thyroid results

[Tjqui00]

I reduced my thyroxine dose in January and instead of my ft4 coming down, it went up higher over range. They don’t seem to test ft3 anymore so I had a private test done ok medichecks. My results have just come in at TSH <0.005, FT4 29.4 (range 12-22), FT3 7 (range 3.1-6.8). I’m on 100 mcg at the moment and reluctant to reduce it again but it looks like I’m going to have to. My TSH has been suppressed as long as I cam remember even when FT3 has been mid range.

[SeasideSusie Remembering]

Tjqui00

You have Hashi's, your results are typical of a Hashi's "hyper" swing. It would seem logical to temporarily reduce your dose of Levo. Don't let GP reduce your prescription though or you might not be able to get it increased again when required. Maybe reduce, do private tests to check your levels, then adjust dose as required.

[Tjqui00 in reply to SeasideSusie]

Yes, my thyroid auto antibodies are over 1,000. I don’t have symptoms of being over, haven’t lost weight or anything. How much would you reduce by? Doctor wanted me to reduce to. 75 mcg but I thought that was too much. I was on 125 one day and then 100 for 2 days and FT4 was 17, then reduced to 100 every day and FT4 went up to 19. I don’t ever remember my TSH being in range.

[SeasideSusie Remembering in reply to Tjqui00]

There's no saying how long this phase will last. The important thing, in my opinion and others, is to get FT4/FT3 into range. Some people stop Levo for a few days and restart when hypo symptoms return. Others find a reduction in dose is enough. I have no personal experience as I don't have Hashi's so it's up to you which way you go. If you decide to reduce, because of the levels you currently have I would probably go for a 25mcg reduction if it was me. You'll soon know when hypo symptoms return and you can retest and readjust dose when necessary.

I wouldn't worry about TSH, mine has been suppressed for over 20 years and my FT4/FT3 are always in range. In my case I have been diagnosed/treated since 1975 and I expect my pituitary is no longer talking to my thyroid, ie the feedback loop is broken.

Of course, my comments are based on you taking your last dose of Levo 24 hours before the test as we always advise, taking it before the test gives a false high FT4 result, also that you haven't taken any supplement containing biotin (eg B Complex) for 3-7 days before the test as this can give false results.

[Tjqui00 in reply to SeasideSusie]

I took my thyroxine 24 hours before and didn’t on the morning of the test. I do take vitamin b12 sometimes, but not for a at least a couple of weeks but might have taken it before the test I had from my GP.

Are you just on levothyroxine? I think T3 medication can suppress TSH. I’m only on levothyroxine.

[SeasideSusie Remembering in reply to Tjqui00]

vitamin b12 sometimes, but not for a at least a couple of weeks but might have taken it before the test I had from my GP.

That is not biotin unless you have a combined supplement. B12 wont affect your test results.

Yes I take some T3 and yes it can suppress TSH but my TSH was suppressed for many years before I added T3. Considering I've been taking Levo for 48 years I expect, as I say, the feedback loop is broken.

[SlowDragon Administrator]

Do you always get same brand levothyroxine at each prescription

When were vitamin D, folate, ferritin and B12 levels last tested

As you have Hashimoto’s are you on gluten and/or dairy free diet

[Tjqui00 in reply to SlowDragon]

I’ve always had the same brand. I haven’t gone gluten free or dairy free. Should I? I’m having a celiac test when I next get my thyroid tested so can’t go gluten free before that, although I would find it hard to.

Vitamin B12 is 331 ng/l, ferritin 48 ug/l, folate 12.3 ng/ml. Haven’t had vitamin D tested. Iron panel results were fine.

[SlowDragon Administrator in reply to Tjqui00]

please add ranges on these vitamin results

B12 and ferritin both look on low side

Gluten and Hashimoto’s

Yes important to remain on high gluten diet until had coeliac test

Assuming coeliac test is negative

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

If coeliac test is positive you will likely 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

[SlowDragon Administrator in reply to Tjqui00]

NHS easy postal kit vitamin D test £31 via

vitamindtest.org.uk

Aiming for vitamin D at least around 80nmol and between 100-125nmol maybe better

[Tjqui00]

The trouble is, my GP wants me to reduce by dose even if my FT4 and FT3 is in range, if my TSH is suppressed. She said if it’s still out of range in August, then I need to either reduce my dose or be referred to an endocrinologist. Not sure i want to be referred as I think an endocrinologist will reduce my dose based on my TSH as well.

[SlowDragon Administrator in reply to Tjqui00]

improving low vitamin levels can improve conversion and uptake of thyroid hormones

Important to maintain OPTIMAL vitamin levels

Serum B12 at least over 500

Folate at top of range

Ferritin at least over 70

Gluten Free/dairy free often improves absorption and gut function

[Decant]

I've not used them myself, but there are "sympathetic" endos available I think who aren't blinded by TSH only. I have this battle soon... Good luck!