Need advice on thyroid issues

[ChoH]

Hello everyone, need some help on my thyroid condition. I was diagnosed with Hashimoto’s thyroiditis in 2019, because of thyroid antibodies being high and with hypothyroidism based on my TSH and T3 and T4 levels. I’ve been taking medication since then, things have been up and down since then.

However last year august I did bloods and my TSH, T3 and T4 seemed stable. I did bloods again this year March and it was found :

TSH : 5.03 mIU/L (0.27 - 4.20)

T4 : 15.4 pmol/ml (12.0 - 22.0)

T3: 2.6 pmol/L (3.1 - 6.8)

Ferritin: 164ug/L (13 - 150)

Total cholesterol- 4.83 mmol/L (<5mmol/L)

All my other blood results were within range. But because of my high TSH and low T3 the dr switched me to alternate between Euthyrox 50mcg and 100mcg on alternate days. Previously I was taking Euthyrox 50mcg daily.

I repeated bloods in June and these are my results :

TSH: 0.01 mIU/L (0.27 - 4.20)

T4: 23.7 pmol/L (12.0 - 22.0)

T3: 4.2 pmol/L (3.1 - 6.8)

Total cholesterol: 5.28 mmol/L (<5)

Triglycerides: 0.87 mmol/L (<1.7)

LDL: 2.65 mmol/L (<3)

HB1AC : 6.0%

Fasting glucose :4.4

MCHC : 31.3 g/dL (32.7 - 34.9)

MPV : 11.8 fL (7.3 - 11.3)

Basophils : 1.30 % (0.06 - 0.10)

Basically dr informed that my TSH levels are gone too low and is now advising me to switch back to Euthyrox 50mcg daily and then repeat bloods in 6 weeks time.

I am feeling very worried with my thyroid issue because now I’ve gone into a hyperthyroid state based on my bloods. I am also concerned about my total cholesterol and HB1AC. Also not sure what to make of my basophil count going high. All other blood results were within normal range such as iron, folic acid, vitamin b and vitamin d. Liver function tests were all normal.

Currently my symptoms are feeling cold, hair fall and loss, brittle nails, irregular menstrual cycle.

I haven’t gained or lost any weight, and I’ve always been a thin person, and I am vegetarian and generally eat quite healthy. I exercise regularly. However I do have gut issues, have a very sensitive stomach to spicy food, I don’t drink milk at all. I don’t eat much gluten besides for bread like once a week.

Current medications I take are:

Euthyrox 50mcg daily

Probiotic

Multivitamin

Mercilon (contraceptive pill)

I would like some advice on the way forward. Not sure which is the best way forward for me to stabilize my thyroid hormone levels. Also feeling worried about my total cholesterol and HB1AC. Also not sure what to make of my basophil count being high and the MCHC and MPV.

Please advise, thank you 🙏

[tattybogle]

50mcg was clearly not enough last time ~ your TSH (Thyroid Stimulating hormone) had risen to 5 to ask for 'more thyroid hormone please' and fT3 was dreadfully low .

And then 75mcg mcg was possibly a little bit too much , because it made the fT4 go slightly over range .

( this don't make you 'Hyperthyroid' in the true sense ... it just means the amount of T4 in 75mcg Levo was perhaps a bit too much ) BUT your fT3 was much better on 75mcg, and if you didn't have any symptoms overmedication, then it might have been perfectly ok for you to carry on on 75mcg . ( in an ideal world they would just give you a bit less T4 and a bit more T3 too balance your levels , but getting a prescription for T3 is extremely difficult)

Logically ,reducing it back to 50mcg is a bit daft.... 50mcg wasn't enough before ,so it probably won't be enough now , and your fT4 was only very slightly over range on 75mcg anyway .... if you do choose to reduce , it would be a much better idea to try a dose in between the two.

eg 62.5mcg...... (50mcg one day/ 75mcg the next) .... or (50mcg + half a 25mcg tablet every day)

[greygoose in reply to tattybogle]

But the OP has Hashi's, so that 'hyper' swing probably had nothing to do with the increase in dose. Doubtful that an increase of 25 mcg is going to have that much effect on the FT4. We should never forget the workings of good old Hashi!

[tattybogle in reply to greygoose]

yes , i agree that the rise in fT4 and fall in TSH is more than you would expect from such a small increase from 50 to 75mcg. So hashi 's influence here is very likely as well as the increase in T4 dose .... i was just dealing with one observation at a time in my reply as brain is stuck in 'go slow' mode this morning. lol .

[ChoH in reply to tattybogle]

Thank you so much for your advice 🙏

[greygoose]

Hi ChoH, welcome to the forum.

As I see it, you have three main problems - apart from the Hashi's, but there's not much you can do about that:

1) you're a very poor converter, FT3 is therefore low, and cholesterol is therefore high.

2) you're taking a multivit, which is really, really not recommended! Multi's do not contain enough of any thing to combat deficiencies, too much of other things, and things that shouldn't be there at all! I could go on, but you get the picture. Drop the multi and get your vit D, vit B12, folate and ferritin tested, and just take what you need. (Do you take your contrceptive pill four hours away from thyroid hormone?)

3) you have an ignorant doctor who doses by the TSH! The TSH is the least important of the three numbers. FT3 is the most important one. But I doubt he knows what T3 is, and he certainly doesn't understand Hashi's with its ups and downs. The important thing is: do you understand Hashi's with its ups and downs?

[ChoH in reply to greygoose]

Thank you for your reply.

1) What would you suggest I do to get my FT3 within the correct range? So that I can also improve my cholesterol.

2)I was taking the multivitamin to try help with my hair fall, my dr recommended I take a multivitamin as I am vegetarian and because of my hair fall and brittle nails. My vitamin B12, vitamin D, ferritin and folate are all within range now. Previously I was deficient in Vitamin D, so was taking calciferol but then my vitamin D got too high so stopped that.

I take my thyroid medication first thing in the morning around 7am and I take my contraceptive pill at night around 10pm.

3) I also feel my dr changes my doses based on the TSH level. He hasn’t given me any advice regarding my Hashimotos condition, he just focuses on me being hypothyroid and dealing with that.

I have been trying to do my own research on Hashimotos and medication dosing etc to try get a better understanding of my condition. The funny thing is with all these changes in my bloods I haven’t felt any different besides for the hair fall, brittle nails, feeling cold, menstrual issues and stomach issues which has been the same throughout. I take the probiotic to help with my stomach issues.

My menstrual cycle has improved slightly after I went to the gynae who switched me from Minesse to Mercilon, which has a higher dose of progesterone/oestrogen.

Not sure what to do about my hair fall and brittle nails ?

With regards to my cholesterol going high, I haven’t felt any different. And I haven’t been eating unhealthy.

[greygoose in reply to ChoH]

1) What would you suggest I do to get my FT3 within the correct range? So that I can also improve my cholesterol.

There's not a lot you can do. Hashi's people are usually poor converters. All you can do is add T3 to your levo. Which is not easy to do. Your GP cannot prescribe it, you would have to see an endo. Or, by your own on-line, and self-treat with it, which I know many people are reluctant to do.

2) Doctors know zilch about nutrients. They do not learn about them in med school. He would not understand why a multi-vit is absolutely the wrong thing to take. Has it helped with your hair-fall?

The main too reasons for hair-loss is being hypo - which you are - and having low iron, which you probably have. But other low nutrients can also cause it. Nutrients just being within the range is not the same as optimal. To be optimal, vit B12 needs to be over 550, vit D and ferritin around 100, and folate at least half-way through the range. But nutrients should be taken individually, not bunched together in one pill, because some of them cancel the others out. There are also co-factors to take into consideration, and the quality and form of the nutrients. Mult-vits tend to use the cheapest, least available forms.

3) I don't suppose your doctor knows anything about Hashi's, very few of them do. It's normal that he's concentrating on your hypothyroidism, but he ought to at least know that you can swing from hypo to hyper and back again without it having anything to do with your dose.

Also, he will never get you well by dosing by the TSH. But there is nothing he - or anybody else - can do about the Hashi's itself. That will just take its course until your thyroid is completely destroyed. Hashi's is for life.

Taking a probiotic is good, but a lot of your stomach issues could be caused by low stomach acid - which most hypos suffer from.

What you need to do about your hair and nails is optimise your thyroid levels and nutrient levels, which of course is an on-going struggle until the thyroid is destroyed and you no-longer have these hyper/hypo swings.

Cholesterol doesn't have any effect on how you feel, whether it's high or low. And, it has nothing to do with your diet. It is a symptom, not a disease, and is absolutely nothing to worry about.