Fatigue

[WW1982]

just had my results back all say Normal which has shocked me i feel so awful so fatigued are there any other supplements i can take to improve this ?

[greygoose]

Hi WW1982, welcome to the forum.

In medical terms, 'normal' doesn't mean normal at all. It just means that the results of a blood test are somewhere within the range. They can be right at the top, or right at the bottom, but as long as they are not over or under they will be classed as 'normal'.

We the patients know better. 'Normal' is not the same as 'optimal'. And 'optimal' is the most important where thyroid is concerned. Therefore it's where the results falls within the range that counts.

Your B12, for example is well within the range, and yet it's too low. Why? Because the ranges are totally unrealistic. Someone with a result of 181 would be within the range, and therefore counted as 'normal' but would be in grave danger of serious neurological damage, and would probably have Pernicious Anemia. With a serum blood test - which is what you had there - B12 should be at least over 550. So, that could be contributing to you feeling awful.

Your TSH is the same, only too high for someone on thyroid hormone replacement. A euthyroid (no thyroid problems) TSH would be around 1. Over 2 means the thyroid is struggling, and over 3 is technically hypo.

Your TSH tends more towards 2 than 1. And often 1 is too high for a hypo. They tend to need their TSH lower than a euthyroid person, because they need their FT4/3 higher.

Your FT4 looks good - on paper. But we cannot take that one result in isolation. It has to be compared with your FT3:

FT4 16 (9-19) 70%

FT3 4.8 (3 - 5.4) 75%

These are on the high-side. Euthyroid FT4/3 are usually around mid-range. And the FT4 is usually slightely higher, percentage-wise, than the FT3.

So we also have to take the TSH into consideration, which is high considering the Frees. One would expect it to be below range.

So, we have to investigate further:

* what are you taking? Levo? Levo + T3? NDT? How much?

* how long after your last dose/doses of thyroid hormone was the blood draw?

* what time of day was the blood draw?

Only when we have all that information can we usefully interpret your results.

[WW1982 in reply to greygoose]

Thank you for replying! I was told if everything come back normal that I wont here back from the doctor . As result say normal it doesn’t really help with how I'm feeling or what i can do to help with symptoms i have

I take 150mg Levothyroxine

I take these before going to bed so around 10pm

Bloods were taken at 9:30 am I did have a cup of tea at 06:30

Not sure if this is relevant ? I have 2 nodules on thyroid one 12mm and 6mm these were monitored for 12 months and have not grown so have been discharged from the consultant.

Previous results from last year show TPO was high someone told me on a Facebook group that is Hashimoto - not had Antibodies test results back yet

Im going to look at diet to see if that will help as I'm over weight feel like im falling apart

[greygoose in reply to WW1982]

I take 150mg Levothyroxine

I take these before going to bed so around 10pm

Bloods were taken at 9:30 am I did have a cup of tea at 06:30

OK, so taking 150 mcg at 10 pm, with the blood draw around 9.30 am, gives us a window of 11 and a half hours, which is not long enough to get a true picture of your normal circulating hormone level. It's best to leave 24 hours - no more, no less. So, that could explain your highish FT4 - a false high.

However, if your TPO antibodies were high last year, then it does mean you have Autoimmune Thyroiditis - aka Hashi's. And that would explain both Frees being high. I would imagine you're at the beginning of a Hashi's 'hyper' swing - do you know how Hashi's works? - and that the TSH hasn't had time to catch up with the higher levels yet. There's no need to retest antibodies because antibodies fluctuate, but Hashi's doesn't go away. It's for life.

I don't think the nodules or the cup of tea are relevant.

Im going to look at diet to see if that will help as I'm over weight feel like im falling apart

Yes, I know that feeling of falling apart. I have Hashi's too - or, to be more precise, I have Ord's, which is Hashi's without the goitre.

Hashi's people are often gluten-sensitive, so cutting out gluten 100% might help your symptoms - although it won't get rid of the Hashi's. Dairy-free is worth trying, too - but not at the same time, or you won't know which one works!

Optimising your nutrients is essential because thyroid hormone won't 'work' with sub-optimal nutrients. But, you do need to get them tested first: vit D, folate and ferritin. We already know that your B12 need some work, but get the others tested first.

When your thyroid hormone levels are low, it affects your stomach acid level - it drops. So, you have difficulty digesting food and absorbing nutrients. Which is why we all take bags of supplements. But, I stress, these things should be tested first, to get a base-line, etc.

Your weight-gain, though, has little to do with your diet. Low-calorie diets are not recommended because you need those calories to convert T4 to T3. And cutting calories will therefore be more likely to make you put on more weight, rather than lose it. Besides, your weight-gain probably isn't fat, it's more likely to be water-weight, as hypos retain a lot of water. So, diets and exercise won't help that. What will probably help is optimising your thyroid hormone levels, but we don't even know what those are yet. Time will tell.

[WW1982 in reply to greygoose]

Yes had them done . Thank you for taking the time to look at my results .

Test results

[SlowDragon Administrator in reply to WW1982]

what about folate, ferritin and B12 results

Get coeliac blood test done BEFORE cutting gluten out

GP should have tested for coeliac at diagnosis of Hashimoto’s

Check if been tested already

If have been you can immediately trial gluten free

[SlowDragon Administrator]

Ft4 falsely high as only Approx 11 hours between last dose levothyroxine and test

In future always leave 24 hours

If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal