Thyroid results

[cneal09]

Hi all I got my lab results back today from medichecks I fasted before and took at 8.30 am no meds taken I ade sure i had a full 24hrs without them I'm currently on 125mg levothyroxine attached are my results all in range tsh for me is high. I had full removal in 2014 due to graves disease. I was on ndt but due to lockdoqn and availability went back on levo. In the 2 years I've been on it I've put on 2st which no matter what I can't seem to shift , I ache so badly, always cold, hair loss , trouble with sleep and fatigue which I didn't think was possible at the same time. Im seeing my gp tomorrow, is there anything else I should be asking to be checked, i honestly thought my t3 would be low. Results are in photo attached. Thanks in advance.

Clare

[crimple]

cneal09 your TSH is far too high for someone on levothyroxine, it should be 1 or less. You are also a very poor converter of T4 to T3 with T4 high in range and T3 low in range. Have you ever been tested for antibodies? TPO which if they were raised would mean you have Hashimotos and would explain the poor conversion rate. Have you ever had your vitamin levels checked: Vit B12, folate, Vit D, ferritin. These will very likely be poor especially if you have Hashis. I have hashis and have been Gluten free for 20 years. A lot of people find gluten free diet makes a big difference. seaside susie on here is great with info on Vitamins.

[cneal09 in reply to crimple]

Thank you x

[cneal09 in reply to crimple]

Could I get hashimoto's even though I had graves?

[SlowDragon Administrator]

Well your Ft3 is very low

FT4: 20.5 pmol/l (Range 12 - 22)

Ft4 is 85.00% through range

FT3: 3.5 pmol/l (Range 3.1 - 6.8)

Ft3 extremely low at just 10.81% through range

Helpful calculator for working out percentage through range

thyroid.dopiaza.org

Like many after total thyroidectomy you have poor conversion of Ft4 to Ft3

Next step is to get vitamin D, folate, ferritin and B12 levels tested

What vitamin supplements are you currently taking

Before considering booking any consultation with thyroid specialist endocrinologist you need to get vitamins tested and supplement to optimal levels

Request GP test vitamins tomorrow

Likely low vitamin D and low ferritin

Come back with new post once you get vitamin results

Email Thyroid U.K. for list of recommended thyroid specialist endocrinologist and doctors who will prescribe T3

[e-mail]

[cneal09 in reply to SlowDragon]

Thank you so much this is so helpful x

[cneal09 in reply to SlowDragon]

These were my test results in November but I will ask again tomorrow x

Screen shot

[SlowDragon Administrator in reply to cneal09]

Optimal vitamin levels are

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

Ferritin at least half way through range - so your ferritin very low

You need full iron panel test for anaemia

Folate at least half way through range so Folate also too low

Serum B12 over 500

What vitamin supplements are you currently taking

[cneal09 in reply to SlowDragon]

I'm not taking anything although about 2 weeks before the test I had a b12 injection done privately as I was so exhausted. So that's probably a false read

[cneal09 in reply to SlowDragon]

Hi , I did have my bloods checked yesterday the Dr marked them as urgent , vit d got rejected though, from what I can tell all is withing normal range so must ne the low t3 making me feel so unwell, I've decided to go back on the ndt as I've now sourced it , thanks so much for your help below are my results

Screenshot

[SlowDragon Administrator in reply to cneal09]

Ferritin better at least over 70

Look at increasing iron rich foods in your diet

[cneal09 in reply to SlowDragon]

Thanks I will do x

[cneal09 in reply to SlowDragon]

Another one

Screenshot

[cneal09 in reply to SlowDragon]

Xx

Screenshot

[cneal09 in reply to SlowDragon]

New results

Screenshot

[SlowDragon Administrator in reply to cneal09]

B12 ….obviously higher than would be without injection

Likely to benefit from daily vitamin B complex

[cneal09 in reply to SlowDragon]

Thanks I'm going to get some x

[pennyannie]

Hello Cneal ;

The accepted conversion ratio when on T4 monotherapy is said to be 1 / 3.50 - 4.50 - T3/T4 with most people feeling at their best when their conversion comes in at 4 or under.

So to find your conversion ratio you simply divide your T3 into your T4 and I'm getting yours coming in at around 5.85 showing very poor conversion of T4 - Levothyroxine.

Conversion can be compromised by non optimal levels of ferritin, folate, B12 and vitamin D and to a lesser extent by inflammation, any physiological stress ( emotional or physical ) depression, dieting and ageing.

Since you have Graves and had a thyroidectomy you will also be missing the T3 that your thyroid supported you with along with this major gland regulating and adjusting your T3/T4 according to needs.

A fully functioning working thyroid would be supporting you daily with trace elements of T1. T2 and calcitonin plus a measure of T3 at around 10 mcg plus a measure of T4 at around 100mcg.

Some people can get by on T4 Levothyroxine only :

Some people find T4 seems to become less effective over time and need the addition of a little T3 to rebalance both these essential, vital, hormones.

Some people can't tolerate T4 and need to take T3 - Liothyronine only :

Others feel better restored on Natural Desiccated Thyroid which contains all the same known hormones as the human gland.

I'm sure you felt a lot better on NDT and there are still a few endocrinologists prescribing, though you'll more to be able to get T3 Liothyronine prescribed, depending where you live, as it is still much of a post code lottery.

Thyroid UK hold a list of recommended endocrinologists that might help you know who to be referred to as currently in primary care doctors can only prescribe T4- Levothyroxine.

If you go into openprescribing.net and then analyse you can see by CCG and surgery how active your area is in prescribing both NDT- ( enter Armour ) and T3 ( enter Liothyronine ) .

I was unable to secure either NDT or T3 through the NHS back in 2018 and resorted to self medicating ever since, with NDT and am much improved.

I'm with Graves but had RAI thyroid ablation in 2005 and managing lingering Graves, thyroid eye disease caused by the RAI and hypothyroidism.

[cneal09 in reply to pennyannie]

Thank you this is very helpful x

[PurpleNails Administrator]

Poor conversion isn’t unique to Hashimoto’s it can occur in those without it.

Poor conversion after treatment or surgery inducing hypothyroidism is very common. Perhaps because there is no thyroid left and also due to nutrients becoming trashed during treatment and the subsequent hypothyroidism.

Elevated TPO & TGab confirm autoimmune and are associated with Hashimoto’s but are also present with Graves, you can also have both.

TPOab (Thyroid Peroxidase antibodies) autoimmune - Hashimoto’s (& Graves)

TGab (Thyroglobulin antibodies) autoimmune- Hashimoto’s (& Graves)

If Graves suspected this should be confirmed will TSI Or TRab, (which should have been tested historically?)

Thyroid-Stimulating Immunoglobulin (TSI) Graves (and or TRab)

TSH receptor antibodies (TRAb) Graves

Antibodies can increase for a period after treatment / surgery but have likely declined in the years after treatment.

Antibodies can’t be treated and hypothyroidism is treated the same regardless of cause so although testing antibodies might be interesting to know it’s not going to help you move forward in your treatment.

Gluten intolerance is common with both graves & Hashimoto’s.

Was celiac test a blood test ever arranged? A blood test will rule out gluten allergy but not a intolerance.

Symptoms are not always obvious eg stomach trouble but can affect absorption of nutrients. You could trial strictly gluten free diet to see any improvement.

Ferritin & folate looks low. In range is acceptable to GP you need optimal.

[cneal09]

Thanks, yes I had graves so antibodies were constantly checked before the full removal, with gluten I'm not good with bread so I don't avoid it but limit it, I don't eat many cards but will try gluten free my mum is coeliac, i did get tested but came back clear but I do suspect I'm intolerant x thanks again for your reply

[PurpleNails Administrator in reply to cneal09]

With gluten it’s all or nothing. Even a reduced amount can cause issues - has to be strictly gluten free.

You will still need to find a sufficient source of carbs. Too low carbs will reduce conversion. Anything under 150g of carbs a day is considered low. Under 50g is drastically low (keto type diet)

I did 80g carbs on 1200 calorie for about 6 months to “reverse” type 2 diabetes. It did reduce HBA1c and I didn’t have to start medication. It did reduce thyroid levels but I’m hyper without carbimazole treatment so this was not detrimental. Wouldn’t want to do it long term or when hypothyroid.