Blood results and Hashimoto's

[vacher]

My latest results:

TPO came out at 253;

Serum TSH level 5.75;

Serum free T3 level 4.4;

Serum free T4 15.7

I would be glad of advice interpreting these results. I have been told I have Hashimoto's. I have all the symptoms: coldness, fatigue, constipation, brain fog, hair loss etc. I have also put on a lot of weight despite watching what I eat, exercising daily and having gluten free bread. I have had a scan and have several thyroid nodules and have been recommended to have a biposy. I have started taking Zn, Se and B vitamins. I was started on 25 mg of levothyroxine in March but took myself off them because of bad side effects: insomnia and very frequent urination. I cannot remember the brand I was given but perhaps another brand would suit. I have read that there have been a lot of bad side effects with the brand TEVA. Any suggestions for help would be welcome. Many thanks

[SeasideSusie Remembering]

Vacher

I would be glad of advice interpreting these results.

Members will be happy to do that but we need the reference ranges please, these vary from lab to lab so we need the ranges that came with your results.

I have been told I have Hashimoto's.

With TPO antibodies at 253 that is high, most ranges go up to 30 or 60 so yes, your result confirms Hashi's and that is the most common cause of hypothyroidism.

I have started taking Zn, Se and B vitamins

What vitamins have you tested and what doses of these are you taking?

Selenium is said to be safe at a dose of 100-200mcg daily without testing.

Zinc should be balanced with copper and we hypos tend to be high in one and low in the other so it's not a good idea to start supplementing zinc because you don't know if you are already high in that.

B vitamins are best tested - Folate and B12. If your levels are low it could be deficiency. Folate below 3ug/L or 7nmol/L is folate deficiency and GP should prescribe folic acid. B12 deficiency may be Pernicious Anaemia and this would need to be treated with B12 injections. So my suggestion is to stop the B vitamins and test the key nutrients:

Vit D

B12

folate

ferritin

I was started on 25 mg of levothyroxine in March but took myself off them because of bad side effects: insomnia and very frequent urination. I cannot remember the brand I was given but perhaps another brand would suit. I have read that there have been a lot of bad side effects with the brand TEVA.

Well, with Hashi's and symptoms of hypothyroidism you need the Levo so I would get your prescription reinstated - at 50mcg not 25mcg (that is a child's dose or for someone who is elderly or has a heart condition). Some people do have adverse reactions to Teva brand and Northstar 25mcg which is made by Teva (but not 50mcg and 100mcg as they're made by a different company for Northstar) so it might be best to avoid that.

You will need retesting 6 weeks after starting Levo. Always advised here, when having thyroid tests:

* Blood draw no later than 9am. This is because TSH is highest early morning and lowers throughout the day. If looking for a diagnosis of hypothyroidism, an increase in dose of Levo or to avoid a reduction then we need the highest possible TSH

* Nothing to eat or drink except water before the blood draw. This is because eating can lower TSH and coffee can affect TSH.

* If taking thyroid hormone replacement, last dose of Levo should be 24 hours before blood draw, if taking NDT or T3 then last dose should be 8-12 hours before blood draw. Adjust timing the day before if necessary. This avoids measuring hormone levels at their peak after ingestion of hormone replacement. Take your thyroid meds after the blood draw. Taking your dose too close to the blood draw will give false high results, leaving any longer gap will give false low results.

* If you take Biotin or a B Complex containing Biotin (B7), leave this off for 7 days before any blood test. This is because if Biotin is used in the testing procedure it can give false results (most labs use biotin).

These are patient to patient tips which we don't discuss with phlebotomists or doctors.

[vacher in reply to SeasideSusie]

Many thanks for this information. The results with ranges are:

TPO 253 iu/ml, range 0.00 - 33.90 iu/ml

Serum TSH level 5.75 mu/l, range 0.30 - 5.50 mu/l

Serum free T3 level 4.4 pmo;/l, range 3.10 -7.00 pmol/l

Serum free T4 level 15.7 pmol/l, range 11.50 - 22.70 pmol/l

[SeasideSusie Remembering in reply to vacher]

vacher

Was this the result that gave you the diagnosis (ie before you started Levo) or when you were on Levo?

[vacher in reply to SeasideSusie]

I forgot to say I am 65 years old.

[SeasideSusie Remembering in reply to vacher]

OK, that explains why they started you on 25mcg Levo.

Can you say if those results were before starting Levo or after you'd been on Levo for a few weeks.

[SlowDragon Administrator in reply to vacher]

So if 65years old then standard starter dose levothyroxine is 25mcg

HOWEVER dose levothyroxine should still be increased up slowly over several months

Likely to need to eventually be on something around 100mcg after 6-12 months

It’s common to feel worse initially when starting on levothyroxine

Taking levothyroxine at bedtime might be better

Always take levothyroxine on empty stomach and then nothing apart from water for at least an hour after

Bloods should be retested 6-8 weeks after each dose increase

[vacher in reply to SlowDragon]

Many thanks for this information

[vacher]

The result was before I started Levo

[SeasideSusie Remembering in reply to vacher]

TPO came out at 253 (0.00 - 33.90)

Serum TSH level 5.75 (0.30 - 5.50)

Serum free T3 level 4.4 (3.10 -7.00)

Serum free T4 15.7 (11.50 - 22.70)

The result was before I started Levo

OK, thanks.

Primary hypothyroidism that is not autoimmune (not Hashi's) would generally require TSH to go over 10 before diagnosis.

Guidelines suggest that when TSH is over range with elevated thyroid antibodies then diagnosis of autoimmune thyroid disease is made and treatment started. You fit the criteria for over range TSH with elevated antibodies.

Your FT4 is 37.5% through range and your FT3 is 33.3% through range. These are low in range and should rise as your Levo increases and starts to take effect.

The aim of a hypo patient on Levo only, generally, is for TSH to be 1 or below with FT4 and FT3 in the upper part of their reference ranges, if that is where you feel well.

Calculator to work out percentage through range here:

thyroid.dopiaza.org/

[vacher in reply to SeasideSusie]

many thanks for this information

[eeng]

Frequent urination when taking Levothyroxine for the first time is possibly because hypothyroidism causes fluid retention in all the body tissues, and being medicated should help your body eliminate the fluid. It should settle down within a week or two, but might recur temporarily each time you increase your dose.