64.29%

Folate 9.91 (>5.38)

Vit D wasn’t tested on this occasion as previously it was very high.

Thanks for reading. Any input would be welcome.

[Lalatoot]

June, as mum is taking glandular containing both hormones then you cannot look at conversion. You can only judge conversion when taking only T4.In those results your mum's FT4 is lower percentage wise than FT3. For some this is no problem. Other folks need FT4 higher so add levothyroxine to NDT or similar to achieve this thus avoiding adding more T3 directly. This might improve levels without feeling overmedicated.

Be aware though that the symptoms of overmedication and under medication are similar. I cannot tell which I am without blood results.

[musicaljune in reply to Lalatoot]

Thank you for clarifying that point. Strange that with this disease it’s difficult to work out whether a person is over or under medicated. Must make tweaking things that bit trickier.

My mum has both lio and levo at the ready for future changes and has considered adding either one or the other to try to move some stubborn weight gain. As explained to radd below she’s not sure what to do. We’ve read extensively on here but it’s not clear to us what the best course of action is and because she’s feeling well she’s a bit nervous about upsetting that balance, namely sleeping. Sleep has been a terrible problem for her for many years and even with the recent improvements in it she still has huge difficulty and my poor dad has to live with her horrible moodiness and irritability. Suggestions for whether to add lio or levo for weight loss and improving her sleep would be amazing. Weight loss in turn might improve her liver function, her enzymes are raised and NAFLD has been mooted but scans show nothing. Her belly and breasts are carrying a lot of fat at the moment and a reduction in circumference might just help her liver function better! It would also be a huge boost to her confidence because she’s very self-conscious about it.

Her GP suggested adding levo but mum is wary and trusts the opinions on here far more than she would of her doctor!

[Lalatoot in reply to musicaljune]

June, It took me 2 years of slowly and gradually changing levo and lio doses one thing at a time to get to doses where I felt symptom free enough to stop.If those were my results and if I was also scared of upsetting my body too much, I would start by increasing levo by 12.5mcg daily. Increasing levo will also slightly increase ft3 as well as increasing ft4. From my personal perspective your mum's ft4 would be too low and her ft3 level is fine. So I would want to increase ft4 without changing ft3 that much which is why I would increase levo very gradually and see how things are.

This is just a suggestion based on my personal experience.

[musicaljune in reply to Lalatoot]

Yes, thank you and I fully understand that you speak from a personal perspective only and not advising her what to do. It’s nevertheless extremely useful to hear yours and others experiences.

In your opinion then, would there be any reason she shouldn’t start on an even lower dose of levo? And again, I appreciate that your response is just an opinion and not advice.

[Lalatoot in reply to musicaljune]

No reason - she could take 12.5mcg every 2nd day making 6.25mcg per day.

[musicaljune in reply to Lalatoot]

Thank you. So then, I presume there’s no reason she can’t go as low as she likes, 6.25mcg on alternate days for instance, or would that be too little to make a difference?

[Lalatoot in reply to musicaljune]

That might be too low to make a difference.

[musicaljune in reply to Lalatoot]

Ok, thank you. She’s due a blood test shortly so will leave any adjustments until she knows lab results.

Your input has been helpful.

[SeasideSusie Remembering]

musicaljune

I reiterate what Lalatoot says about conversion, you can only see how well you convert when taking T4 only.

Iron Studies

Ferritin 73 (10 - 291) 22.42%

Serum iron level 23.6 (10 - 30.4) 66.67%

Transferrin 2.84 (2.5 - 3.8) 26.15%

% iron sat 37% (16 - 50) is it correct to say that a percentage iron saturation of 37% is 61.76% through the range?

Optimal iron panel levels according to rt3-adrenals.org/Iron_test_... are:

Serum iron: 55 to 70% of the range, higher end for men - your mum's is 66.67% so that's very good.

Saturation: optimal is 35 to 45%, higher end for men - your mum's is 37% so is good. We don't work out percentage through range, the measurement is in percentage and the article gives the optimal percentage to aim for.

Total Iron Binding Capacity (TIBC) or Transferrin: Low in range indicates lack of capacity for additional iron, High in range indicates body's need for supplemental iron - your mum's is low in range so that's good.

Ferritin: Low level virtually always indicates need for iron supplementation. Ranges vary quite a bit for ferritin, there are ranges for pre menopausal females, post menopausal females and another range for males (goes higher than the female ranges). My GP surgery tends to have the same range for everyone, and when I do a private test I think they use the pre menopausal range even though my date of birth si given and shows I'm obviously very post menopause! However, even though we generally say that the recommended level for ferritin is half way through range, it's not always appropriate. Some experts say that the optimal level for thyroid function is 90-110ug/L.

Your mum's level is not dire by any means and the rest of her iron panel rule out iron deficiency, her levels are good. If she wants to improve her ferritin level then try doing it with diet, eg eating liver regularly, maximum 200g per week due to it's high Vit A content, also liver pate, black pudding, and including lots of iron rich foods in your diet

bda.uk.com/resource/iron-ri...

everydayhealth.com/pictures...

[Noelnoel in reply to SeasideSusie]

Thank you SeasideSusie for your comprehensive and easy to understand reply. Thank you also for the links and sensible advice regarding raising her ferritin levels.

[musicaljune in reply to SeasideSusie]

Seasidesusie thank you for your comments and interesting links. Would it be right to say that she doesn’t necessarily have to try to raise her ferritin?

[SeasideSusie Remembering in reply to musicaljune]

Musicaljune

"Some experts say that the optimal level for thyroid function is 90-110ug/L."

That is where, ideally, I would like mine.

Her other iron panel results are good, she doesn't have iron deficiency and her Ferritin level isn't dire but might be better nearer the 90-110ug level. Considering that liver is a superfood containing B2, B9 (Folate), B12, Vit A, iron, copper, is low in fat and high in protein, then it's worth considering eating regularly as it may hopefully boost her Ferritin level.

[musicaljune in reply to SeasideSusie]

Thank you for your suggestions. Liver is an amazing food, what a shame it went out of fashion.

[radd in reply to musicaljune]

musicaljune,

'Would it be right to say that she doesn’t necessarily have to try to raise her ferritin?'

No, your Mum needs to continue trying to raise her ferritin levels as this is her spare supply of iron, as should she be ill and not consume her regular iron supply, her serum iron levels would quickly deplete.

Ferritin also withholds iron in the presence of infection to deprive bacterial growth, a sort of defence mechanism that helps protect immune cell function.

SeasideSusie has offered good advice re dietary sources to encourage higher levels of ferritin.

[radd]

musicaljune,

Your Mums TFT’s are classic of someone taking glandulars, ie lowish FT4 and higher FT3 levels. Many people find thyroid glandulars good and given their easy availability and cost it makes sense to take them but for others they don’t work no matter what labs say.

Therefore, your Mum needs to be mindful of feeling over/under medicated and possible hypo symptoms reappearing, as may need to add some Levo if she can't obtain enough from the galndulars. Are thyroid antibodies managed, ie gluten free diet, maybe supplementing selenium, etc?

Vit B12, folate and iron levels are all good.

‘% iron sat 37% (16 - 50) is it correct to say that a percentage iron saturation of 37% is 61.76% through the range?’ No, you are not aiming for optimal here because it refers to the transferrin saturation indicating the amount the body is iron saturated. Good results vary between 25% -45% so your Mums at 37% is ideal.

Ferritin is lowish so maybe try raising with iron rich meals. I wouldn’t suggest supplementing iron because your Mum is not iron deficient (ferritin is a storage protein for iron and not iron itself).

[musicaljune in reply to radd]

So sorry radd, I worded a lengthy reply a couple of hours ago and as someone else has mentioned about theirs mine has also disappeared

[musicaljune in reply to radd]

Hello radd,

Thanks for your reply. Interesting that you say her levels are classic for someone on glandulars but can you clarify:

Many people find thyroid glandulars good and given their easy availability and cost it makes sense to take them but for others they don’t work no matter what labs say.

Do you mean that for some who take glandulars, even when their results show good levels of hormone and in theory should feel well, that those particular individuals don’t feel well and are still hypothyroid? Meaning that the circulating hormone, for whatever reason, isn’t working?

Yes, she recently re-started gf and obtains selenium from Central America brazils as per suggestions on here.

[radd in reply to musicaljune]

musicaljune,

'Do you mean that for some who take glandulars, even when their results show good levels of hormone and in theory should feel well, that those particular individuals don’t feel well and are still hypothyroid? Meaning that the circulating hormone, for whatever reason, isn’t working?'

Yes exactly that. My own experience of glandulars wasn't good and so I pick up on other members who have shared my same experience. However, I must stress for others their experience has been positive.

[musicaljune in reply to radd]

Radd

However, I must stress for others their experience has been positive.

Yes, my mum being one of those. However, the weight she gained won’t budge. Any suggestions apart from eating less and exercising a bit more? Both of which she does. She’s also adapted her diet to exclude bad carbs in the form of bread and pasta, including gluten-free, mostly on the basis that they’re disgusting! She’s thought of adding a smidgeon of lio/levo but hasn’t yet because she’s unsure which way to go. We think that adding levo will raise her Ft4 and if she converts well it may also raise her Ft3 and that adding lio will raise her ft3 but then Ft4 may go into decline. Have we got that right? The aim is to lose the excess weight without affecting equilibrium as she feels well apart from terrible sleep problems.

Do you mean that for some who take glandulars, even when their results show good levels of hormone and in theory should feel well, that those particular individuals don’t feel well and are still hypothyroid? Meaning that the circulating hormone, for whatever reason, isn’t working?

Yes exactly that.

Fascinating and curious, though I suppose the same applies to lab made hormones, in that even though the circulating hormone numbers are good the patient is still hypo and feels unwell. It’ll be interesting to see what my mum’s next results show since raising her dose.

[radd in reply to musicaljune]

musicaljane,

Body weight is influenced not only by the amount of calories we eat and the energy we expend but also thyroid & other hormone levels, proteins and neurotransmitters.

Don’t cut out all carbs or it can encourage leptin resistance and actually cause the body to slow further to burn fewer calories (deplete muscle tissue) and possibly gain weight. Also messes up thyroid hormones by turning more T4 to RT3.

If your Mum has enough thyroid hormone that is working effectively and eats a sensible diet, then for weight gain look towards stressed adrenals. Stress can be mental or physical, ie unbalanced thyroid/adrenal hormones. A great read is an old book by Marilyn Grenville that explains the effects of stress called ‘Fat Around The Middle”..

She might also have a little unknown insulin resistance. The liver mediates between the pancreas (insulin), adrenal glands (cortisol) and thyroid glands which signal to the liver to release glucose. However, if the adrenals and/or thyroid hormones aren't working properly, are out of synch or else the liver is sluggish/toxic (due to low thyroid hormones?) the result can be elevated excess insulin.

T3 takes many different paths, ie not all will be transported & metabolised within the cells because of the many metabolic losses that increase if essential cofactors aren't met, such as enough iron, cortisol, balanced blood sugars as well as adequate supplies of all the usual nutrients. This is when we can have great thyroid hormone labs but still be experiencing classic hypo symptoms such as weight gain.

[musicaljune in reply to radd]

No, quite right. She eats plenty of veggie carbs and loves a roast potato!

If your Mum has enough thyroid hormone that is working effectively and eats a sensible diet…

That’s exactly her question. Does she have enough? Could it be that she needs just a bit more thyroid hormone and if so, which? Her Ft4 certainly looks as though a nudge north might be beneficial but not too much because if she converts well that could increase her ft3.

Her adrenals have been addressed having found out a few years ago that they need attention. An adrenal cortex glandular seems to have helped a great deal and we think is responsible or at least partially, for her sleeping better. However, we can’t be sure that’s the case because insomnia can be caused by so many different factors and sometimes multiple factors.

There is definitely something up with her liver, as LFTs confirm. The interaction that you mention between pancreas, liver and adrenals sounds complex, is there a test for elevated insulin? She tests her urine regularly for glucose and at least that seems normal but in this instance, is that test even relevant.

Marilyn Grenville’s book sounds like an interesting read, not just for my mum! Thank you you for the recommendation and all the other really interesting points you raise.

[radd in reply to musicaljune]

mj,

Balanced blood glucose levels are very relevant as signify balanced cortisol levels. Yes, insulin can be tested with a blood test but if your Mum is having good glucose readings there would be little point, and it’s great she has been able to support adrenals with ACE.

However, elevated liver enzymes are a classic sign of inadequate thyroid hormone (or adequate that are not working effectively) and so if she is feeling (or wondering if she could be) under-medicated then if those were my labs I would be adding a little thyroxine.

I love Marilynn Grenville 😁 but this link details another angle.

dtc.ucsf.edu/types-of-diabe...

[musicaljune in reply to radd]

It’s really mad. Neither her GP, thyroid endo or gastroenterologist have made the connection between thyroid and liver function. How scary is that!

Yes, Lalatoot has talked about adding thyroxine and it makes sense. She doesn’t feel under-medicated in health terms but she struggles terribly with sleeping properly (a symptom of under-medicated?) and of course that impacts her energy levels and state of mind and will be wreaking untold damage as it continues. She could increase her glandulars a tad to test before going down the thyroxine route because they must be working at some level, so maybe she’s just not taking quite enough but who knows, perhaps they aren’t working well enough. It’s such a balancing act trying not to miss that optimal level that some call the sweet spot.

Thank you for the link. I’ve read it twice and just can’t grasp it. Are you able to explain in really simple terms, what it’s saying, please? Absolutely no rush, I know how precious everyone’s time is so I don’t expect an immediate response.

[musicaljune in reply to radd]

Hi radd,

do you know of any other articles relating thyroid disease and liver problems please? Have looked and looked and can’t find anything specific. My mum will be seeing another gastro which I fear will be a waste of time if he doesn’t at least explore the possible connection between Hashimoto’s/hypothyroidism and her raised liver enzymes.

There may be no relationship at all but it should at least be ruled out I think.

Thank you for anything you can suggest reading.

[radd in reply to musicaljune]

musicaljune,

.

The interplay between thyroid and liver: implications for clinical practice

pubmed.ncbi.nlm.nih.gov/321...

.

Relationship between liver function tests and thyroid hormones in thyroid disorders

pubmed.ncbi.nlm.nih.gov/242...

.

Here is an easy explanation

boostthyroid.com/blog/fatty...

.

I'm not sure what you are hoping to achieve or why your Mum should be seeing 'another gastro' when you say she is well except for sleep problems/weight gain? Gut issues can be yet another hypo symptom and a gastro may not make the liver/thyroid connections, although a hematologist might.

If she feels hypo symptoms, you said she has some available levo/lio to add to her glandulars (weight gain & sleep issues are both hypo symptoms). As explained above not everyone can gain wholly well-being on glandulars alone in spite of good labs, and it is quite usual to mix & match meds. If I were her I would reduce the glandulars, add some Levo, retest in 6 weeks and see if symptoms have abated any.

[musicaljune in reply to radd]

Thank you radd, those posts have helped.

She was already in the system for a second appointment and decided she may as well make use of it but as it happens, well two things really; this morning she got her lab results and amazingly the enzymes have completely normalized. Very strange because they’ve been “deranged” for years but it’s a welcome surprise, if a bit mysterious so she really wants to discuss this with the gastro.

Secondly, the consultant’s secretary called to say her appointment had been cancelled due to an emergency. She’ll await a new appointment and will still attend because she so wants to discuss her results now.

About three weeks ago she started a liver supplement which came highly recommended and has had lots of apparent success but surely it can’t have worked so quickly if at all. I’m a bit sceptical but some of the reviewers were raving about it.

Seeing a haematologist would be extremely useful, so thanks for suggesting but again, why hasn’t her GP thought of that.

She doesn’t feel hypo even though clearly something is still wrong. She looks and feels well despite disrupted sleep and large abdo will continue as before until her next TFTs are available.

Thank you for your time.

[radd in reply to musicaljune]

musicaljane,

What's the liver supplement called?

[musicaljune in reply to radd]

Bioray

[musicaljune]

Bioray liver life

[radd in reply to musicaljune]

musicaljune, Looks great 😊

[musicaljune]

Well, if it’s responsible for the lowered liver enzymes it’s a miracle in a tiny bottle BUT humanbean has done some sums which, if correct it’s not good value. However, she’s not taking anywhere near the recommended dose. She started on 40 drops and got pains in the liver region that persisted until she reduced to 3 drops x once/day and she’s remained on that dose for 2.5 weeks.

[radd in reply to musicaljune]

musicaljune,

Yes, I agree it looks very expensive.