Help with results

[Shona81]

HI, I've been diagnosed with underactive thyroid over 10 years ago and always trusted doctors , had my yearly blood test when rang for results they always said everything fine no further action needed ...for some time now I'm not feeling 100 % so decided to start looking after my health and done private blood test with medicheck...I have appointment booked with doctor for next month after reading lots of posts on this forum I will definitely ask for increase of my medication ( I'm on 50 mg of levothyroxine) ... also my antibodies are high , could that mean I have Hashimo? Thanks for reading any help with be appreciated x

[SlowDragon Administrator]

Welcome to the forum

50mcg levothyroxine is only the standard starter dose levothyroxine

Likely to need further increase in levothyroxine over coming months

Which brand of levothyroxine are you currently taking

Take these results to GP

Request 25mcg dose increase in levothyroxine…..

but having been left very under medicated for long time, you might initially want to cut 25mcg in half and add 12.5mcg for first 6-8 weeks. Assuming that’s ok….then increase to 75mcg daily

Retest thyroid again 6-8 weeks after being on 75mcg every day

Ferritin is deficient

Request GP do full iron panel test for anaemia

You may need iron supplements

Vitamin D is too low, but not low enough for GP to prescribe

What vitamin supplements are you currently taking

[Shona81 in reply to SlowDragon]

Hi,thank you for reply ...I'm currently not taking any vitamins or supplements ...I'm on Teva or Wockhardt tablets depending on whats available at my pharmacy...this month I'm on Teva

[SlowDragon Administrator in reply to Shona81]

Many people find Levothyroxine brands are not interchangeable.

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.

Teva is the only brand that makes 75mcg tablet.

So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half

But for some people (usually if lactose intolerant, Teva is by far the best option)

Glenmark or Aristo (100mcg only) are lactose free and mannitol free. May be difficult to track down Glenmark, not been available very long 

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

beware 25mcg Northstar is Teva

List of different brands available in U.K.

thyroiduk.org/if-you-are-hy...

Posts that mention Teva

healthunlocked.com/search/p...

Teva poll

healthunlocked.com/thyroidu...

Once you find a brand that suits you, best to make sure to only get that one at each prescription.

Watch out for brand change when dose is increased or at repeat prescription.

New guidelines for GP if you find it difficult/impossible to change brands 

gov.uk/drug-safety-update/l...

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.

academic.oup.com/jcem/artic...

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

verywellhealth.com/best-tim...

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

REMEMBER.....very important....stop taking any supplements that contain biotin a week before ALL BLOOD TESTS as biotin can falsely affect test results - eg vitamin B complex

[SlowDragon Administrator in reply to Shona81]

Low vitamin D

NHS Guidelines on dose vitamin D required

ouh.nhs.uk/osteoporosis/use...

GP will often only prescribe to bring vitamin D levels to 50nmol.

Some areas will prescribe to bring levels to 75nmol or even 80nmol

leedsformulary.nhs.uk/docs/...

GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)

mm.wirral.nhs.uk/document_u...

But with Hashimoto’s, improving to around 80nmol or 100nmol by self supplementing may be better

pubmed.ncbi.nlm.nih.gov/218...

vitamindsociety.org/pdf/Vit...

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

Test twice yearly when supplementing 

Once year with full thyroid and vitamins, once via NHS private testing service

vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function.

There’s a version made that also contains vitamin K2 Mk7. 

One spray = 1000iu

amazon.co.uk/BetterYou-Dlux...

Another member recommended this one recently

Vitamin D with k2

amazon.co.uk/Strength-Subli...

It’s trial and error what dose we need, with thyroid issues we frequently need higher dose than average

Vitamin D and thyroid disease 

grassrootshealth.net/blog/t...

Vitamin D may prevent Autoimmune disease 

newscientist.com/article/23...

Web links about taking important cofactors - magnesium and Vit K2-MK7

Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

Only make one change at a time or add one supplement at a time

Then wait at least 10-14 days to assess results before adding another

[Jaydee1507 Administrator]

Yes you have Hashimoto's disease. The antibodies are destroying your thyroid, hence the need for thyroid replacement hormones. Not much you can do about them I'm afraid. Some people feel better going gluten free.

As SlowDragon says, your current dose of 50mcgs levo is just a starter dose. When you have bloods done and feel unwell, you should make an appointment with the GP to discuss how you feel. Let them know how unwell you are and demand an increase in your Levothyroxine.

Your low ferritin will also be making you feel unwell. Unfortunately doctors get no training in nutrition and believe you only get symptoms when your level falls below the range. This just isn't true and a level of ferritin below 75 will give you symptoms. Yours is now at 23. I'll let others advise on supplementing but do try and start on focussing on eating iron rich foods such as chicken liver pate, pumpkin seeds and lentils.

[Shona81 in reply to Jaydee1507]

Hi I have to admit I’m very uneducated about thyroid but thankfully I’m learning a lot from this forum …I’m pescatarian so I eat a lot of fish and veg always thought there’s enough vitamins in what I eat but apparently I’m wrong …I have appointment booked for November with my doctor trying to find out as much I as can to pass on …thank you for reply x

[Jaydee1507 Administrator in reply to Shona81]

The problem in people who are hypo is that we don't absorb vitamins well. Possibly due to low stomach acid, especially if undermedicated as you are. I used to think the same as you but it really isn't true sadly.

With a level as low as yours your GP should be prescribing iron, although I think it's recommended here to get a full iron panel first.

If you are vegetarian/pescatarian then you won't be able to get enough B12 from your diet anyway and should supplement with a B complex. That would bring your folate level up over 50% too. Thorne Basic B is the one recommended here.

[SlowDragon Administrator]

GP should do coeliac blood test for anyone with autoimmune thyroid disease

Most important steps are

1) get dose increase in levothyroxine

2) get full iron panel test for anaemia.

Meanwhile increasing iron rich foods in your diet

3) supplementing vitamin D…..then magnesium

In 2-3 months consider trialing strictly gluten free diet….once you have had coeliac blood test done

Hashimoto's 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 

While still eating high gluten diet ask GP for coeliac blood test first or buy test online for under £20, just to rule it out first 

Assuming test is negative you can immediately go on strictly gluten free diet 

(If test is positive you will need to remain on high gluten diet until endoscopy, maximum 6 weeks wait officially) 

Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse

chriskresser.com/the-gluten...

amymyersmd.com/2018/04/3-re...

thyroidpharmacist.com/artic...

drknews.com/changing-your-d...

Non Coeliac Gluten sensitivity (NCGS) and autoimmune disease

pubmed.ncbi.nlm.nih.gov/296...

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

nuclmed.gr/wp/wp-content/up...

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

restartmed.com/hashimotos-g...

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.

[SlowDragon Administrator]

low folate

supplementing a good quality daily vitamin B complex, one with folate in (not folic acid) 

This can help keep all B vitamins in balance and will help improve B12 levels too

Difference between folate and folic acid 

chriskresser.com/folate-vs-...

Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid.

thyroidpharmacist.com/artic...

B vitamins best taken after breakfast

Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule) 

IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate methyl folate supplement and perhaps a separate B12

As you Active B12 level is over 70 just vitamin B complex likely enough

If Active B12 dropped under 70, or serum B12 under 500 would need to add a separate B12 until levels improved

Low B12 symptoms 

b12deficiency.info/signs-an...

B12 drops 

healthunlocked.com/thyroidu...

[Shona81 in reply to SlowDragon]

Thank you for all the info , it's gonna be busy afternoon for me ..lots of reading and research to do x thanks again