Help with blood test results please 🙏

[Vdubbers]

I've just received my blood test. I am hypothyroid for 20 yrs, menopause, gut issues...you know the score. Currently on 50mcg levo daily, and 10mcg T3 twice daily. See photo of tests. Seeing g Dr at 4pm today. I know he wants to reduce T3. Antibodies are high.

[SlowDragon Administrator]

Welcome to the forum

Was test done early morning, ideally around 9am and last dose levothyroxine 24 hours before test

Do you always get same brand levothyroxine at each prescription

Day before test …..ideally split T3 as 3 doses

10mcg waking, 5mcg mid afternoon and 5mcg at approx 9-10pm (last dose T3 should be 8-12 hours before test)

Many (most? ) on levothyroxine plus small doses of T3 find they need BOTH Ft4 and Ft3 approx 70% through range

Currently your Ft4 is BELOW range

How much levothyroxine were you taking BEFORE T3 was added

Frequently (almost always) endocrinologist will reduce levothyroxine dose too much

Suggest you get 25mcg dose increase in levothyroxine and retest in 6-8 weeks

Ignore the low TSH

That’s just what happens when add T3

Plus your vitamin levels are poor …..probably because Ft4 is too low

Low vitamin levels tend to lower TSH too

[SlowDragon Administrator]

Your antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).  

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 with Hashimoto’s 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. 

Are you already on gluten free diet or dairy free diet?

 A trial of strictly gluten free diet is always worth doing

Only 5% of Hashimoto’s patients test positive for coeliac but a further 81% of Hashimoto’s patients who try gluten free diet find noticeable or significant improvement or find it’s essential

Similarly few months later consider trying dairy free too. Approx 50-60% find dairy free beneficial

Hashimoto’s and leaky gut often occur together

Both dairy and gluten are inflammatory foods

A 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 may 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.

[Alfie8 in reply to SlowDragon]

Hi first of all I am really surprised you have been given the extra T3 as where I live it is a NO.

[SlowDragon Administrator in reply to Alfie8]

Almost 62,000 prescriptions for liothyronine in England in last year

Searchable by ICB region

openprescribing.net/analyse...

T3 on NHS …initially must be prescribed via NHS endocrinologist

After 3-6 months trial, ongoing care and cost transferred to GP with annual review by endocrinologist

Email Thyroid U.K. for list of thyroid specialist endocrinologists and doctors who will prescribe T3

[e-mail]

Before booking any consultation get FULL thyroid and vitamin testing done

[SlowDragon Administrator]

On levothyroxine we need OPTIMAL Vitamin levels

Ferritin is too low

Red blood cells too high

high haematocrit

High haemoglobin estimation

You need more testing ….probably via haematologist

nhs.uk/conditions/polycytha...

Health conditions that can cause secondary polycythaemia include:chronic obstructive pulmonary disease (COPD) and sleep apnoea – these can cause an increase in erythropoietin, due to not enough oxygen reaching the body's tissues

Do you suffer from sleep apnea?

Very common with Hashimoto’s

thyroidpharmacist.com/artic...

pubmed.ncbi.nlm.nih.gov/227...

You need vitamin D tested

NHS easy postal kit vitamin D test £29 via

vitamindtest.org.uk

[Vdubbers in reply to SlowDragon]

So I did the sleep apnea quiz from the Dr, scored 14. So possibly. Am sleeping better, and do seem to have more energy.Dr said red blood count is too high due to smoking. So won't refer me to haematology.

Vit D was tested. See above.

Wondering how much of my symptoms are related to menopause. Daily headache, frequent migraines. Am on HRT, but don't think it's right. Used the patches successfully for a few years, but then reacted on my skin. Changed to gel ostradiol and progesterone tablet.

So symptoms here are out of breath easily, short fuse, get dizzy, and can't concentrate.

It's such a mixed bag, and seems to be forever changing. No one day is the same. Glad for any help provided.

[SlowDragon Administrator in reply to Vdubbers]

HRT tablets frequently result in needing increase in replacement thyroid hormones

Vitamin D at 85nmol is reasonable

Get increase in dose levothyroxine

[Vdubbers in reply to SlowDragon]

OK, many thanks for your help. I only went an hour early, having forgotten a my notes. So sat writing it all over a coffee (decaff) lol. Really appreciate your help 🙏

[SlowDragon Administrator]

Suggest you consider you might agree to small reduction in T3 as 3 x 5mcg …….providing Levothyroxine is increased to 75mcg daily