Test Results Advice

[Belinda1136]

Good Morning,

I was diagnosed around 7 years ago and last 9 months or so have been felling pretty awful - no energy, forgetful, hair falling out, vertigo worse than usual, dry skin and if you were to just place your hand around your throat no pressure that is what I feel all the time

I was on 125mg of levo (same brand) for the last 6 years with annual checks that have gradually been getting worse but Dr kept saying they were in range.

Tests on 17th April showed (test done at 8:30am no levo taken before the test)

Serum TSH Level 5.16 mlU/L (range 0.40 to 4.90)

Serum Free T4 Level 12.1 pmol/L (range 9.0 to 19.0)

Anti-TPO antibody 810.0 (range 0.0 to 24.9)

After these results my Dr gave me a 25mg increase to150mg levo and I have seen a slight improvement mainly to skin and vertigo but still very tired

New results on 5th June show (test done at 9am no levo taken before the test)

Serum TSH level 0.29 (range 0.40 to 4.90)

Serum free T4 15.1 pmol/L (range 9.0 to 19.0)

Serum Free T3 4.3 (range 2.6 to 5.7)

Anti-TPO antibody 919.0 (range 0.0 to 24.9)

I am now not sure what to expect when I go to my next Dr appointment next week and am concerned they will want to reduce my dose again and I will be back to square one. Also confused why my Anti-TPO antibodies are getting worse?

Any advice would be appreciated.

Thank You

[SlowDragon Administrator]

Was new test done early morning and last dose levothyroxine 24 hours before test

Do you always get same brand levothyroxine at each prescription

How long since dose increase

Refuse to reduce dose

FT4: 15.1 pmol/l (Range 9 - 19)

Ft4 only 61.00% through range

FT3: 4.3 pmol/l (Range 2.6 - 5.7)

Ft3 only 54.84% through range

Request GP test vitamin D, folate, B12 and full iron panel test including ferritin

Low vitamin levels extremely common with autoimmune thyroid disease, especially if been left under medicated as you have been

We need GOOD vitamin levels for good conversion of Ft4 (levothyroxine) to Ft3 (active hormone)

Hairloss linked to low iron/ferritin

Low iron/ferritin will cause fatigue

What vitamin supplements are you currently taking?

Are you pre or post menopause

Vegetarian or Vegan

High thyroid antibodies confirms autoimmune thyroid disease also called Hashimoto’s

Assuming you are not already on strictly gluten free diet

Request coeliac blood test done as per NICE guidelines

[Belinda1136 in reply to SlowDragon]

Thank you for both your responses.

Yes test were done early morning and no levo for 24 hours before, do have the same brand of Levo

Only taking Vit B Complex as that was low on tests earlier in the year.

Thank you for all the information and links, I will read though it

[SlowDragon Administrator in reply to Belinda1136]

Remember to stop vitamin B complex 5-7 days before any test as contains biotin

In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate folate supplement (eg Jarrow methyl folate 400mcg)

[SlowDragon Administrator in reply to Belinda1136]

was retest done at least 6-8 weeks after increase in dose levothyroxine

Do you always get same brand levothyroxine at each prescription

Strongly recommend you get vitamins tested before any consultation

All four vitamins need to be optimal

Frequently necessary to be strictly gluten free and/or dairy free

[SlowDragon Administrator]

Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels 

Low vitamin levels affect Thyroid hormone working and results in symptoms due to low vitamin levels

Extremely common to need to supplement vitamin D, vitamin B complex and magnesium daily

Many also initially need separate B12

And many members struggle to maintain good iron/ferritin

But ALWAYS test first before starting any supplements and retest at least annually

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