Could someone look at my results please?

[Ansteynomad]

I'm on 125mcgs of Levothyroxine and always have Mercury Pharma, which I think suits me.

Results in May 2021 were as follows:

TSH (0.27-4.2) <0.02

FT4 (9-26) 23.4

FT3 (2.8-7) 6.5

Results in August 2022

TSH (0.27-4.2) <0.02

FT4 (9-26) 21.8

FT3 (2.8-7) Not done

Interestingly, as my FT4 level has come down, my total cholesterol has gone up and is now 5.4, so I'm expecting to have the statins conversation again.

I had the tests done because I have been suffering from severe abdominal pain for the last two weeks and no cause has yet been found.

All other tests (FBC, LFT, U&E etc) were fine apart from below range bilirubin and haemoglobin down to 124 (120-150) when it was 138 this time last year with the same range.

Does anyone have any thoughts or comments please? Thank you

[SlowDragon Administrator]

When were vitamin D, folate, ferritin and B12 levels last tested

What vitamin supplements are you currently taking

What replacement thyroid hormones are you currently taking and how much

Are you on gluten free diet or dairy free diet

[Ansteynomad in reply to SlowDragon]

All vits and mins were tested last year and levels were all good.

Vitamin D was 80 (50 -)

Folate and B12 were both well over range

Ferritin was 140 (15-350)

I had a long hard haul with vit and min deficiencies over ten years ago, so I keep on top of them. Currently taking a B complex which includes methyl folate, 2,000iu Vitamin D3 (4,000iu daily in winter) and vitamin K2.

I am gluten and dairy free and currently taking 125mcg Levothyroxine having gone back to it two years ago when I couldn't get Thyroid S any more.

We believe this to be secondary hypothyroidism as a result of pituitary damage caused by the Epstein Barr Virus. I also now have an atrophied thyroid, an incidental finding on a recent scan.

[SlowDragon Administrator in reply to Ansteynomad]

So as you need to be gluten and dairy free…..highly likely to need addition of T3 prescribed alongside levothyroxine (typically 3 x 5mcg doses at 8 hour intervals)

…..and possibly a small reduction in levothyroxine

Have you done Dio2 gene test

thyroiduk.org/deiodinase-2-...

regeneruslabs.com/products/...

[Ansteynomad in reply to SlowDragon]

Not done the D102 test. Was on T3 only at one point. 30mcgs a day. No relief of symptoms and a 30% weight gain in two years. Not keen to go down that route again.

[SlowDragon Administrator in reply to Ansteynomad]

Hardly surprising if only on 30mcg T3 …..more typical when ONLY on T3 to be on 50-60mcg per day

Levothyroxine plus SMALL Dose T3 …..…if Ft4 is over range or right at top of range (as you are) …usually small reduction of levothyroxine….and add 3 x 5mcg T3

Might need to reduce levothyroxine by 12.5mcg per day …..wait a week…..add 5mcg initially….. wait another 1-2 weeks before adding 2nd 5mcg dose T3

Possibly adding third 5mcg dose 2-3 weeks after ….but not always necessary

Retest bloods 6-8 weeks after

If Ft4 mid range….just adding T3

If Ft4 low in range….increase levothyroxine

[HowNowWhatNow]

Slow Dragon’s advice is of course the first course of action for thyroid issues.

Abdominal pains can mean so many things and I’ve been down this road a lot of times for many different reasons ..

Have blood pressure, heart rate and / temperature observations been taken? And cultured urine test (not just dipstick) been done?

Also (depending where pain is) troponin, the hormone that indicates major heart problems? I ask because heart issues can show up as referred pain in the upper stomach. Heart being more often missed in woman. I don’t mean to worry unduly - I don’t know whether the type / location of symptoms suggest it. You would have an ECG too if they thought it was heart and you are being looked at in hospital.

Where is the pain and when do you get it in the day? And how about when standing / sitting / moving around / sleeping?

My son used to get unexplained stomach pains all the time and after checking (palpating) organs in and around his stomach and asking lots of other questions doctors would tend to alight on either mesenteric adenitis or constipation. Never both! Then my son went GF - now not so many stomach pains. You want to be really sure you’ve ruled out the more serious things though. And pain from gluten wasn’t (for him) constant day round.

Thinking of iron - Are you on a birth control method like coil or pill? Are periods any different to usual? If your HB level is coming down gradually, have you had a stool test to rule out blood traces and bacteria, too?

Hopeful that kidney stones / pancreatitis / appendicitis / blood sugar pathways are covered, too - which am sure they would be by now.

[Ansteynomad in reply to HowNowWhatNow]

BP, heart rate, temp done. All within normal range.

No urine test of any sort by GP or hospital.

ECG was normal.

Pain is constant, with unpredictable waves of more intense pain.

Post-menopausal so no period issues. Blood tests show Hb has come down since last year, but at 124(120-150) it's not the lowest it's been in recent years. Blood sugar is fine. The NHS wants me to be diabetic and has subjected me to all sorts of tests over the years, but I'm still not!

Waiting for the results of a FIT test.

I have no appendix and kidney stones and pancreatitis have been ruled out.

I'm a mystery apparently.

[HowNowWhatNow in reply to Ansteynomad]

What do you want them to do next? And why do they (or you) think your HB levels are reducing?

Is it normal for menopausal women’s HB to reduce like this?

[HowNowWhatNow in reply to Ansteynomad]

Any digestive issues?

Burping, noisy stomach, acid reflux etc?

I guess the FIT is supposed to cover this.

[HowNowWhatNow in reply to Ansteynomad]

Did they do an U/S or other scan of your stomach, to rule out kidney stones and pancreatitis?

And are your white blood cells and inflammatory markers level? Presumably they are.

You could of course ask to do to a urine sample but you might have noticed relevant symptoms if this was the problem.

In your shoes I might be asking for an endoscopy / colonoscopy if they’ve ruled out all these other things.

[Ansteynomad]

I'm due an ultrasound in three weeks, but to be honest, I am in so much pain today that I think I may have to ask if it can be brought forward, or even get it done privately.

White blood cells are all right, but inflammatory markers have not been checked and nor has my CA 125.

No digestive issues.

Only got the blood test results today. They said they would ring me if there was anything amiss. I'm half expecting to be told I need less thyroxine, which would be a disaster.

[Meno56]

Have they checked whether you may have Gallstones?

Because you say the pain is constant, it doesn't naturally follow that gallstones will be the issue, as Biliary Colic is usually intermittent as the gallstone passes through. However, one might be stuck somewhere?

I only mention gallstones as a possibility, because there is a link between Hypothyroidism and gallstones and when I was undermedicated last year I had months of the wretched attacks, but once my Levo dose was increased, they disappeared.

[Ansteynomad in reply to Meno56]

Pain is in the wrong place for gallstones, unless it can refer to the pelvis?

[Spangle15]

Hi. Can I just ask how you manage to get Mercury Pharma every time. I think that’s what suits me best but everytime I pick up my prescription, it’s a different brand. Thank you.

[Ansteynomad in reply to Spangle15]

I stipulated that this was the brand I wanted and so far my local pharmacy has complied. At one point they couldn't get 100s, so they went straight back to the GP and asked if it was OK to give me two 50s instead, which it was.

I know I'm lucky on that one.

[Spangle15 in reply to Ansteynomad]

Thank you. Who did you stipulate with, the GP? Is it written on your prescription?

[Ansteynomad in reply to Spangle15]

Stipulated to the pharmacist. I never see my prescription, so I don't know what that says.

[Sonbleu]

If you are in that much pain go to the ER. I don’t think you’re going to be able to figure it out here.

[Ansteynomad in reply to Sonbleu]

I've been to A&E. They couldn't find any obvious cause either. I only mentioned this as,the reason the tests were done. I'm trying to get it sorted out.

[Gingernut44]

This is just a thought - have you tried a lactose free Levothyroxine or any other brand other than Mercury Pharma. I know you say MP seems to suit you but it could be down to a simple thing like excipients.