hi, my first post so please excuse if not done correctly! Feeling in rather a mess as have various things going on (in title) and very hard to unpick everything!
Looking for any advice on how to improve energy, mood and digestion when I have hashimotos and SIBO (small intestinal bacterial overgrowth) I’m always tired and hungry but have to be careful what/ when I eat or I get terribly bloated and food hangovers the next day. Please see my profile for more info.
Basically underactive thyroid and on Levo since 2016 when had first baby. Am now on 100mcg levothyroxine after endocrinologist diagnosed hashimotos in September 2022. am slightly underweight and low ferritin. Low testosterone.
Have seen various docs, Specialists, functional health and nutritionists and making slow progress but the lack of energy, low mood and muscle strength is really sucking the joy out of life and my ability to do things.
Pretty sure I’m perimenopausal due to worsening PMT, ovulation symptoms, shortening cycle, SIBO bloating worse during ovulation and week before period. Also very dry eyes, sleep hit and miss. Terrible brain fog. Aches and pains. Mood low too. SAD in winter makes it worse. Aim to get daylight, movement, gentle exercise, decent sleep every day. Gluten free and mostly dairy free. No alcohol, low sugar. I eat healthily including meat.
Hit head 13 years ago and stamina and resilience virtually disappeared overnight. Wondering if vagus nerve / gut connection?
Sorry this is so long!
Any thoughts / advice very gratefully received. Also any thoughts on my blood results (from summer, not had done yet since dose increased to 100mcg)
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Hopetoheal22
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I don't see any blood results? You can edit your post and add them or post in comments.
What are you doing for your low ferritin?
All of us here suffer low vitamin levels due to low stomach acid. For best results with replacement thyroid hormone we need OPTIMAL vitamin levels of ferritin, folate, B12 and D3/ Have you had any of the others tested?
Hi Jaydee and thanks for your reply 😊 sorry can’t see how to upload photo of results so here are the most recent ones:
Latest bloods in July 2022
FT3 - 3.1
Free T4 - 14.7
TPO antibodies 21.4 (0-75)
Thyroglobulin 8.1ug/L (<1.0ug/L)
They didn’t test TSH
Vit D Roche cobas - 131.9 (range >50)
B12 505 (197-771)
Ferritin 32 (13-150)
Testosterone 0.2 (0.2-1.65)
In May 2022
TSH was 2.57, FREE T4 was 17.8
Ferritin was 54, b12 was 752 (197-771)
Interestingly I suspect I have low stomach acid, but I had a stool test to test for causes of SIBO last which suggested stomach acid was normal. Are there other tests I can do? I feel much better and bloat less if I have juice of half a lemon in some water before meals.
Can you add the reference ranges to the tests please? They vary from lab to lab.
If your TSH was 2.57 in May then you were undermedicated at that point even. Hard to say 100% but your FT4 has dropped since then so it might have got worse. Many of us here pay for private blood tests from Medichecks or Monitor My Health to get the right bloods done that we need.
You're missing a folate result.
You do need to be working on the low ferritin as that in itself will be making you tired etc Try adding iron rich foods to your diet - liver, chicken liver pate, lentils.
thanks so much Jaydee, Sorry the range is 3.1-6.8 for FT3 and 12-22 for FREE T4.
Folate wasn’t tested in July but was greater than 20ng/ml in May. No range was given. Lab questioned if I’d fasted, I think I did but prob took multivits night before. In june 2021 it was 18.10 (8.83-60.8)
I do feel worse! Much more tired and weak muscles.
Thanks re the iron, I do eat red meat twice a week, lentils too. And I eat liver when I remember. But don’t feel it gets absorbed as I don’t feel better! Maybe need to eat more?
So your Ft3 is currently bottom of the range and no wonder you feel terrible. I'd get onto your GP surgery today and demand a dose increase of 25mcgs. Insist on it.
Add chicken liver pate in twice a week to diet. Remember to eat liver at least once a week. Ferritin is slow to raise. Try cutting dairy out completely. Really helped my aches and pains.
Thank you Jaydee, so helpful. I feel so exhausted and it’s hard to rest when looking after two lively kids!!
Will do re dairy. What do you use instead of butter? I do like some on GF toast. I’ll eat liver more often too. Lunch today 😋
Did you mean ask for an increase in levothyroxine? I don’t take any T3 but have asked if I can try some due to low level. Endo explained hard to source. They increased my Levo from 75 to 100 at end of September and will retest at end of November.
Sadly if anything I feel worse so far on 100, even more tired. Could be the change in season. And having had three colds since sept! 🤧 I hope you’re keeping well x
sorry meant to add I wonder if I have trouble converting T4 to T3, perhaps due to the gut issue, SIBO? Convinced my liver isn’t great either as I feel poisoned if I drink even small amount of wine.
and I weigh about 58kg. I’m 1.79m so underweight for my height. Probably as most of my family are slim. I do eat well (always hungry!) and would like to gain weight and muscle.
I buy olive oil spread. It's never going to be the same as butter but some of them get pretty close these days. It's the proteins in butter that affect us. They can block the B vitamin pathways apparently.
T3 is not hard to source. He probably doesn't like prescribing it. For now though you just need a levo increase which looks like you have had.
Remember that your ferritin is low too, don't blame it all on your thyroid levels as that will be making a major contribution as to how rubbish you feel.
Low thyroid issues can cause vagus nerve issues. A shock to the system like a bumb on the head may have triggered your Hashi's?
thank you Jaydee, I’ll check out the spread. Trying to avoid seed oils so hard to find alternatives! Interesting about blocking but B pathways.
Yes I’ve no doubt low iron affecting me. Muscles v weak and feel like not enough air in my lungs if that makes sense.
So I don’t need to push for T3? Should the extra T4 boost my T3? Also think SIBO makes me feel yuck.
Head injury was 7 years before my post partum under active thyroid so not sure but suspect it didn’t help. Heard that humming and singing can help vagus nerve, so might have to try that!
I use a vagus nerve stimulator made by Parasym, I do have lots of autonomic issues!
Always read the label when buy a new dairy free product. I've found several olive oil spreads that contain dairy. Just a matter of trying them out and finding whats acceptable to your taste buds.
Low ferritin could also be affecting your conversion of T4 to T3 at the moment. You might sstill need some T3 but very hard to tell with incomplete results. Stick with Levo for the time being until you get closer to optimal levels.
A way to work out your very estimated final dose is weight in kilos x 1.6.
Can you add the range for the FT4 and FT3, please. Always necessary to add ranges because they vary from lab to lab.
Your antibodies are low. Were they higher when your endo diagnosed Hashi's? I ask because of what you said about the blow to your head, and losing stamina etc. afterwards. Makes me wonder if the pituitary or the hypothalamus wasn't affected causing Central Hypo. Which would explain why they didn't test your TSH, because it would be of much use.
For stomach acid levels, try the home test at the end of this article:
Thanks so much grey goose. Sorry the range is 3.1-6.8 for FT3 and 12-22 for FREE T4
Folate wasn’t tested in July but was greater than 20ng/ml in May. Lab questioned if I’d fasted, I think I did but prob took multivits night before. No range was given. In june 2021 it was 18.10 (8.83-60.8)
Is it best to stop multivits a few days before tests or take as normal?
Re low antibodies, had private test done in June 2021 and anti thyroglobulin abs was 297 (<115) and anti thyroidperoxidase was <9. (<34) yes they don’t seem that high; they were never tested before I stopped gluten so maybe that’s helped? It became under active after first child six years ago so was attributed to post partum, TSH was 14 then, so endo diagnosed hashimotos in sept this year on basis of that I think. But I think if I hadn’t asked her she wouldn’t have said anything. It seems they just treat the same whether auto immune or not. It is deeply confusing!
sorry meant to add, interesting point re head injury - that happened 13 years ago but thyroid hormones were normal when I was tested during my first pregnancy 7 years ago, only became underactive after birth. Don’t think antibodies were tested then to my knowledge. Doc always said didn’t matter as treatment would be the same.
Oh dear! Your FT3 is very low. Not surprising you don't feel good. Your FT4 isn't even mid-range, either, so you're very under-medicated.
Your folate is pretty low, too. You'd probably benefit from a good B complex. Oh, and by the way, multi-vits are a very, very bad idea. For many reasons. Total waste of money. If you tell me which one you're taking, I'll explain why - they're all slightly different, but all bad.
Going gluten-free may have reduced your Tg antibodies, but that's not exactly 'helping', because the antibodies are not the problem. They are a result of the disease - and an indication that you have it - not the cause of the damage it does.
Treatement for Hashi's is the same as the treatment for hypothyroidism caused by anything else: Thyroid Hormone Replacement. There is no treatment for the autoimmunity. But, you do need to know if you have it because of the way the disease behaves. Do you know how Hashi's 'works'?
interesting point re head injury - that happened 13 years ago but thyroid hormones were normal when I was tested during my first pregnancy 7 years ago, only became underactive after birth.
There's no such thing as 'normal' where thyroid hormones are concerned. When a doctor says 'normal', all he means is 'somewhere within the range'. But, as the ranges are so wide, it's where within the range the result falls that is important. Your present FT3 could be said to be in-range, but it is very, very far from being normal!
However, if your TSH went up to 14, then it's doubtful your pituitary or hypothalamus were damaged by the blow to your head.
thank you for all your advice greygoose, I’ve felt so lost with all this for a long time now and am tired of the struggle 🙃
Ha ha that’s a good point re TSH And head injury, phew good news!
I’m reading a couple of books on hashimotos and think I understand it, but my brain fog and memory so bad I don’t retain much 😂 I don’t think I’ve ever had the hyper swing. Read that you need 3 things to trigger it - the genetics, leaky gut and environmental trigger - I definitely have the last two (SIBO and pregnancy) love to know more if you have time to share.
Love to know more re multivits! I currently take one of the biocare methyl multinutrient a day, also some magnesium glycinate, fish oils, recently added more VIt D
Is being gluten free very important if I do have hashimotos?
Yes I do appear undermedicated but not feeling better after increase to 100mcg Levo 5 weeks ago. Feel like it’s not really helping and maybe some T3 would help? Endo wasn’t keen
Re Hashi's: Read that you need 3 things to trigger it - the genetics, leaky gut and environmental trigger
Possibly. But pretty sure it's a lot more complicated than that.
OK, so Hashi's is an autoimmune disease – commonly called by doctors Autoimmune Thyroiditis - where the immune system attacks and slowly destroys the thyroid. It is diagnosed by blood testing Thyroid Peroxidase (TPO) antibodies and Thyroglobulin (Tg) antibodies.
(It's necessary to understand that the blood test to see if your hypothyroidism is autoimmune might not give you any further information, for three reasons:
* What they are testing for are TPO antibodies. Antibodies fluctuate all the time, so one test might be negative, and the next positive. But, if you have one over-range test, it does mean you have Autoimmune Thyroiditis.
* There are two types of Hashi's antibodies: TPOab and TgAB. The NHS only tests TPOab, and they might be negative, but if your TgAB are positive, it means you have Hashi's anyway.
* Some Hashi's people never even have over-range antibodies. They are diagnosed by ultrasound. So, a negative antibodies blood test does not mean you don't really have it.)
There are two types of Autoimmune Thyroiditis: Ord's and Hashimoto's. But, we call them all Hashi's for convenience. The difference is, that with Hashi's, you have a goitre, with Ord's you don't. But, the end result is the same: a dead thyroid.
Contrary to popular belief, it is not the TPO/Tg antibodies themselves that attack the thyroid:
"When lymphocytes infiltrate the thyroid gland, mistakenly taking it for a foreign bacteria invader, they damage the thyroid gland and release thyroid peroxidase &/or thyroglobulin into the blood stream. These don't belong outside of the thyroid gland so antibodies are developed to mop them up.
The antibodies are a result of the attack on the thyroid gland, the antibodies don't cause the attack."
After every immune system attack on the thyroid, the dying cells release their stock of thyroid hormone into the blood stream, causing the levels of the Frees to shoot up - FT4 to around 30 something, FT3 around 11/12 - and the TSH therefore drops to suppressed.
There is no knowing how long these high levels will persist, but eventually, they will drop by themselves as the excess hormone is used up or excreted, and not only will you become hypo again, but slightly more hypo than before, because there is now less thyroid to make hormone.
(NB: A Hashi's 'hyper' swing is not true hyperthyroidism in that your thyroid is over-producing thyroid hormone. It's physically impossible to 'go hyper' if you are basically hypo. The thyroid cannot regenerate itself to the point of over production of hormones - or even normal production. Very few doctors appear to know that.)
Therefore, it's very important that your doctor does not reduce your prescription, because you’re going to need it again! If you start to feel over-medicated at that point - some do, some don't - the best thing is to stop levo for a few days, then, when you feel hypo again, start taking it again. It's very important to know one's body, and how it reacts.
There is no cure for Hashi's - which is probably one of the reasons that doctors ignore it - apart from the fact that they know nothing about it, of course!
However, between the 'hyper' swing, and the descent back into hypothyroidism, there can be a phase - quite a long one, sometimes - of normality, where the person is neither hypo nor 'hyper'. This is where people sometimes start talking of having 'cured' their Hashi's, by whatever means. But, it doesn't last. Eventually, you will go hypo again.
But, there are things the patient can try for him/herself to help them feel a bit better:
a) adopt a 100% gluten-free diet. Hashi's people are often sensitive to gluten, even if they don't have Coeliac disease, so stopping it can make them feel much better. Worth a try. Some say that going gluten-free will reduce antibodies – I’ve never seen conclusive proof of that, but, you should be aware that even if you were to get rid of the antibodies completely, you would still have Hashi's, because the antibodies are not the disease. It is not the TPO/Tg antibodies that do the attacking.
b) take selenium. This is not only reputed to reduce antibodies, but can also help with conversion of T4 to T3 - something that Hashi's people often find difficult.
c) the best way to even out the swings from hypo to 'hyper' (often called Hashi's Flares, but that doesn't really sum up the way it works) is to keep the TSH suppressed. This is difficult because doctors are terrified of a suppressed TSH, for various false reasons, and because they don't understand the workings of Hashi's. But, TSH - Thyroid Stimulating Hormone (a pituitary hormone) - tries to stimulate the thyroid to make more hormone, which also stimulates the immune system to attack. So, the theory is, the less gland activity there is, the less immune system activity there will be, meaning less attacks, gland destruction slowed down and less swinging from hypo to hyper and back.
You shouldn't be taking a multivitamin anyway for all sorts of reasons.
* If your multi contains iron, it will block the absorption of all the vitamins - you won't absorb a single one! Iron should be taken at least two hours away from any other supplement except vit C, which is necessary to aid absorption of iron, and protect the stomach.
* If your multi also contains calcium, the iron and calcium will bind together and you won't be able to absorb either of them.
* Multi's often contain things you shouldn't take or don't need : calcium, iodine, etc. These things should be tested before supplementing.
* Copper and zinc need to be kept balanced, but hypos are often high in one and low in the other - often low in zinc. So, both should be tested before supplementing. Taking either of them when you already high in it, will reduce the other and make you feel worse.
* Multi's often contain the cheapest, least absorbable form of the supplement : magnesium oxide, instead of magnesium citrate or one of the other good forms; cyanocobalamin instead of methylcobalamin; folic acid instead of methylfolate; etc. etc. etc. This is especially true of supermarket multis.
* Multi's do not contain enough of anything to help a true deficiency, even if you could absorb them.
* When taking several supplements, you should start them individually at two weekly intervals, not all at once as you would with a multi. Because, if you start them all at once, and something doesn't agree with you, you won't know which one it is and you'll be back to square one.
* Most supplements should be taken at least two hours away from thyroid hormone, but some - iron, vit D, magnesium and calcium (should you really need to take it) should be taken at least four hours away from thyroid hormone.
*Vit C should be taken 2 hours away from B12 because it affects how the body uses B12.
*Never take magnesium/zinc/calcium at the same time as they affect the absorption of each other.
*Take zinc and copper separately as zinc affects the absorption of copper, if you need to take both.
*Vits A/D/E/K are all fat soluble vitamins, and if taken together can compete for the source of fat. They are best taken away from each other.
* The magnesium you take - and just about everybody needs to take it - should be chosen according to what you want it to do:
Magnesium citrate: mild laxative, best for constipation.
Magnesium taurate: best for cardiovascular health.
Magnesium malate: best for fatigue – helps make ATP energy.
Magnesium glycinate: most bioavailable and absorbable form, non-laxative.
Magnesium chloride: for detoxing the cells and tissues, aids kidney function and can boost a sluggish metabolism.
Magnesium carbonate: good for people suffering with indigestion and acid reflux as it contains antacid properties.
Worst forms of magnesium: oxide, sulphate, glutamate and aspartate.
With a multivitamin, you are just throwing your money down the drain, at best, and doing actual harm at worst. Far better to get tested for vit D, vit B12, folate and ferritin, and build up your supplementation program based on the results. A vitamin or a mineral is only going to help you if you need it, anyway. More of something you don’t need is not better, it's either pointless or even dangerous, as with iodine, calcium, iron or vit D.
Is being gluten free very important if I do have hashimotos?
It's important to try a gluten-free diet to see if it helps. Many Hashi's people are gluten-sensitive, so cutting it out can help them enormously. But, it won't have any effect on the Hashi's. Not everybody needs to be gluten-free - it did nothing for me - but unless you try, you won't know.
Yes I do appear undermedicated but not feeling better after increase to 100mcg Levo 5 weeks ago.
Not surprising. It's still quite a low dose, and with such a low FT3 you're probably going to need a lot more than that.
maybe some T3 would help?
Too soon to tell. You need to get that FT4 up a bit before we'll be able to see how well you convert. Like most things, T3 won't help if you don't need it.
But many endos are not keen on prescribing T3, mainly because they don't understand what it is!
re dose and T3 - thank you, I’ll see what results are at end of this month and speak to endo. No doubt I’ll be back here asking for your advice, it’s gratefully received thanks so much 🙏
so helpful thank you! Gosh so vitamin supplements are a bit of a complex minefield 🤯 magnesium glycinate is the only I’ve noticed feeling better on and sleeping better.
I might stop taking the others (would save a fortune!) and get a comprehensive vitamin test done first, can you recommend a company to do that please? Doc will test folate, B12, vitamin D and ferritin, maybe that’s enough?
What are your thoughts on iron supps (I’ve heard constipating so trying to eat meat/liver/lentils) and omega 3 from fish oil supps?
Folate, B12, vit D and ferritin would do for a start, if you can get them done. Then post the results and ranges on here and people will advise on supplementing.
I'm not very well-up on iron - that is complicated! But, I've never found iron supplements constipating because I take a huge dose of vit C at the same time. Even if you're eating iron-rich foods to try and raise iron/ferritin, you do need to eat a vit C source with it. Like mashed potatoes and oinion gravy with your liver. The vit C helps with absorption of the iron and avoids constipation.
thanks so much grey goose, your knowledge is truly amazing! 🤩 so helpful, thank you.
So my TPO seems to be in range, but thyroglobulin has been above, so it is hashimotos, is that right?
Even though I’ve never had the swing to hyper? (To my knowledge at least, I was full of energy for two weeks post partum then it was slowly downhill, so maybe I did? A lot depended on how much sleep I got)
That’s helpful re gluten thanks, makes sense. Gastro said I had non coeliac gluten sensitivity based on my symptoms I think, intolerance test showed gluten and wheat ok but know they’re not reliable.
I try eat 4-6 Brazil nuts every day , would that give me the selenium?
Well, think is, Tg antibodies can be high for all sorts of reasons, and yours aren't that high, so there is some doubt. But, have you ever had an ultrasound on your thyroid?
As for Brazil nuts, depends where they're grown. Does it say on the packet that they're grown in selenium-rich soil? If not, they probably don't have much selenium in them. But, if they are grown in selenium-rich soild, you are eating far too many! Two or three should be the maximum.
thank you greygoose. Never had an ultrasound. Should I ask for one? Perhaps it doesn’t matter, just more about getting everything to the right levels.
Not sure where Brazils grown but it says they contain 1917µg per 100g… so 4 Brazil’s might be 20g = 383ug… gosh just googled and 60ug is all I need per day, so better just have one nut a day! Also saves money 😊 maybe that’s why they don’t make me feel better…
Just to say ….Be careful with Brazil nuts as they can contain 50-90ug selenium per nut (according to the differing selenium content of soil). However studies have shown that supplementing above 400ug per day can be toxic. I take a supplement of 100ug selenium daily (although increase to 200ugif I have a flare of my Thyroid Eye Disease)
Regarding your dry eye symptoms. Use preservative free eye drops liberally. Such as HycoSan or Hyloforte.
Do keep posting if you have further questions or require support. We are here to help! 🦋
Thanks so much Buddy195. That’s a really helpful point - I ate about six a day for a few days and felt a bit rough - a lot of things make me feel rough but maybe that was it this time! I’ll definitely stick to only 1 or 2 Brazil’s a few times a week.
Good advice re HycoSan thank you, I’ve got some and will make I use often, thanks again x
thanks so much SlowDragon, very helpful, I’ll check out all those links and test my stomach acid tomorrow.
The 75 pill was teva I think. And 100 is accord / North Star which I’m taking now. Started 100 dose on 30 sept I think. Definitely not feeling better or more energetic so far… I do struggle with British winters though, the damp sucks my energy!
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
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
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
thanks so much slowdragon, I felt better on teva and think I’ve had mercury too and felt ok, but hard to know if other factors involved or maybe that 100mcg doesn’t agree with me. I do try and leave an hour before breakfast after taking pill, and now take vits at lunchtime. It’s all rather complicated isn’t it! Glenmark and aristo sound good, I’ll see if I can get those.
The others have done their usual thorough, superb job covering thyroid, vit's and min's.
I'll pick up on your testosterone which is low and will add to feeling weak and muscle lose
I would absolutely recommend getting yourself down to the GP's and requesting HRT (body identical) transdermal so as not to add to your stomach issues, the cross over in symptoms with low thyroid and low sex hormones are hard to separate so you are looking to find your balance as they affect each other, it's a juggle but you'll get there 🤗
p.s. you might have to be persistent to get your testosterone depending on how up to speed your GP is 😉but they absolutely can prescribe it!
thank you so much Eeyore100, really helpful. I think my doctor is happy to prescribe testosterone so I’ll speak to her. Going to wait to see how I feel and what bloods are after the trial on 100mcg Levo. Yes it’s all a balancing act isn’t it! Incredibly grateful to you all for all your wisdom and support, I feel so informed and supported thank you 🙏
thank you so much Jaydee, SlowDragon, greygoose & Eeyore for sharing your incredible knowledge, wisdom and support. It’s helped me enormously and I feel much more informed and supported now 🙏 I’ll update you when I have some results. Wishing you all the very best with your health journeys 🥰
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Any advice welcome
Disappointed with private endo
Test results - complicated and would welcome any thoughts!
