In August 2021 I went to my GP feeling under the weather, dizzy, shaky and faint when hungry. Blood tests showed;
TSH 6.48
T4 normal
I was diagnosed with borderline hypothyroidism and tried 2 weeks of 50mcg Levothyroxine but had palpitations, extreme anxiety, insomnia, sweating.
In Dec 2021 I paid to see a specialist
Results;
THS 3.33
T4 13.4
T3 5.14
Anti-thyroglobulin abs 263
Anti-thyroperoxidase abs 486
Anti-THS receptor antibodies -1.10
He said my thyroid function was normal but I had highly positive anti thyroid antibodies. He suggested blood test twice a year and Levothyroxine if my THS levels went up.
In July I felt under the weather again- weak, with tired puffy feeling around the eyes. Hungry and shaky 2 hours after food. A return of hot flushes despite 10 years since menopause.
My GP blood test came back as;
THS 9.5
T4 12.5
Given my bad reaction to Levothyroxine I have chosen to test again in 6 weeks. Are there any suggestions for diet that could help? I see an acupuncturist and am hoping I can feel better without taking thyroxine. My other bloods were fine including blood sugar.
I am 61 and new to this although thyroid issues run in my family with a Father who was over active and a nephew who is underactive. Any ideas are much appreciated.
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Because reference ranges vary from lab to lab, we always need the result plus the range when interpreting results. Maybe you could edit your post to add the ranges, they should be in brackets if you have a print out of your results, or if you have online access to your results they should be there. To edit your post click on MORE below your original post, click on EDIT, make changes then click on SUBMIT (I think).
Are there any suggestions for diet that could help? I see an acupuncturist and am hoping I can feel better without taking thyroxine.
It wont happen I'm afraid, see below.
Anti-thyroglobulin abs 263
Anti-thyroperoxidase abs 486
Even without ranges we know that these antibodies are high and confirm autoimmune thyroid disease, known to patients as Hashimoto's. Hashi's is where the immune system attacks and gradually destroys the thyroid so the only thing that can be done is to replace the thyroid hormone that your thyroid can't produce.
Fluctuations in symptoms and test results are common with Hashi's.
Most doctors dismiss antibodies as being of no importance and know little or nothing about Hashi's and how it affects the patient, test results and symptoms. You need to read, learn, understand and help yourself where Hashi's is concerned.
Some members have found that adopting a strict gluten free diet can help, although there is no guarantee.
Gluten contains gliadin (a protein) which is thought to trigger autoimmune attacks so eliminating gluten can help reduce these attacks.
You don't need to be gluten sensitive or have Coeliac disease for a gluten free diet to help.
Supplementing with selenium l-selenomethionine 200mcg daily is said to help reduce the antibodies, as can keeping TSH suppressed.
Did you have nutrients tested:
Vit D
B12
Folate
Ferritin
Hashi's can cause gut/absorption problems which can lead to low nutrient levels or deficiencies. It's important that these are tested and any low levels addressed. Optimal nutrient levels are needed for thyroid hormone to work properly. You are welcome to post results/ranges for your nutrients and members will make suggestions for supplementing if/where necessary.
tried 2 weeks of 50mcg Levothyroxine but had palpitations, extreme anxiety, insomnia, sweating.
First of all, over 60s should be started on 25mcg according to NICE guidelines, so maybe you were started on too high a dose. It might even be worth starting at 12.5mcg and increasing gradually.
Also, what brand of Levo were you given? Different brands have different fillers although the active ingredient is the same. Sometimes we can react to fillers in which case we should try another brand.
Also, for future reference, always advised here, when having thyroid tests:
* Book the first appointment of the morning, or with private tests at home no later than 9am. This is because TSH is highest early morning and lowers throughout the day.
In fact, 9am is the perfect time, see first graph here, it shows TSH is highest around midnight - 4am (when we can't get a blood draw), then lowers, next high is at 9am then lowers before it starts it's climb again about 9pm:
If we are looking for a diagnosis of hypothyroidism, or looking for an increase in dose or to avoid a reduction then we need TSH to be as high as possible.
* Nothing to eat or drink except water before the test - have your evening meal/supper as normal the night before but delay breakfast on the day of the test and drink water only until after the blood draw. Certain foods may lower TSH, caffeine containing drinks 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). See
biotin use can result in falsely high levels of T4 and T3 and falsely low levels of TSH
These are patient to patient tips which we don't discuss with phlebotomists or doctors.
Also, take your Levo on an empty stomach, one hour before or two hours after food, with a glass of water only, no tea, coffee, milk, etc, and water only for an hour either side, as absorption will be affected. Take any other medication and supplements 2 hours away from Levo, some need 4 hours.
I've never used Brazil nuts for selenium nor do I take a selenium supplement, sorry.
However, if you are thinking of trying Brazil nuts then the package needs to show that they are grown in selenium rich soil or they probably wont contain any. The amount of selenium depends on where they are grown - see
Members have kindly given me the following information about Brazil nuts containing a declared amount of selenium available from well known shops/supermarkets here in the UK so if thinking of using Brazil nuts you might want to check out the following (it is an old list so detailed information needs checking):
Sainsburys SO organic brazil nuts contain 50mcg selenium per 30g serving of nuts
One member has said that M&S Natural Brazil Nuts say "harvested by hand in the Amazon forest and naturally high in selenium". You would have to check the nutritional information on the pack to see if it says exactly how much selenium per xxg of Brazil nuts.
Also, check out Aldi's "The Foodie Market" Brazil nuts, the packaging is said to show selenium content as 79mcg per 30g serving.
Another one is 'My Garden of Eden' Brazil nuts from Home Bargains.. They say "High in Selenium and high in vitamin E" on the front of the packet and the Nutritional Information says "one serving (25g) gives 63ug of Selenium".
More recently I've been made aware of Morrisons Market St brand which states 254mcg per 100g or 101.6mg per recommended 40g portion.
Also Waitrose Duchy Organic Brazil Nuts which they claim contain a rather startling 479mcg selenium in a 25mcg serving although that does seem to be out of proportion when looking at the others and I wonder if it's a mistake and should be 47.9mcg selenium in a 25mcg serving:
My level seems to be naturally good enough from my diet. I've checked out this list of selenium rich foods and I actually include quite a lot of them in my diet (without realising they're selenium rich):
Thanks very much for the reply and advice. I have just tested negative for coeliacs. Here are more detailed results from the specialist in December 2021;
THS 3.33 uIU/mL (0.35 to 4.94)
FT4 13.4 pmol/L (9 to 22)
FT3 5.14 pmol/L (2.63 to 5.70)
Anti-thyroglobulin abs 263 UI/mL (0 to 100)
Anti-thyroperoxidase abs 486 IU/mL (0 to 50)
Anti-THS receptor antibodies <1.10 IU/L (0 to 1.75)
Lots of other tests were done but the specific ones you mentioned are as follows;
B12 335 pg/ml (187 to 883)
Iron 24.6 umol/L (8.0 to 25.0)
Total iron binding capacity 54.7 umol/L (45 to 70)
Raised Tg andTPO antibodies confirm Hashimoto's but diagnosis is generally only made when TSH goes over range and at the same time these antibodies are over range.
Anti-THS receptor antibodies <1.10 IU/L (0 to 1.75)
These antibodies are for Graves disease (overactive thyroid) and this is a negative result.
B12 335 pg/ml (187 to 883)
This is low. According to an extract from the book, "Could it be B12?" by Sally M. Pacholok:
"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".
"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."
Some people with B12 in the 300s have been found to need B12 injections.
Do you have any signs of B12 deficiency – check here:
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If you do then list them to discuss with your GP and ask for testing for B12 deficiency and Pernicious Anaemia. Do not take any B12 supplements or folic acid/folate/B Complex supplements before further testing of B12 as this will mask signs of B12 deficiency and skew results and if you have B12 deficiency is not detected and treated then this could affect your nervous system. B12 deficiency should be treated before starting folic acid because folic acid can sometimes improve your symptoms so much that is masks B12 deficiency.
If no symptoms then it would be a good idea to supplement with sublingual B12 methylcobalamin, along with a good bioavailable B Complex to keep all the B vitamins balanced. One bottle of B12 should be enough then continue with the B Complex for maintenance.
Iron 24.6 umol/L (8.0 to 25.0)
Serum iron optimal level is suggested as 55-70% of range (higher end for men) and yours is high at 97.65%. Have you been supplementing?
Total iron binding capacity 54.7 umol/L (45 to 70)
Low in range TIBC suggests no capacity for additional iron. This and your serum iron level suggest that you should not supplement iron.
25 Hydroxyvitamin D 67 nmol/L (75 to 150)
The Vit D Council, Vit D Society and Grassroots Health recommend a level of 100-150nmol/L, with a recent blog post on Grassroots Health mentioning a study which recommends over 125nmol/L.
You might want to check out a recent post that I wrote about Vit D and supplementing:
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and you can check out the link to how to work out the dose you need to increase your current level to the recommended level.
Your current level of 67nmol/L = 26.8ng/ml
On the Vit D Council's website you would scroll down to the 3rd table
My level is between 20-30 ng/ml
The Vit D Council, the Vit D Society and Grassroots Health all recommend a level of 100-150nmol/L (40-60ng/ml), with a recent blog post on Grassroots Health mentioning a study which recommends over 125nmol/L (50ng/ml).
So now you look at how much is needed to reach 50ng/ml and you'll see that they suggest 3,700iu per day, nearest is 4,000iu.
If you start to supplement then retest after 3 months to check your level.
Once you've reached the recommended level then a maintenance dose will be needed to keep it there, which may be 2000iu daily, maybe more or less, maybe less in summer than winter, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. This can be done with a private fingerprick blood spot test with an NHS lab which offers this test to the general public:
Doctors don't know, because they're not taught much about nutrients, but there are important cofactors needed when taking D3. You will have to buy these yourself.
D3 aids absorption of calcium from food and Vit K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems such as hardening of the arteries, kidney stones, etc. 90-100mcg K2-MK7 is enough for up to 10,000iu D3.
D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds if taking D3 as tablets/capsules/softgels, no necessity if using an oral spray.
For D3 I like Doctor's Best D3 softgels, they are an oil based very small softgel which contains just two ingredients - D3 and extra virgin olive oil, a good quality, nice clean supplement which is budget friendly. Some people like BetterYou oral spray but this contains a lot of excipients and works out more expensive.
For Vit K2-MK7 my suggestions are Vitabay, Vegavero or Vitamaze brands which all contain the correct form of K2-MK7 - the "All Trans" form rather than the "Cis" form. The All Trans form is the bioactive form, a bit like methylfolate is the bioactive form of folic acid.
Vitabay and Vegavero are either tablets or capsules.
Vitabay does do an oil based liquid.
Vitamaze is an oil based liquid.
With the oil based liquids the are xx amount of K2-MK7 per drop so you just take the appropriate amount of drops.
They are all imported German brands, you can find them on Amazon although they do go out of stock from time to time. I get what I can when I need to restock. If the tablet or capsule form is only in 200mcg dose at the time I take those on alternate days.
If looking for a combined D3/K2 supplement, this one has 3,000iu D3 and 50mcg K2-MK7. The K2-MK7 is the All-Trans form
Magnesium should be taken 4 hours away from thyroid meds and as it tends to be calming it's best taken in the evening. Vit D should also be taken 4 hours away from thyroid meds. Vit K2-MK7 should be taken 2 hours away from thyroid meds. Don't take D3 and K2 at the same time unless both are oil based supplements, they both are fat soluble vitamins which require their own fat to be absorbed otherwise they will compete for the fat.
Hi SeasideSusieThanks for all the info. I will talk to my doctor about vitamin B because I have some of the symptoms although my letter from the specialist says I do not have pernicious anemia.
I was confused about your reply about vitamin D.
Your current level of 52nmol/L = 26.8ng/ml
My level is 25 Hydroxyvitamin D 67 nmol/L (75 to 150)
My level is between 20-30 ng/ml
Does this mean you are also currently low?
I also have a question about the below
Raised Tg andTPO antibodies confirm Hashimoto's but diagnosis is generally only made when TSH goes over range and at the same time these antibodies are over range.
Is it possible to have raised Tg and TPO antibodies and not have Hashimotos?
My level is 25 Hydroxyvitamin D 67 nmol/L (75 to 150)
Yes, my apologies. I respond to so many posts about Vit D that I have notes and copy/paste then personalise them, I just forgot to substiute your 67 for the 52 which is in my notes in my reply to you; however, the 26.8ng/ml was correct (I did substitute this). This is what is should be and I will edit my reply above to avoid any confusion:
Your current level of 67nmol/L = 26.8ng/ml
So as the 26.8ng/ml is correct then everything else I wrote is correct, it was just that I omitted to substite your level and yes, your level is on the low side.
Is it possible to have raised Tg and TPO antibodies and not have Hashimotos?
Apparently TPO antibodies can be raised in Graves disease (overactive thyroid) but in your case your Graves antibodies are negative:
Anti-THS receptor antibodies <1.10 IU/L (0 to 1.75)
Having been tested for coeliac it’s ALWAYS worth trying strictly gluten free diet despite negative coeliac result
Hashimoto's frequently affects the gut and leads to low stomach acid and then low vitamin levels
Low vitamin levels affect Thyroid hormone working
Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common.
According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 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 and slowly lower TPO antibodies
Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and 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.
Thanks for the reply SlowDragon. I could do with some advice.
On 13th September I started 25mcg NorthStar levothyroxine in response to my Blood results taken on 30th August which were;
THS 14.6 T4 11.3 (12/22)
Since taking them I have been feeling increasingly ill. Most days I need to eat very 2 hours especially in the morning. Tend to feel better in the afternoons. I get Hypoglycaemia type symptoms despite normal blood sugar levels on finger prick tests- hungry, shaky, weak, trembling, foggy head, difficulty thinking and speaking, hot, dry mouth, tingling and aching in hands and feet, unsteady walking, twitching muscles, numbness in both middle toes.
12th October started 3 drops of B12 and B complex every day. Tingling and aching in hands and feet improved but other symptoms continued.
25th October early evening had rapid heart beat-over 200 for 10 minutes and then 120bpm for another 15 minutes- went to A & E. ECG and blood tests relating to heart all normal. A & E doctor said it could be Thyroid medication.
Had GP thyroid and vitamin test on 27th October at 9am. Didnt take thyroxine before test and stopped B complex 4 days before.
Note amended reference range due to change toGen II assay.
Serum folate12.2ng/mL 2.90 - 26.80ng/mL. If no change in dietary habits, a normal serumfolate makes folate deficiency unlikely
Serum total 25-OH vit D level - (EMMAS) - Normal - No Action
Serum total 25-OH vit D level 55nmol/L25.00 - 120.00nmolL
Deficient <25 nmol/L
Insufficient 25-50 nmol/L
Consider reducing dose >200 nmol
As a result of the tests my GP initially emailed to say I should increase my Levothyroxine to 50mcg a day. I rang to see if they had read the hospital report about the rapid heartbeat (they hadn’t) They consulted an endo and then rang me back to tell me to stop the thyroxine altogether.I stopped on 30th October.
I am concerned about undoing the work I did in trying to get used to thyroxine but also dont want to continue feeling worse and having another rapid heart beat episode. My symptoms seem Hyper but blood test show I clearly am Hypo.
My B12 has gone up due to the supplements which I am continuing to take. I am aware that my vitamin D levels are on the low side and have gone down since last test. I will begin supplements. I am also going to investigate seeing a private endo from the Thyroid UK list to see what they suggest. I will also consider going gluten free. I am very sensitive to all medicine. This time last year I started on 50mcg of levo and had extreme hyper symptoms- sweating, palpitations, insomnia, anxiety and doc told me to stop (my thyroid results were borderline at that point)
In December 21 I had blood tests showing iron on the high side- I was not supplementing (apart from occasional zinc) and I dont eat meat.Iron 24.6 umol/L (8.0 to 25.0)
high heart rate can be hypothyroid symptom…..most medics think it’s only linked to hyperthyroid
Teva brand upsets many many people
Suggest you get new prescription either for for 50mcg tablets levothyroxine
Perhaps try Wockhardt 25mcg tablets. Wockhardt only make 25mcg tablets, but some people find they are easiest to tolerate and so remain on Wockhardt even when on full replacement dose
or either Mercury Pharma brand (made by Advanz) or Accord brand
Accord don’t make 25mcg tablets
Initially start on 25mcg ……after 2-3 weeks increase to 50mcg daily. You may find it better to split levothyroxine, taking half dose waking and half at bedtime
Retest in 6-8 weeks
Likely to need further increase in levothyroxine after next test
Typically dose is increased SLOWLY upwards in 25mcg steps, retesting 6-8 weeks after each dose increase until TSH is around one, Ft4 in top third of range and Ft3 at least half way through range
Typically eventual dose levothyroxine likely to be approx 1.6mcg per kilo of your weight per day
It’s trial and error what brand levothyroxine suits you best
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.
But for some people (usually if lactose intolerant, Teva is by far the best option)
Most easily available (and often most easily tolerated) are Mercury Pharma or Accord
Mercury Pharma make 25mcg, 50mcg and 100mcg tablets
Accord only make 50mcg and 100mcg tablets
Accord is also boxed as Almus via Boots, and Northstar 50mcg and 100mcg via Lloyds ....but Accord doesn’t make 25mcg 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.
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).
Levothyroxine is an extremely fussy hormone and should always be taken on an empty stomach and then nothing apart from water for at least an hour after
Many people take Levothyroxine soon after waking, but it may be more convenient and perhaps more effective taken at bedtime
No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.
Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away
(Time gap doesn't apply to Vitamin D mouth spray)
If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test
Similarly if normally splitting your levothyroxine, take whole daily dose 24 hours before test
If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
400mcg a day since 16 years old 
My 12 year old son has u active thyroid.
11 year old with hypothyroidism 
Goiter in 10 year old
My 16 year old Daughter
