Could I please ask for your advice again with my latest thyroid results, I have an appointment with my doctor next week, so would appreciate your thoughts before I go and see her.
I recently started on HRT, about three months ago so wanted to see how my thyroid was being affected.
I still do not feel brilliant, constantly tired, everything an effort, weight gain since my medication was lowered earlier this year is a stone and do not seem to be able to loose anything. Bad constipation. When I last spoke to my doctor she said my thyroid was fine and it was all because of the peri-menopause, which I understand as they have very similar symptoms.
Thanks for all your help.
Thyroid Hormones
TSH 0.60 mU/L (Range: 0.27 - 4.2)
Free T3 4.35 pmol/L (Range: 3.1 - 6.8)
Free Thyroxine 18.5 pmol/L (Range: 12 - 22)
Autoimmunity
Thyroglobulin Antibodies X 322 IU/mL (Range: < 115)
Thyroid Peroxidase Antibodies X 396 IU/mL (Range: < 34)
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Kay1566
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Yes the test was 7.45 in the morning and yes last dose of levothyroxine the morning before.
I currently take 112.5 levothyroxine, I was on 150 but it was reduced at the beginning of the year to 125 and then 112.5,
Yes it seems to be the same brand, accord 100 - teva 12.5.
So I am having to retake the ferritin and folate as the labs were unable to test with the blood sample. Vitamin D - 78 nmol/L range 50-100, I was defficient last year so supplemented, but my doctor told me to stop in March, so have not taken any since.
I am using the estrogen gel and progesterone tablets. I had read that you might need an adjustment once starting HRT, so asked my doctor if I could have a blood test to check how things were.
No I a not on a gluten free or diary diet, but have had coeliac tests and they came back negative.
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).
Netherlands (and Germany?) guidelines are for thyroid patients to always get same brand levothyroxine at each prescription
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
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
Always worth trying strictly gluten free diet with Hashimoto’s ….suggest you consider it in New Year
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 test positive for coeliac, but a further 80% find strictly gluten free diet helps or is essential due to 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.
Thank you Slow Dragon, I appreciate your help.No I am not taking any B supplements, but my B12 always seems high but no one knows why.
I shall ask to change the brand of my medication and speak to my GP next week, but whenever I ask to increase and explain why she won't have it and just says it was too low before, but I think for me to feel a bit normal I need my levels low, it is very frustrating.
It’s the message from pituitary asking thyroid to function
Many, many people will have very low or suppressed TSH when adequately treated
As long as Ft3 is not over range you’re not over medicated
You may need to go over GP’s head and see an endocrinologist if GP won’t increase dose levothyroxine
Approx how much do you weigh in kilo
Guidelines on dose levothyroxine by weight is that typical dose is 1.6mcg per kilo per day
Some people need higher dose, few need a bit less
Most important results are always Ft3 followed by Ft4
If GP says " I have to reduce your dose because the guidelines say i can't let you have a below range TSH" .....
The first paragraph in the NICE (NHS) Thyroid Disease, Assessment and Management guidelines says :
nice.org.uk/guidance/ng145
"Your responsibility
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian. "
Comprehensive list of references for needing LOW TSH on levothyroxine
I feel like I'll never understand how to interpret thyroid and nutritional tests. Would be fantastic if there was a course to figure it all out! I guess it's a matter of reading these threads and other good sources until it becomes second nature. Hats off to these clever, kind admin on Health Unlocked!
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