Lactose intolerance advice and absorption issues

[Sailing14]

I am taking my thyroxine at 7.30 am and 2 hours before breakfast with no tea before. Some days I feel I am absorbing the hormone but it doesn’t last, and I had a day recently when I had energy and wellness, but it only lasted an hour followed by intense hunger (after a meal) and then feeling like I normally do again.

I was going to trial lactose free, as my caeliac blood test was normal from last week. I have also been cleared recently of h-pylori. gastritis and ulcer.

My other results were;

Vit D 104 >49.9

Full blood count - satisfactory (I do not have print out at present)

T4 16.1 (9-19)

T3 4.3 (2.4-6)

TSH 0.24 (0.4-4.9) All taken early am before thyroxine and food.

Could I not be converting the hormone properly due to digestive issues (wind and bloating and feeling like I need to go to the toilet more)? I have previously suffered with IBS but not with these symptoms.

I have also been experiencing headaches recently and as my vitamin D was 104, I thought it may be this as if is usually around the 90 mark (I recently started to take with food so may be absorbing it more). Do I stop it for a few weeks to lower it down if the headaches are from this?

My stress levels are continuing due to ongoing issues, and I don’t know if it is making things worse with regards to my thyroid and converting maybe?

I was advised on here to take a B and D supplement following recent results of all vitamins, but I haven’t commenced the B vitamin yet due to trying to eliminate other causes.

Thank you for advice and help.

[SlowDragon Administrator]

Do you know if cause of your hypothyroidism is autoimmune thyroid disease also called Hashimoto’s

Have you had both TPO and TG thyroid antibodies tested

Gluten intolerance is extremely common with Hashimoto’s and cutting gluten out may significantly reduce IBS type symptoms

Only 5% test positive for coeliac, but further 80% find gluten free diet is beneficial or absolutely necessary

FT4: 16.1 pmol/l (Range 9 - 19)

Ft4 is 71.00% through range

FT3: 4.3 pmol/l (Range 2.4 - 6)

Ft3 not as good at 52.78%

Was test done early morning and last dose levothyroxine 24 hours before test

Do you always get same brand levothyroxine at each prescription

you need B12, folate and ferritin levels tested

For good conversion rates of Ft4 to Ft3 we need optimal vitamin levels

[Sailing14 in reply to SlowDragon]

Thank you for your reply. I had a TPO test but not TG test in February last year and it was negative. What is a TG test? My GP recently said at diagnosis in 2004, it was not autoimmune and it could have been an infection which led to hyperthyroid (I then had radio iodine and became hypothyroid).

I had test early morning and continue on the same brand (Accord). My results for vitamins were:

Vit D - 104 >49.9

Ferritin -59 (15-204)

Folate - 11.0 (3.1-20.5)

B12 - 489 (187-883)

Are these okay?

Thank you for the advice on gluten free. I will be looking into this after lactose free diet.

[SlowDragon Administrator in reply to Sailing14]

So you started with Graves’ disease…..autoimmune HYPERthyroid

Now hypo after RAI

So you may still find gluten free diet is beneficial

[Sailing14 in reply to SlowDragon]

Thank you. Is it Graves disease even though I had no antibodies at diagnosis and at a test last February?

[SlowDragon Administrator in reply to Sailing14]

For Graves’ disease endocrinologist will have tested TSi or Trab antibodies

Link about Graves’ disease

thyroiduk.org/hyperthyroid-...

Graves Disease antibodies test

medichecks.com/products/tsh...

[SlowDragon Administrator in reply to Sailing14]

Folate, ferritin and B12 might be better a little higher

Look at increasing iron rich foods in your diet to improve ferritin

And perhaps a daily vitamin B complex to help maintain good B12 and 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 

healthline.com/nutrition/fo...

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) 

Thorne currently difficult to find at reasonable price, should be around £20-£25. iherb.com often have in stock. Or try ebay 

Other options 

healthunlocked.com/thyroidu....

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

[Jaydee1507 Administrator]

Just because coeliac test was negative doesn't mean you still can't benefit from a gluten free diet. Same goes for any lactose tests. These things are intolerances and not necessarily likely to show up in any test. Just try eliminating one at a time and see if symptoms improve.

The difference between a vit D of 90 and 104 is really neither here nor there. Optimal vit D is said to be 100-150 so its unlikely to be that.

Would recommend starting on the B vitamins, hopefully a good B complex you have there?

Free T4 (fT4) 16.1 pmol/L (9 - 19) 71.0%

Free T3 (fT3) 4.3 pmol/L (2.4 - 6) 52.8%

Your conversion rate really isn't terrible and the B vitamis might just get you to where you need to be. If you could get an increase then that would help.

Digestive upsets are very common with hypo people. Often down to inbalances in the gut microbiome, also FODMAPS. Unnlikely to affect absorption or conversion. Here are some things that you can try to improve this.

►Try a low FODMAP elimination diet. monashfodmap.com/ibs-centra...

►Try adding a teaspoon of apple cider vinegar (must contain the ‘Mother’, see label) to a glass of water before your main meal. This helps acidify the stomach.

►Reduce sugar and processed (especially ultra processed) foods, they feed the bad bacteria.

►Add probiotic foods such as natural yogurt, kefir, kombucha, sauerkraut, kimchi, pickles. Dairy free versions are available in supermarkets or online. Ask staff to help you find the dairy free section, some supermarkets have a better selection than others. You can also make your own versions of these at home including water kefir.

►Eat the rainbow. This includes a variety of meats including game (if omnivore), vegetables and fruit.

Good overview of gut improvement foods: joinzoe.com/learn/how-to-im...

[Sailing14 in reply to Jaydee1507]

Thank you for your help and advice. I will try lactose free first and then maybe gluten. By doing this, what vitamins would I be lacking in for either the lactose or gluten free diet?

I have got some vitamin B supplements recommended here so I will commence them as soon as I can.

Digestive upsets are very common with hypo people. Often down to inbalances in the gut microbiome, also FODMAPS. Unnlikely to affect absorption or conversion. Here are some things that you can try to improve this.

Could you explain this again please and the absorption part particularly.

I will read through all your link this evening.

Thank you again.

[Jaydee1507 Administrator in reply to Sailing14]

I didn't mean lactose free, I meant dairy free, big difference.

Lactose is a sugar in dairy that some people can't break down which gives gut symptoms. Dairy contains proteins too and certain people find that consuming dairy and by that I mean any milk product from any animal. If you are going dairy free you need to be checking food labels carefully as milk is in many things you might not even expect it to be in such as some gravies. It also goes by other names like whey or casein, curds.

I'm not a technical person but absorption often takes place in the stomach and improving the gut makes changes further down the digestive tract.

Out of interest what was in the meal that you felt hungry after?

[Sailing14 in reply to Jaydee1507]

Thank you. If I try dairy free do I need extra vitamins because of this?

I had a roast dinner including chicken. It did not satisfy the hunger I felt and seemed to make me feel more hungrier. I can’t explain why apart from me feeling unwell again after the energy previously.

[Jaydee1507 Administrator in reply to Sailing14]

No you don't need any extra vitamins. Just be sure to be eating other sources of calcium or some non dairy milks are fortified with calcium if you are particularly concerned.

bbcgoodfood.com/howto/guide...

The roast chicken meal that made you feel worse, I would suspect the gravy that was used. I'm not sure what it is about gravy but it was one thing that used to make me feel terrible and has also happened to my son who now avoids a pubs Sunday roasts due to that. They seem to have cleaned up gravy a little as some used to contain MSG and all manner of additives. Look for gluten free ones and also dairy free with least additives.

[Sailing14 in reply to Jaydee1507]

Thank you for all your help and advice. I will look into these options.