More advice please!

[UKmale_hypo]

Hi All -

Thanks for all who responded to my post here - healthunlocked.com/thyroidu......

I do think my next step is to investigate/test vitamin D, folate, B12, and ferritin. This is not an aspect that I know much about, so I have various questions.

A very quick recap on my situation first:

Established partial idiopathic hypopituitarism with growth hormone deficiency diagnosed and treated since Nov 2020, which gave huge improvements. But not all symptoms relented, and those remaining all look like hypothyroidism. Results (see picture) showed Central Hypothyroidism (CH). I increased dose to 150mcg on 20th March and am due further testing. I intend to ask for the following:

FT4

FT3

TSH

Vitamin D

Folate

Vitamin B12

Ferritin

Cortisol

First question - do I need anything else tested and why?

Regarding Vitamin D, Folate, Vitamin B12, and Ferritin, it would help me to know a little more on how and why these are important regarding the thyroid so I can help myself and interpret my results properly. Excuse my ignorance.

Do deficiencies in these things cause a lack of absorption of thyroid meds, such that one would struggle to get FT4 up, or will FT4 rise with medication but the deficiencies prevent the body from using the thyroid hormone properly, resulting in still feeling symptomatic?

Does hypothyroidism CAUSE these deficiencies, and do they develop more the longer one goes untreated?

When the deficiencies are corrected with medication, and (hopefully) the thyroid treatment then works, will one's body then potentially be able to maintain the levels properly, or will levels constantly deplete and need topped up?

I also wonder if there might be a cortisol issue too, although my last morning cortisol was 315 nmol/L [133-537] with a corresponding ACTH of 24 ng/L [0-46]. However I have difficulty getting up in the morning, fatigue, and sexual dysfunction, and just wonder if there might be a cortisol element to this, though these numbers do seem reasonable.

Many thanks in advance!

[SlowDragon Administrator]

will FT4 rise with medication but the deficiencies prevent the body from using the thyroid hormone properly, resulting in still feeling symptomatic? 

Yes for good conversion of Ft4 (levothyroxine) to Ft3 (active hormone) we need OPTIMAL vitamin levels

Does hypothyroidism CAUSE these deficiencies, and do they develop more the longer one goes untreated? 

yes. Being hypothyroid frequently results in LOW stomach acid, this results in poor nutrient absorption from foods and low vitamin levels

When the deficiencies are corrected with medication, and (hopefully) the thyroid treatment then works, will one's body then potentially be able to maintain the levels properly, or will levels constantly deplete and need topped up? 

High percentage of patients on replacement thyroid hormones find they need to supplement vitamin D and vitamin B complex continuously

Some people find they need separate B12 initially…..or possibly ongoing, especially if vegetarian or vegan

Many thyroid patients, especially women pre menopause, struggle to maintain ferritin levels.

I also wonder if there might be a cortisol issue too

Adrenals try to compensate for lack of thyroid hormones. Initially this often results in high cortisol levels. But eventually can result in low levels as adrenals fail to keep making increased levels

Regenerus cortisol and DHEA test may be helpful

regeneruslabs.com/products/...

portal-app.inspira-regeneru...

Improving conversion rate of Ft4 to Ft3 by maintaining optimal vitamin levels may improve Ft3 levels enough to improve cortisol issues

Or may need addition of small doses of T3 prescribed alongside levothyroxine if Ft3 still remains low

Being male…….also important to test testosterone levels

[UKmale_hypo in reply to SlowDragon]

Many thanks for all this information - very useful. I am messaging my endo today to ask for all this testing.