Hi I’ve recently had a medichecks advanced thyroid test and just had the results which I wonder if you could give some advice on
My last blood tests (nhs) showed TSH 7.42 in September so GP increased my dose from 50 to 75, retested in December and it had come down to 0.14 (0.38-5.33) which the go said was too low so put me back to 50 mcg daily. I also felt very jittery and couldn’t relax when on 75 so I guess it was too high a dose. Fast forward to this weeks results
CRP 8.49 (0-5)
Ferritin 55.3 (13-150)
B12 83.5 (37.5-150)
Vit D 84 (50-200)
TSH 11.3 (0.27-4.2)
T3 3.87 (3.1-6.)
Free T4 12.2 (12-22)
Thyroid peroxidase antibodies 236 (<34)
Thyroglobulin antibodies 1632 (<115)
I don’t understand how my TSH can have shot up so much, that’s the highest it has ever been even before I was on thyroxine it wasn’t that high. I started on hrt patches in December, could that have made a difference to thyroid function?I’ve got an nhs blood test next week and obviously will discuss with gp after that, but any input on these results will be welcome. I feel grim to be honest, so tired I could cry some days and terrible achey bones that im constantly taking painkillers for.
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Happygirly
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So ... if you felt jittery on 75mcg but 50mcg is clearly not enough (according to your TSH)
Then the next logical step is to try 62.5 mcg, which can be achieved by taking 50 one day and 75 the next (or by splitting a 25mcg tablet in half each day of you prefer)
GP will hopefully suggest you try that for 6/8 weeks / then retest .. and then decide whether to try 75mcg again if TSH is still high.
It may well be that even though 75mcg felt too much before, your needs have now changed and you might need it now .. but trying 62.5mcg first seems sensible.
I know that taking oral HRT can definitely mean people needed to take a higher dose of thyroid hormone to get the same results they did before , but patches ? i'm not so sure if they have the same effect.
But basically if you change your estrogen level it does have impacts on how your thyroid hormone is transported.. increase estrogen means more of the T4 is 'bound'.. and less of it is 'free'... so higher doses of levo can be needed.
Thank you, that’s so helpful. Do you know anything about the other results as I’ve only ever had TSH discussed before and possibly the antibody one which I think was about 150 a couple of years ago so obviously has changed quite a bit!
Antibodies fluctuate. Testing antibodies is only really useful to diagnose autoimmune thyroiditis aka hashimotos thereafter there is no need to test.Antibodies are there to clean up the mess left when your autoimmune system has attacked your thyroid.
Thank k you I’m on North Star I think and haven’t had any problems with it. I was tested for coeliacs and it came back fine so hopefully that’s not something I need to worry about.
So if you had 25mcg Northstar that’s frequently the cause of issues
Northstar 50mcg and 100mcg are Accord brand
Accord only make 50mcg and 100mcg tablets
Accord is also boxed as Northstar 50mcg and 100mcg via Lloyds ....and as Almus via Boots
but Accord doesn’t make 25mcg tablets
beware 25mcg Northstar is Teva
So if on Accord request 50mcg tablets and cut in half to get 25mcg
(Or cut into 1/4’s to get 12.5mcg )
Many people find Levothyroxine brands are not interchangeable.
Many patients do NOT get on well with Teva brand of Levothyroxine.
Teva contains mannitol as a filler, which seems to be possible cause of problems. Teva is the only brand that makes 75mcg tablet. So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half
But for some people (usually if lactose intolerant, Teva is by far the best option)
Teva, or Aristo (100mcg only) are the only lactose free tablets
Most easily available (and often most easily tolerated) are Mercury Pharma or Accord
Mercury Pharma make 25mcg, 50mcg and 100mcg tablets
If a patient reports persistent symptoms when switching between different levothyroxine tablet formulations, consider consistently prescribing a specific product known to be well tolerated by the patient. If symptoms or poor control of thyroid function persist (despite adhering to a specific product), consider prescribing levothyroxine in an oral solution formulation.
Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).
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
As coeliac 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.
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
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
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.
Looking back at previous posts - are you aware that you have Hashimoto's auto immune thyroid disease and have you put any measures in place to try and off set potential causes?
I read of many people learning from the research of Dr Izabella Wentz regarding food intolerances and first lookin to check for absorption issues and repairing the gut.
With Hashimoto's you will experience erratic thyroid hormone production, and swings of hyper type symptoms but when this attack is over and the swing swings back, your thyroid gland will be further damaged and you will likely need an increase in your thyroid hormone replacement.
As this disease progresses your thyroid will become less and less productive and you will become increasingly reliant on more support from thyroid hormone replacement medication.
No thyroid hormone replacement works well until your vitamins and minerals are up, and maintained at optimal levels, and other factors that can effect T4 working well are inflammation, any physiological stress ( emotional or physical ) depression, dieting and ageing.
Your inflammation is high and over range showing your body under stress :
Your ferritin needs to be at least over 70 - and probably more like 100 :
I aim for a an active B12 at 75 ++ and a vitamin D at around 100 :
I can't see a result/range for folate ?
Obviously your TSH is much too high and your T3 and T4 much too low :
I read that some people, sensing a " swing " coming on - drop their T4 dose a little to try and offset the severity of the symptoms experienced - and then after the attack return to the original dose of T4 and likely need a little more T4 to rebalance and compensate for the further damage their thyroid gland has suffered.
Ultimately you will likely need to be taking full spectrum thyroid hormone replacement as your gland become fully disabled.
Thank you. I’m vegetarian and eat what I think is a fairly good diet but will look into cutting out gluten. I take prescription b12 1000 mcg a day so I’d have thought my b12 would have been higher. I’m desperately trying to lose some weight before summer and have been running 3 times a week with zero weight loss. I’m fairly stressed as I’m a single parent (widow) with a teenager a dog and a full time job! Interesting about sensing a swing coming on, I just know I’m knackered at the moment but when I was in the 75 mcg thyroxine I felt the opposite, like I was wired all the time which was horrible.
Well there is a middle ground if you halve a 25mcg as you'll get around 62 mcg then - and T4 is inert anyway so the odd mcg here and there will not make any difference.
It reads as though you are pushing yourself too much, dieting and exercise do not work well until your core strength is strong and you are optimally medicated.
Your T4 needs to convert into T3 which is the active hormone that runs the body.
Currently your T4 is barely in the range at not even at 10% and your T3 is being protected at just 20% ( starvation mode ) through it's range and it looks like you are running on empty and you can't sustain this.
Dieting and exercising are currently having a negetive effect of your health and well being and both will work better when your core strength is strong and you are on optimum thyroid hormone replacement.
We generally feel at our best when out T4 is in the top quadrant of its range as that should in theory convert to a good level of T3 at around a 1/4 ratio T3/T4 :
Thank you for your reply. When you day core strength do you mean core as in when you do sit ups etc? I’m so desperate to lose some weight and feelLike myself again, and I do feel better if I’ve done some exercise although I see what you’re saying about running on empty. I’ve just done the couch to 5 k and it’s the last session of the program tomorrow so maybe I’ll scale it back after that and try something gentler like yoga or swimming.
I mean your core strength vitamins and minerals as detailed above and you should not consider any strenuous exercise until your are optimally medicated and you are currently very undermedicated.
Your TSH needs to be down under 2 and more likely 1 :
This will happen as you slowly increase your T4 medication :
We generally feel at our best when both our T3 and T4 are in the top quadrants of their ranges and running at around a 1/4 - T3/T4 ratio.
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