blood results

[Zoe1979]

hi could anybody read these for me please I understand I have an under active thyroid but is it really low or moderately I don’t really understand it 🤦‍♀️

[SlowDragon Administrator]

Sorry image isn’t readable

Can you reattach in a reply within this post

Click on reply and choose the rectangle with mountain…..add image

Was test done early morning

[Zoe1979 in reply to SlowDragon]

I really can’t remember

[helvella Administrator in reply to Zoe1979]

I've removed the image because it reveals information that is best not published. Including names of two individuals, your GP practice, etc.

(The image on your original post is so bad, I cant make out if there is any such information or not!)

Please try to avoid posting such information for your own safety and security as well as that of those who work in the practice. Fold the paper, edit the image, use a black felt-tip, zoom in/get closer when taking photo?

[Zoe1979 in reply to helvella]

think it’s easier I just write them down Thankyou for explaining what I need to do this brain fog I have it terrible 🤦‍♀️

[helvella Administrator in reply to Zoe1979]

It's often the case! But I had to explain why I removed your image anyway.

[tattybogle]

Hi Zoe, could you type them i like this: (picture its to blurry to read )

TSH result [range ]

fT4 result [range]

[Zoe1979 in reply to tattybogle]

I’m trying to put 3 lots on but won’t let me I’m useless 😂

[tattybogle in reply to Zoe1979]

you can only add one image in the main post, and one image per reply.

[Zoe1979 in reply to tattybogle]

aww ok I’ve got 3

[Zoe1979 in reply to Zoe1979]

can you see any without it being blurry

[tattybogle in reply to Zoe1979]

nope .... sometimes it's less stressful to just type them in .

have you got a TSH result and an fT4 result ?

[Zoe1979 in reply to tattybogle]

hi I’ve just sent them 😁

[Zoe1979 in reply to tattybogle]

tsh is 10.9mIU/L Serum t4 is 3.4pmoI/L

[tattybogle in reply to Zoe1979]

after the fT4 results there should be a range , [7-14 ] or [12-22] or something else .. what is it ?

[SlowDragon Administrator in reply to Zoe1979]

So TSH is over 10 and Ft4 is below range so you have clinical hypothyroidism

Roughly how old are you?

Have you seen/spoken to GP

You will need to be started on levothyroxine

Standard starter dose is 50mcg

ALWAYS take levothyroxine on empty stomach and then nothing apart from water for at least an hour after

Many people taking it waking up (or set alarm for 1 hour before you need to get up)

But can be more convenient to take at bedtime. But nothing apart from water for at least an hour before and a meal at least 2 hours before

Bloods will need retesting 6-8 weeks after starting on levothyroxine

GP should also have tested thyroid antibodies to see if cause of your hypothyroidism is autoimmune

and important to test vitamin D, folate, ferritin and B12

Request these are tested now if not been tested yet

About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high thyroid antibodies 

Autoimmune thyroid disease with a goitre is Hashimoto’s

Autoimmune thyroid disease without goitre is Ord’s thyroiditis. 

Both are autoimmune and generally called Hashimoto’s.

Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)

20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis 

In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)

Recommended that all thyroid blood tests early morning, ideally just before 9am and last dose levothyroxine 24 hours before test 

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

[Zoe1979]

12-22.0

[tattybogle in reply to Zoe1979]

TSH 10.9 (this is be over range , all TSH ranges are aprox 0.4 - 5 ish )

Serum T4 3.4 [12-22]

ok so those are "very" hypothyroid results,

They are classed as 'overtly hypothyroid' becasue the TSH is over range AND the fT4 is VERY below range .

Some basics to help you understand :

TSH is Thyroid Stimulating Hormone which is just a message form your pituitary (brain) to your thyroid asking it to try to make more thyroid hormones ( T4 and T3)

When the thyroid has a problem and it can't make enough T4 ,, the TSH rises to try to stimulate it to make more T4 (and T3).

if the thyroid can't manage to make any more T4 you end up with result like yours .. a high TSH and low T4.

and as a result of the low T4 ( and eventually low T3) you get symptoms of hypothyroidism (not enough thyroid hormone).

Think of TSH and T4/T3 sitting on opposite ends of a see saw :

.. as T4/T3 go lower ... TSH goes higher .

as T4/T3 go higher ....TSH goes lower .

When you replace the low T4 with replacement thyroid hormone , the TSH will go lower again.

The high TSH isn't the problem that causes symptoms though, it is the low T4 /T3 that causes symptoms .

once hypothyroidism is is diagnosed .. the low T4 is replaced by T4 from a daily tablet , which is the same thing as your own thyroid made.

 SlowDragon

TSH 10.9

Serum T4 3.4 [12-22]

[Zoe1979 in reply to tattybogle]

Thankyou for this information very greatful, I have other blood results what I’m concerned with can you read these as well if I send them please

[SlowDragon Administrator]

Can see you made another post about acid reflux and histamine intolerance

Acid reflux is EXTREMELY common hypothyroid symptom and will improve as dose levothyroxine is slowly increased over coming months

Assuming your hypothyroidism is autoimmune…..

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. 

 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

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 - as per NICE guidelines.

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.

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

Hashimoto’s and leaky gut often occur together

[Zoe1979 in reply to SlowDragon]

Thankyou for this information and yes I’ve had a diagnosis of leaky gut, the problem I have is I’m reacting to every food and supplement the histamine intolerance is torturing me 🤦‍♀️ and I’m only eating 3 foods which is chicken sweet potatoe and coconut oil. I’ve kind of scared myself as well I don’t know which way to turn getting no luck from drs as they aren’t familiar with histamine intolerance

[SlowDragon Administrator in reply to Zoe1979]

Have you started on levothyroxine yet

Unless you know you are lactose intolerant, perhaps try to avoid Teva brand levothyroxine initially

Most easily available (and often most easily tolerated) are Mercury Pharma or Accord

Mercury Pharma make 25mcg, 50mcg and 100mcg tablets 

Mercury Pharma also boxed as Eltroxin. Both often listed by company name on pharmacy database - Advanz 

Accord only make 50mcg and 100mcg tablets. Accord is also boxed as Almus via Boots

 Many patients do NOT get on well with Teva brand of Levothyroxine. Teva is lactose free.

Teva contains mannitol as a filler instead of lactose, which seems to be possible cause of problems. Mannitol seems to upset many people, it changes gut biome 

Teva is the only brand that makes 75mcg tablet. 

So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half

But for some people (usually if lactose intolerant, Teva is by far the best option)

Aristo (currently 100mcg only) is lactose free and mannitol free. 

March 2023 - Aristo now called Vencamil

healthunlocked.com/thyroidu...

Wockhardt is very well tolerated, but only available in 25mcg tablets. Some people remain on Wockhardt, taking their daily dose as a number of tablets 

 

List of different brands available in U.K.

thyroiduk.org/if-you-are-hy...

Posts that mention Teva

healthunlocked.com/search/p...

Teva poll

healthunlocked.com/thyroidu...

Once you find a brand that suits you, best to make sure to only get that one at each prescription.

Watch out for brand change when dose is increased or at repeat prescription.

Government guidelines for GP in support of patients if you find it difficult/impossible to change brands 

gov.uk/drug-safety-update/l...

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. 

academic.oup.com/jcem/artic...

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).

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

verywellhealth.com/best-tim...

markvanderpump.co.uk/blog/p...

markvanderpump.co.uk/blog/p...

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

[Zoe1979]

drs had to take me of it I was allergic to it making my nose run and rash’s etc yes I’ve had test for dairy and I’m lactose intolerant