I am 12 weeks post RAI after toxic nodules causing hyperthyroidism leading to liver and heart issues. It was urgent RAI and I have now been off my medication since the start of feb.
My bloods last month showed TSH at 0.23, free T4 at 8 and free t3 at 6.3, which from what I can work out is a mixed result. I am planning fertility treatment in September 23 and want to keep on top of my levels and what I need to be doing but have fit a brick wall in my research. Am I hyper still or hypo? Or neither? Do I need to be chasing my consultant for medication or are my levels actually ok. There is so much contradicting information out there.
Thank you in advance for your advice!
L x
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LillySP
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Please can you add ranges to lab results (ranges vary between labs)
By most ranges the TSH is low, FT4 very low and FT3 very high but within range.
TSH isn’t reliable. I have nodule taken carbimazole over 4 years & TSH has never risen.
When hyper did your FT3 run particularly high in proportion to FT4? Can occur with toxic nodules.
Your Dr may conclude you are hyper as they often go by TSH alone. I think you may need to monitor levels for a little longer to see if FT4 / FT3 drop / rise. Hopefully they will balance.
But the body often prioritises FT3 and when that’s compromised this measure could drop too & you will need replacement.
The full effect of RAI can take months.
Have nutrients been checked? Folate, ferritin, B12 & vitamin D, they can often be depleted during thyroid disfunction & treatment.
Before my treatment my t4 was in the high 30s (the week before when I was off my tablets in prep for my RAI).
My TSH was 0.02 just after treatment (about 2 weeks after, I can’t see my TSH results before treatment, just know I was hyper).
My T3 went to 17.9 before treatment (the week before when I was off my tablets in prep for RAI)
So my levels are doing something, it just feels like I am in no mans land a little at the moment. I haven’t had any other levels tested but this has been something that has been on mind in prep for diet when I am told what I need to focus on, the diets/lifestyles for hypo/hyper seem so different and that’s why I think I feel a bit stuck because I feel like I cannot actively help myself fully yet until I know where my levels will land.
I’m doing ok after my RAI treatment. I have had a couple of bad days but no palps anymore, no anxiety anymore, I do get tired easily but wouldn’t call it fatigue, My hair, nails and eyes are all getting strong again, no shakes, no more dizzy spells or rashes. I still get a migraine day here and there but probably only 2 since the RAI.
I got a cheap version of a Fitbit and tracker on there, so far my heart rate has been fine which is amazing as the hyper caused so many heart and liver problems!
Thank you, my instinct was to hold out a little longer and see what my levels do naturally after the RAI. I just want to give my body time to work with the treatment before chucking another load of tablets in my system.
Sounds like your hyper symptoms are easing but migraine / feeling tired common with hypo too.
Do you have repeat thyroid function scheduled?
Did the hyper cause AFib? Carbimazole treatment affect liver? Has this improved?
How much selenium do you take? 200mcg is ok for 6 months then reduce to 100mcg longer term.
Hyper can often cause high ferritin (iron stores) but that doesn’t necessarily mean you have good iron levels. A full iron panel should be tested.
If by prenatal you mean a multivitamin, that’s not recommended.
Many supplements include the cheapest form of supplement eg for B12 they include Cyanocobalamin, whereas Methylcobalamin is better bioavailable & absorbable form. Synthetic folic acid whereas Methylfolate is best.
Most Multis do not contain doses at meaningful level.
Taken in a multi some nutrients may bind together & not absorb either.
Many contain Biotin (in low doses) so would need to left off prior to blood tests, biotin can interfere with testing process & skew results.
Extra Iodine (in addition to normal diet) can affect those with thyroid issues in complex & unpredictable ways. Normal diet includes adequate iodine.
Recommended to complete an iron panel complete before taking any iron.
Extra calcium not recommended.
If taking D3 and K2 dietary calcium should be adequate. (K2 directs calcium to where needed -bones & teeth- away from tissues/arteries. Magnesium other vitamin D co-factor)
Always best to test & see exactly what level key nutrients are & how much to supplement by is needed.
Often GPs won’t / can’t test full thyroid function and nutrients + many use private testing companies using a fingerprick test kit, to get a full picture.
Some offer a full thyroid function / thyroid antibodies / nutrients & CRP inflammation marker eg Medichecks. Others offer function only or vitamin D separately. Eg Monitor My Health
Have you ever have thyroid antibodies tested. Usually they are tested to investigate cause & source of hyper. Presumably your nodules were discovered by ultrasound scan? Did you have an uptake scan to confirm hyper function of nodules.
Nodules are common with autoimmune but do occur without (my solitary nodule has no autoimmune involvement). Many with autoimmune find they have gluten issues. When testing for gluten you must be on a diet including gluten. This will detect any gluten allergy, but won’t detect a gluten intolerance. So recommend to test so if positive a confirmation investigation can be undertaken. Then you can trial strictly gluten free diet. Gluten reduction will be on no benefit - has to be total.
Things to remember when testing:
(C + D won’t apply as not on replacement)
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
Not since last year, I will call my doctor Monday and ask for a vitamin blood test of the above, thank you. I did ask about starting prenatals in prep for fertility treatment at the end of the year but was told no as I am not allowed to take iron, wasn’t really explained why.
I only take selenium for my eyes, hair and nails, nothing else at the moment. I cant seem to find a start answer where I am going through the RAI part of the treatment. I am tried speaking to Nutritionist and a homeopath but all said they wont touch me until after the 6 month mark. I just want to feel like I am doing my best to work with the RAI treatment and not against it.
I am not on a gluten free diet no, I didn’t know if it would fully help in the this situation but will 100% look into this.
As I understand things you will ultimately become hypothyroid as the RAI will slowly burn out your thyroid in situ.
When metabolism runs too fast as in hyperthyroidism or too slow as in hypothyroidism the body struggles to extract key nutrients through food no matter how well and clean you eat.
It is essential therefore to maintain ferritin, folate, B12 and vitamin D at optimal levels to help support your body through this period, and perhaps longer term.
Going forward it is essential that you are dosed and monitored on Free T3 and FreeT4 readings and not a TSH reading seen isolation.
If your eyes are sore, dry, watering and light sensitive please ensure that any potion, spray drops or ointments you use are all Preservative Free - even those prescribed by the NHS.
I have Graves Disease ad was treated with RAI thyroid ablation back in 2005.
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