Good morning, So after the initial emotional kurfuffle of coming to terms with hashimotos and the implications, I'm just posting a little update of where I'm at..I was diagnosed in mid march and started the autoimmune protocol diet beginning of April, I sent off a poop sample for gut bacteria analysis ( private not NHS) and have had iron profile from GP I have as so many of us on here do more than one string to this fiddle ..in spite of GP rating my ferritin level as satisfactory (23) it seems looking back through my medical records I've been low in ferritin for the last 20 years at least! The iron profile shows no other issues other than ferritin and reading the literature around iron and thyroid it comes as no surprise I find myself in this state. The other issue I have sat on for years is gut health.. the analysis shows difficulties metabolising gluten and lactose as well as B vitamin deficiency and poor gut bacteria. So work has begun on restoring gut health as a priority as I'm probably not absorbing any supplements or anything else for that matter effectively. I have adapted the autoimmune protocol diet slightly but remain gluten-free and dairy free, energy levels are slowly improving but the energy crashes are getting less frequent. I think until my gut and iron levels are back to some kind of normal it is absolutely pointless arguing the toss around thyroxine prescription with a GP that has no awareness of the connection between these issues . My current thyroid situation is within range and perfectly satisfactory for the medical records. The symptoms I have experienced are combined gut, iron, thyroid and menopause unpicking is difficult but I'm feeling like I'm making progress. Long game for sure 😃
Iron deficiency and thyroid : Good morning, So... - Thyroid UK
Iron deficiency and thyroid
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Well done on making it this far! Like you, I am newly diagnosed with the same symptoms and more and made all the same changes you have mentioned, bar from a ‘autoimmune protocol diet‘. Although, I wouldn’t be surprised if my diet closely resembles it just by sheer coincidence anyway.
I’m having to reach my ‘optimal’ dose for Levothyroxine slowly, but with the changes made I have already seen a difference in my gut health (as demonstrated by my more but not perfect nourished stool - never thought that’s something I’d be saying/sharing).
May I enquire more about this gut analysis?
Thank you 😊 and yes of course, I used atlas microbiome testing, it gave quite a detailed analysis and offers solutions through food/ dietary changes,the test it self took about five weeks for results so not quick, but I felt it's was worth it. There is a half hour consultation with dietitian in the price which I have yet to book. Goodness me yes a nourish stool ...I aspire to a healthy poo 💩💩 😂
Oh tell me about it! I knew I was showing signs of malnutrition but the GP was hell bent on diagnosing IBS without a cause only. It’s a disgrace how much we have to suffer without diagnosis and treatment.
And, thank you. I shall look into the test. And, seriously, well done again and do report back of the nourished stool when it happens. It will. Hang in there 🫶🏽
Thank you, yep it's been a challenge and actually when I look at everything I've put up with it's a bit embarrassing..that said I'm on it now ..as are you!! It takes so much energy to keep on this path 😄 you must be feeling pleased with your progress? And stool report will follow 🤣
In moments yes. There’s still so much to process of my journey so far and the consequences of not being treated. I’m still achy and cold (when is the hot sun coming again? That helps) etc. but, each day there is some gratefulness, yes. And, as you say, we’re on it now and things can only get better, especially with the valuable insights on here 💚
Keep on swimming 💪💪🥽 😊yes it can only get better...and this place is amazing for information and it's helping me process this situation I'm in. 😊
Snaps! Caio for now x
Reading through previous posts
Have you had dose levothyroxine increased to 75mcg yet?
Hi slow dragon unfortunately nope , there is absolutely no discussion with GP as like I say bloods appear within range. It's a hard call when so much else contributes to symptoms..I'm giving myself til September which will have given me six months to help the gut and four/five months of iron magnesium and selenium support then i will be asking for repeat bloods to see if the iron supplements have improved the ferritin and energy.. arguing the case for thyroxine increase I want to be able to say I've worked on those other elements..and can confidently assert my case . Ridiculous really that I'm peddling so hard to compensate for the service provider that actually should have connected the dots with me years ago!! I first asked for thyroid tests in 2017 and looking at my history can see why they thought it was 'normal' .. anyhoo working with the GP practice is a negotiation skills usually above my pay grade 🙄
Levothyroxine doesn’t “top up” failing thyroid, it replaces it
You’re going to need dose increase in levothyroxine
Request 25mcg tablet prescribed alongside 50mcg and make sure you get same brand (think you are on Mercury Pharma?)
Even if we frequently start on only 50mcg, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose
NICE guidelines on full replacement dose
nice.org.uk/guidance/ng145/...
1.3.6
Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.
Also here
cks.nice.org.uk/topics/hypo...
pathlabs.rlbuht.nhs.uk/tft_...
Guiding Treatment with Thyroxine:
In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months.
The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).
The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range.
……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.
The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.
Comprehensive list of references for needing LOW TSH on levothyroxine
healthunlocked.com/thyroidu....
TSH should be under 2 as an absolute maximum when on levothyroxine
gponline.com/endocrinology-...
NHS England Liothyronine guidelines July 2019
sps.nhs.uk/wp-content/uploa...
Page 9
Test for Deficiency of any of the following: Vitamin B12, Folate, Vitamin D, Iron
See page 13
1. Where symptoms of hypothyroidism persist despite optimal dosage with levothyroxine. (TSH 0.4-1.5mU/L)
Graph showing median TSH in healthy population is 1-1.5
web.archive.org/web/2004060...
LEVO DOSE SHOULD NOT BE DETERMINED BY TSH
Diogenes/Toft paper:
bmcendocrdisord.biomedcentr...
healthunlocked.com/thyroidu...
The link between TSH, FT4 and FT3 in hyperthyroidism is very different from taking thyroid hormone (T4) in therapy. In hyperthyroidism, FT4 and FT3 are usually well above range and TSH is very low or undetectable. In therapy, FT4 can be high-normal or just above normal, TSH can be suppressed but FT3 (the important hormone that controls your health) will usually be in the normal range. FT4 and TSH are of little use in controlling therapy and FT3 is the defining measure. A recent paper has shown this graphically:
Heterogenous Biochemical Expression of Hormone Activity in Subclinical/Overt Hyperthyroidism and Exogenous Thyrotoxicosis
February 2020 Journal of Clinical and Translational Endocrinology 19:100219
DOI: 10.1016/j.jcte.2020.100219
LicenseCC BY-NC-ND 4.0
Rudolf Hoermann, John Edward M Midgley, Rolf Larisch, Johannes W. Dietrich
LlINK TO PAPER:
Thank you for the information, I'll have a good look through, so given my results from May and given my symptoms could be connected with iron deficiency as well ..what I'm saying is it hard to challenge the GP until I've improved the iron situation. I understand thyroxine replaces rather than tops up , I understand that I will have to ask for the next dose I just want to approach it knowing I've worked on the other variables that cause symptoms. So I have a clear rationale for my GP ...it's a shame there isn't an GPS guide..ooh hang on yes there is but they don't actually use it !! Sorry for sounding curt but I'm tired 😩 you all know how exhausting a day is without navigating a conversation with a doctor...I do appreciate the information and will sort through it thank you 😊
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