My daughter has finally received results of blood test by consultant 22 July. This result also contains information on fertility. She had RAI December last year to treat hyperthyroid. I hope I can copy and paste result here and not too long.
Please note new FT4 reference range as of 25/11/21
Serum free triiodothyronine 5.4 pmol/L 3.1 - 6.8
Serum TSH * 0.04 mu/L 0.27 - 4.2
On these results her thyroxine has been reduced from 100mcg to 75mcg. She is due another blood test, but the support and efficiency of both consultant and GP has been rather concerning.
A couple of questions.
How are female eggs affected by RAI and how does RAI and continued use of thyroxine affect a developing foetus?
Thank you for all your help and advice.
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Piombino
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Conception 6 months after treatment is considered safe.
Thyroxine is not harmful to unborn baby. However insufficient replacement is detrimental & increase in dose often necessary at start of pregnancy.
Ferritin very low. Has Dr investigated this?
Most feel well with TSH lower part of range. FT4 top third FT3 at least half way. Dr has reduced dose as TSH underage. Was she well with current dose? FT3 not too high. 25mcg reduction may be too much.
What time was test & how long was Levo taken before draw?
See if Vitamin D can be tested. Need to be optimal for levo to work well & convert FT4 to FT3.
Hello PurpleNails and thank you for your reply. I will pass to my daughter for more information. Finding a doctor is a great idea but hasn't been so easy in practice. If anyone knows of any GP service which is actually working in the Brighton area, would be grateful to know.
I’ll admit to groaning out loud when I got to the bit about reducing her levothyroxine dosage. They’re dosing according to her TSH and that’s not good news.
Her TSH is likely suppressed because of previously having Graves—sometimes TSH never really recovers to so-called normal levels post RAI or thyroidectomy in Graves’ patients. This is well documented but it’s amazing how many doctors don’t seem to know. I wouldn’t have said she was overmedicated anyway—her FT4 was only just over range and FT3 nowhere near the top of the range. I think a much smaller dose reduction would have been more appropriate (if one were needed at all).
Vit B12 looks rather low and the high in range MCV would suggest there might be an issue there. Before supplementing, I would advise asking the doctor to test for pernicious anaemia.
Ferritin is also low.
Don’t worry about levothyroxine affecting a developing foetus—the main thing is that the mother is on sufficient thyroid hormone replacement during the pregnancy. I think you’ll need to find a doctor who isn’t wedded to dosing by TSH levels though!
Hello Jazzw - thank you for your advice too. Seems a great deal depends on the medical support. My daughter is currently trying to get the Vit D etc. tested by her doctor - no medical kits for a month or so. Always something. Hopefully we can find someone who can help and will look at doing tests privately. Unfortunately funds don't stretch to going private.
You might like to read around all things Graves Disease on the Elaine Moore Graves Disease Foundation website elaine-moore.com as I found it the most complete of all the websites and books I've read on my own journey with Graves post RAI thyroid ablation.
It is essential your daughter is monitored and dosed on her T3 and T4 blood test results and not a TSH reading.
The TSH reading is not a reliable measure of anything as her HPT axis - the Hypothalamus / Pituitary / Thyroid feedback loop on which this TSH reading relies is now not complete as the thyroid has been disabled nd this loop incomplete.
Graves patients can also have antibodies ' stuck down ' on TSH receptor sites for years which can distort TSH readings giving a false low and the assumption is made that this means there is too much thyroid hormone in circulation when in fact a T3 reading can be very low and more, not less medication is needed.
Graves is an auto immune disease for which there is no cure.
The thyroid is the the victim in all this and not the cause.
The cause is one of an immune system response and Graves is said to be stress and anxiety driven.
RAI is known to be more difficult to treat as there is no way of knowing how much of the gland has been destroyed at any given time - as RAI can be a low burn - but ultimately the gland will be fully disabled and burnt out in situ.
RAI is known to " trash " vitamins and minerals and no hormone replacement works well until ferritin, folate, B12 and vitamin D are up and maintained at optimal levels.
Apart from Elaine Moore. her website and books there is :
Barbara S Lougheed - From Hyper, to Hypo, to Healing : a book by another lady who went through RAI treatment for Graves :
On a basic biology / physiological level a book written by a doctor - Barry Durrant - Peatfield entitled - Your Thyroid and How To Keep It Healthy - written to educate patients on thyroid hormone replacement options and how the thyroid regulates full body synchronisation.
Thyroid UK is the charity who supports this forum and where you will also find all things thyroid should you wish to dip in - thyroiduk.org
P.S. Just looked back and see I wrote most of this to you months ago !!!
Hi PennyannieThank you for all your advice. I pass this info on to my daughter but she is overwhelmed by it. Stress and anxiety have played a major part and so can see the connection there.
Did your daughter feel well before the dose reduction? That would be my question. Wellness is a better indicator for sure. Can highly recommend getting the vits up 👍
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