hi everyone I have had an under active thyroid for many years and treated with Levothyroxine then in 2019 it went over active and I was put on carbimazole then back to under active again. I have recently had bloods done
TSH 0.100
T3 6.8
T4 24.8
Can anyone work out what is going on
welcome to forum
How much carbimazole have you been given & for how long. How long have you been off hormone replacement / antithyroid for?
What are ranges of FT4 & FT3, by most ranges they are high but not very over range.
What thyroid antibodies have been tested?
TPOab (Thyroid Peroxidase antibodies)
TGab (Thyroglobulin antibodies) - Both signify thyroid autoimmune affecting thyroid - can be either under active or over active.
If hyper Graves suspected this can be confirmed by;
TSI - Thyroid-Stimulating Immunoglobulin (signifies hyper Graves)
TRab - TSH receptor antibodies (TRAb) (signifies Graves)
Suspect you have Hashimoto’s (autoimmune) and a temporary rise can occur from the damage to thyroid and release of hormone. Carbimazole should used and it’s not an over production the levels will lower too quickly.
TSH: 0.38 -5.33 mU/L, Free T4 7.9 – 14.4 pmol/L, Free T3: 3.8 – 6.0 pmol/L
When I went over active in 2019 and said that I had hashitoxicosis they put me on carbimazole for about 6 weeks from the end of 2019 I have been back on Levothyroxine
Also essential to test vitamin D, folate, ferritin and B12
Was this test done early morning
What are you currently taking …..Levo or Carbimazole
100mcg Levothyroxine
My folate was 2.3 and on folic acid and my B12 was 385
Test was done at 10am
Had you taken levothyroxine in morning before blood test?
when were vitamin D and ferritin levels last tested
Please add results
B12 too low as well but not low enough for GP to prescribe
on Levo it’s essential to maintain GOOD vitamin levels
Have you started folic acid supplements?
Ideally you should start B12 supplements first before adding folic acid
Low B12
b12deficiency.info/signs-an...
methyl-life.com/blogs/defic...
Do you have Low B12 symptoms
With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a B12 supplement
When you finish your prescription folic acid look at starting a vitamin B Complex
Then once your serum B12 is over 500 (or Active B12 level has reached 70), you may be able to reduce then stop the B12 and just carry on with the B Complex.
If Vegetarian or vegan likely to need ongoing separate B12 few times a week
Very effective B12 drops
natureprovides.com/products...
Or
B12 sublingual lozenges
uk.iherb.com/pr/jarrow-form...
cytoplan.co.uk/shop-by-prod...
B12 range in U.K. is too wide
Interesting that in this research B12 below 400 is considered inadequate
healthunlocked.com/thyroidu...
When completed folic acid prescription
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...
Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid.
thyroidpharmacist.com/artic...
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 any blood test, when you stop vitamin B complex, you might want to consider taking a separate folate supplement and continue separate B12
Have you had coeliac blood test
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 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 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
TSH 0.100 (0.38 - 5.33)
FT3: 6.8 pmol/l (Range 3.8 - 6) 136.36%
FT4: 24.8 pmol/l (Range 7.8 - 14.4) 257.58%
Hashitoxicosis is transient elevation & not from thyroid overproducing but from damaged thyroid cells releasing hormones stores. (During autoimmune attacks)
Carbimazole stops / reduces production of new hormone & therefore should only be given if thyroid continuously overproducing, not what happening during Hashtoxicosis. Which is why you became hypo again & went back on levo.
Your levels are currently quite high with FT4 2.5X Normal range & FT3 elevated too. Had you taken levo a few hours before mid morning test? If so may be falsely higher but I would say is far higher than it should be.
Usually levo is adjusted by 25mcg per day at a time if over medicated. What did doctor suggest? You might want to reduce by a more or just take a very low dose temporarily. If Doctor suggests you are hyper & stop or restart carbimazole - don’t agree.
Retest in 6 weeks. Most nutrients need to be in top 50% of range & ranges vary between labs so you need to add result & range.
Things to remember when testing:
A - Always check what’s being tested & collect test results with reference range.
B - Biotin - cease 3 days before draw to avoid possible test interference
C - Consistent unchanged dose - minimum 6 weeks previously before retest
D - Delay replacement dose on day of test (take after blood draw)
E - Early morning appointment. (Book as close to 09.00 as possible) F - Fast overnight. This can have a slight impact. Drink lots of water
Hello Steph and welcome to the forum :
You have a diagnosis of Hashimoto's auto immune thyroid disease which can present with periods of over range T3 an T4 readings when your immune system is active and mistakenly attacking your thyroid rather than defending it.
These episodes are transient and the T3 and T4 usually fall back down into range by themselves and not usually medicated with an Anti Thyroid drug - Carbimazole - which blocks / disrupts your own daily natural production of T3 and T4 thyroid hormones.
An AT drug is generally only prescribed when the diagnosis is Graves Disease which is much higher levels of T3/T4 which keep building and seen as life threatening if not medicated.
You might like to read around Hashimoto's AI thyroid disease and many forum members find the research of Dr Izabella Wentz very useful. thyroidpharmacist.com
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