Newly diagnosed with under active thyroid

[888F]

I’m looking for some help in understanding my test results please. I’ve had two blood tests 4 weeks apart to test my thyroid function as I was having issues such as low mood, weight gain, insomnia’ low libido and fatigue. My GP called me last week and said based on my results I am developing an under active thyroid and has put me on 50mg daily of Levothyroxine which I’ve taken since Friday and will do another blood test in 8 weeks time. I have a printed copy of my first results and will ask for my second ones to be printed at my next appointment with the nurse. I only know the TSH has increased from 11 to 18.7. Can anyone help me make sense of my results? Thank you.

[SeasideSusie Remembering]

888F

Yes, we can interpret your results for you, when you have them then post results with reference ranges and we will comment, they should look like, eg

TSH: 5 (0.27-4.2)

FT4: 9 (12-22)

Post everything you have.

The fact that your TSH has risen and that they are both over range confirm overt hypothyroidism.

You should take your Levo on it's own, one hour before or 2 hours after food, with a glass of water and water only either side, no otber medication or supplements for two hours (some need four hours), this all ensures that nothing affects absorption of the Levo.

When doing thyroid tests we advise

* No later than 9am for highest TSH which usually is needed when looking for an increase in your dose or to avoid a reduction

* Water only before the test so that no food or drink affects TSH

* Last dose of Levo 24 hours before the test to avoid a false low or false high FT4

* No biotin or B Complex for 3-7 days before the test as this gives false results .

[888F in reply to SeasideSusie]

Thank you. I have had three blood tests and have taken a photo of the results if you can help me make sense of them. My GP hasn’t seen me in person and told me I wasn’t unwell and just to take my medication. Would appreciate any help.

Results

[SeasideSusie Remembering in reply to 888F]

888F

That's one blood test. Do you have the results/ranges of the others please including your most recent one? There is no doubt with results of a TSH of 18.74 (0.35-5.00) along with TPO antibodies of1557.7 (<6.0) that you have Hashimoto's - autoimmune thyroid disease - the main cause of hypothyroidism.

Are you still taking 50mcg Levo?

Do you take your Levo and do your thyroid tests as outlined in my first reply above?

[888F in reply to SeasideSusie]

Hi, I am now on 75mg of Levo and take it first thing in the morning and don’t eat anything for 2 hours after it. I’ve moved the time of my vitamins to evening too. I’ll post my latest results - I thought I uploaded them too but it ja at worked. Thank you for taking the time to help.

Results

[SeasideSusie Remembering in reply to 888F]

888F

So your latest results from 31st May are

TSH: 9.83 (0.35-5.00)

FT4: 10.6 (9-21)

I am now on 75mg of Levo

Was your dose increased to 75mcg after this test upon seeing the results or were you already on 75mcg Levo when this test was done?

I see the latest test was done at around 1pm. It is better to do thyroid tests at 9am or very close, this becomes more important as you get nearer to your optimal dose. The reason for this is because TSH is highest early morning and lowers throughout the day. We need the highest possible TSH when testing because if you have a low TSH from a later test then you risk having a reduction in your dose of Levo or you may miss out on an increase.

and take it first thing in the morning and don’t eat anything for 2 hours after it.

You don't need to wait 2 hours to eat. Advice is to take Levo one hour before or two hours after food. So if you took your Levo say at 7am you could have breakfast at 8am.

Vit D: 52nmol/L

This is very low. The Vit D Council, Vit D Society and Grassroots Health all recommend a level of 100-150nmol/L with a recent blog post on Grassroots Health recommnding at least 125nmol/L.

Do you take a Vit D supplement? If so what dose daily? And do you take it's important cofactors magnesium and Vit K2-MK7?

[888F in reply to SeasideSusie]

Hi, my blood test was at 08:50am I don’t know why it shows 1pm . I was moved from 50mg to 75 mg after these results. I take 2000iu of Vitamin D3 +K2 everyday and have done for around 7 months. I also take 200mg of Magnesium everyday. Thanks.

[SeasideSusie Remembering in reply to 888F]

my blood test was at 08:50am I don’t know why it shows 1pm

Ah, it's probably the time that it was tested then

I was moved from 50mg to 75 mg after these results.

So that was the correct thing to do. You will now need testing again 6-8 weeks from the increase. You still have a long way to go so I expect another one or two increases will be needed. Unfortunately this can't be rushed, we can't increase more than 25mcg at a time and we must leave a few weeks after the increase for levels to settle.

I take 2000iu of Vitamin D3 +K2 everyday and have done for around 7 months.

OK, well that's not enough. You might want to check out a recent post that I wrote about Vit D and supplementing:

healthunlocked.com/thyroidu...

and you can check out the link to how to work out the dose you need to increase your current level to the recommended level.

Your current level of 52nmol/L = 20.8ng/ml

On the Vit D Council's website

web.archive.org/web/2019070...

you would scroll down to the 3rd table

My level is between20-30 ng/ml

The Vit D Council, the Vit D Society and Grassroots Health all recommend a level of 100-150nmol/L (40-60ng/ml), with a recent blog post on Grassroots Health mentioning a study which recommends over 125nmol/L (50ng/ml).

So now you look at how much is needed to reach 50ng/ml and you'll see that they suggest 3,700iu per day.

Bearing in mind that your only 20.8 you could also look at the 2nd table for current level between 10-20ng/ml and you'll see that one suggests 4,900iu D3 daily.

You should be perfectly OK to supplement with 4,000iu D3 daily so just double your current dose and retest after 3 months. You can come back with new result for guidance or use the Vit D Council's table to work out if you need to adjust your dose.

I also take 200mg of Magnesium everyday.

That's good, the magnesium helps the body convert the D3 into it's usable form. Magnesium should be taken 4 hours away from thyroid meds.

However, another important cofactor of D3 is Vit K2-MK7.

D3 aids absorption of calcium from food and Vit K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems such as hardening of the arteries, kidney stones, etc. 90-100mcg K2-MK7 is enough for up to 10,000iu D3.

D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds if taking D3 as tablets/capsules/softgels, no necessity if using an oral spray. D3 and K2 shouldn't be taken at the same time unless both supplements contain their own fat for absorption, otherwise they will compete for any fat available and you wont necessarily get best benefit from both.

For Vit K2-MK7 my suggestions are Vitabay, Vegavero or Vitamaze brands which all contain the correct form of K2-MK7 - the "All Trans" form rather than the "Cis" form. The All Trans form is the bioactive form, a bit like methylfolate is the bioactive form of folic acid.

Vitabay and Vegavero are either tablets or capsules.

Vitabay does do an oil based liquid.

Vitamaze is an oil based liquid.

With the oil based liquids the are xx amount of K2-MK7 per drop so you just take the appropriate amount of drops.

They are all imported German brands, you can find them on Amazon although they do go out of stock from time to time. I get what I can when I need to restock. If the tablet or capsule form is only in 200mcg dose at the time I take those on alternate days.

Another "all trans" one worth considering if the others aren't availaable:

amazon.co.uk/Vitality-Biore...?

[888F in reply to SeasideSusie]

wow so much great information! Thank you for your time Seaside Susie. I’ll need to digest the information in chunks. So much more I still need to learn about my diagnosis so I’m grateful for this group.

[tattybogle]

Hi 888F

simplified explanation .

TSH (Thyroid Stimulating Hormone ) ~ this is a message from the pituitary to the thyroid asking it to make more/ or less thyroid hormones (T4 / T3)

when T4 goes too low , the TSH level goes up to ask thyroid to try to make more T4.

if thyroid is able to make enough T4, then TSH goes down again ,

but if thyroid can't make enough T4 for some reason , then TSH continues to rise.

The most common reason for the thyroid being unable to make enough T4 is the immune system (mistaking the thyroid for an invader) has been damaging the thyroid ~ this is Autoimmune Thyroid Disease (Hashimoto's/ Ord's )

You TSH has risen to 11 to ask for more T4 , but your thyroid couldn't make enough T4 .. hence TSH rose higher to 18 (and was probably even higher on latest test), but T4 is already very low , and would get lower over time .

Hence the symptoms ..caused by not enough thyroid hormone (T4 / T3)

The cause of your hypothyroidism is definitely autoimmune , we can tell from the very high TPOab result (Thyroid Peroxidase antibodies) .

When the thyroid is damaged by the immune system , some Thyroid Peroxidase (from inside the thyroid) is spilled , and these antibodies attach to this spilled thyroid peroxidase as markers , and so they are very useful for diagnosis.

Autoimmune Thyroid Disease causes slow ongoing damage to the thyroid over many years , the damaged thyroid tissue can't regenerate , the T4 goes below range, and eventually the T3 will go below range (T3 is the most important one) ..... causing worse and worse symptoms of hypothyroidism .

Levothyroxine is replacement T4.

[888F in reply to tattybogle]

thank you for the explanation. I appreciate it.