Thyroid levels advice for friend with newly dx Hashi and P.A please?

[Opal79]

Hi, a friend has been supporting me in getting a Pernicious Anaemia diagnosis, as she also has it. She also has a recent Hashimoto's dx (like me, plus I'm hypothyroid too) but I've been trying to help her with it as it's all very new and overwhelming and she's been really ill with P.A for a long time.

Anyway my friend told me her Thyroid antibodies were tested by the GP confirming Hashi's earlier this year around the time she finally got a P.A dx too. And has showed me her thyroid Medichecks results from March this year which I'll paste below. Her antibodies this time are fine, maybe due to her B12 treatment or maybe cos they fluctuate alot with Hashi don't they?

Anyhow, looking at her TSH, FT3 and FT4 things look almost optimal, with FT3/4 both to my still abit untrained eyes, to be on the cusp of middle range to the top third range. Is this high enough though? Symptom wise there's so many crossovers with P.A and she is also iron anaemic.

Ferritin didn't show in the screenshot but it was low and she now has iron infusions. Her B12 was high due to non absorption because of intrinsic factor antibodies and being dealt with now too via a private anaemia Dr, as are the other vits. So really we mainly need thyroid advice please!

She's asking if she needs T4, and as things look abit hazy to me I'm not really sure what to advise, I dont know if she is hypo (yet) and what is safest for her. Can anyone help please? I've explained that T4 to T3 conversion may be a problem. But also with P.A it's so linked to Hashi and liver processing so I do wonder if waiting and seeing for now is better?

She is taking more Medichecks next week to compare with March, so will be interesting to compare and see if anaemia treatment may be enough to help for now and tackle Hashi with diet, supps etc, but I don't know if thyroid meds are also needed? I'm sure a GP would think definitely not but in my and her experience its not worth consulting ours anyway! If anyone has any extra advice we would really appreciate it please! 🙏

[SeasideSusie Remembering]

Opal79

Her antibodies this time are fine, maybe due to her B12 treatment or maybe cos they fluctuate alot with Hashi don't they?

Yes, the do fluctuate and this test has caught the TPO antibodies below range. Do you have her GP antibody results/range?

Her thyroid results at the moment are good, don't show hypothyroidism and don't show poor conversion. Her FT4 is 64% through range with FT3 is 57.03% through range. A normal healthy person with no thyroid condition generally has TSH no more than 2, often nearer 1, with FT4 around mid-range-ish.

For a diagnosis she would need TSH to be over range with elevated antibodies, or over 10 with normal antibodies.

Did she do her thyroid test as we advise (and remind her to do it this way when she does them in future :

* No later than 9am. This is because TSH is highest early morning and lowers throughout the day.

In fact, 9am is the perfect time, see first graph here, it shows TSH is highest around midnight - 4am (when we can't get a blood draw), then lowers, next high is at 9am then lowers before it starts it's climb again about 9pm:

healthunlocked.com/thyroidu...

If we are looking for a diagnosis of hypothyroidism, or looking for an increase in dose or to avoid a reduction then we need TSH to be as high as possible.

* Nothing to eat or drink except water before the test - have your evening meal/supper as normal the night before but delay breakfast on the day of the test and drink water only until after the blood draw. Certain foods may lower TSH, caffeine containing drinks affect TSH

* If you take Biotin or a B Complex containing Biotin (B7), leave this off for 3-7 days before any blood test. This is because if Biotin is used in the testing procedure it can give false results (most labs use biotin).

These are patient to patient tips which we don't discuss with phlebotomists or doctors.

[Opal79 in reply to SeasideSusie]

Thanks so much I will feed all this back to her and let you know if she can send the earlier results too...I did ask for them already so hopefully she can find them. Thanks again!

[Hidden]

these results looks very good to me, better than many euthyroid results. But symptoms really matter. Once she treats her anaemia it’s worth reassessing but until then IMHO she doesn’t require any hormone replacement atm.

[Opal79 in reply to Hidden]

That's great thankyou and confirming what I was thinking, so good to have these replies thankyou!