Update blood results via Medichecks

[Humphre]

After a change in medication & wanting to find out bit levels & if autoimmune antibodies decided on Medichecks as a hospital nearby & able to book early appointment, followed all advice on here(thank you) 11 weeks after change. After reading docs summary I'm not sure which to do🤔 I will of course send via email to my GP(hasn't a clue really so open to suggestions which is useful) I feel better on this 100mcg but wonder if I should go back to 75/100 on alternating days? 75 I get low moods Brian fog aches & pains ....on a 100 feel great! Any ideas suggestions welcome. I've put my results up as it really doesn't make sense. I do have osteoporosis in wrist & osteopenia starting in thigh bone & spine

[SeasideSusie Remembering]

Humphre

I feel better on this 100mcg but wonder if I should go back to 75/100 on alternating days? 75 I get low moods Brian fog aches & pains ....on a 100 feel great!

So what is making you wonder if you should go back to 75/100?

TSH: 0.203 (0.27-4.20)

FT4: 18.8 (12-22) = 68% through range

FT3: 4.2 (3.1-6.8) = 29.73% through range

You can see from your FT4 and FT3 levels that you are nowhere near being overmedicated, in fact there is room to increase dose. Your T4:T3 conversion is not particularly good, if it was they would be better balanced, eg FT3 5.5 with that FT4 result.

Don't let the low TSH concern you. TSH is useful for diagnosis but once on replacement thyroid hormone it doesn't have much use, it's the FT4 and FT3 which tell us our thyroid status and FT3 is the most important result.

Don't worry about the Medichecks doctor's comments, they're frequently not helpful and, like most GPs, tend to look at TSH to decide if you're overmedicated regardless of FT4 and FT3 levels. If doing private tests in future, always say no to doctor's comments and come to the forum for interpretation.

CRP is good, nice and low so showing no signs of inflammation.

Ferritin - well I do struggle to take the range given by INUVI seriously considering most other labs use 13-150 or 15-300. Some experts say that the optimal ferritin level for thyroid function is 90-110ug/L but they don't specify a range.

Folate: 12.9 (8.82-60.8) - this is very low in it's range. Folate is recommended to be at least half way through it's range. With this level you might want to take a methylfolate supplement temporarily, say one bottle, then retest to see how your level has improved BUT SEE COMMENTS FOR B12 FIRST.

Active B12: 65.7 (37.5-188) - Active B12 below 70 suggests testing for B12 deficiency according to Viapath at St Thomas' Hospital:

viapath.co.uk/our-tests/act...

Reference range:>70. *Between 25-70 referred for MMA

There is a link at the bottom of the page to print off the pdf to show your GP.

Do you have any signs of B12 deficiency – check here:

b12deficiency.info/signs-an...

b12d.org/submit/document?id=46

If you do then list them to discuss with your GP and ask for testing for B12 deficiency and Pernicious Anaemia. Do not take any B12 supplements or folic acid/folate/B Complex supplements before further testing of B12 as this will mask signs of B12 deficiency and skew results and if you have B12 deficiency and it is not detected and treated then this could affect your nervous system. B12 deficiency should be treated before starting folic acid because folic acid can sometimes improve your symptoms so much that is masks B12 deficiency.

If you don't have any signs or symptoms then you could supplement with some sublingual methylcobalamin B12, say one bottle, along with a good quality bioavailable B Complex to help keep all B vitamins balanced. Once the bottle is finished you should be fine to continue with just the B Complex. It would be worth testing when you've finished the B12 to check that level and also to see how your folate is coming along. If close to half way through range (35 with that range) you could stop the methylfolate and just continue with the B Complex.

Vit D: 75.1nmol/L = 30.04ng/ml - not too bad but the Vit D Council, Vit D Society and Grassroots Health all recommend a level of 100-150nmol/L with a recent blog post on Grassroots Health recommending at least 125nmol/L.

You might want to check out a recent post that I wrote about Vit D and supplementing:

healthunlocked.com/thyroidu...

and you can check out the link to how to work out the dose you need to increase your current level to the recommended level. You'll see that they suggest 2,500iu D3 daily, but because it's borderline with the lower range (20-30ng/ml) and that suggests 3,700iu, then you could take maybe 3,000iu D3 daily along with it's important co-factors magnesium and Vit K2-MK7. If you want suggestions for supplement brands then please ask.

Your raised antibodies confirm that the cause of your hypothyroidism is autoimmune, did you already know that?

[Humphre in reply to SeasideSusie]

Thank you for the reply, I'll certainly look into all you've suggested I did think a little extra levothyroxine, maybe increase by 12.5mcg as it maybe beneficial, the docs comments confused me thanks for clarifying.

I wasn't sure if it was autoimmune my past record don't clearly say either way🤦

[SlowDragon Administrator]

Improving low folate and B12 should help increase Ft3 result and TSH should then rise higher

As you have Hashimoto’s GP should do coeliac blood test BEFORE you consider trialing strictly gluten free diet

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

Low vitamin levels affect Thyroid hormone working

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

[Humphre in reply to SlowDragon]

Thanks, I had a Celiac test ages ago but I'll check my records. Yes I suffer with stomach problems, food intolerance test showed I didn't have pepsin so I take Beltaine HCL & careful what I eat, I'm off lansprazole & I'm much better.I will be doing more study before contacting my GP👍

[SlowDragon Administrator in reply to Humphre]

you will see hundreds of Hashimoto’s patients on here who, despite testing negative for coeliac, find gluten free diet is extremely beneficial or absolutely essential