Help please with thyroid test interpretation and supplements guidance

[eggsforlunch]

Hello everyone,

I am new here and learning such a lot from the hugely valuable resource that is this forum - thank you all for the time you take to help people like me.

Please could I have some help in interpreting my recent Medichecks advanced thyroid panel and how to move forward from this assessment.

Background: I have had raised TSH coupled with normal T4 registered on several occasions over the past 20 years or so, but various GPs have taken very little interest in this. It has come and gone, showing up here and there and correcting itself later.

Over the past 18 months I have had an elevated TSH and normal T4 more consistently. For example last year in July 2022 (I don’t have the figures for this, but was told by the GP it was similar to the May 2023 test) and again on 15th May 2023 where TSH was 7.96 mIU/L (range 0.27-4.20) and fT4 was 14 pmol/L (range 11-22), but the bloods were done in the middle of the day.

Here are the recent Medichecks values from 14.08.23. Please note that I followed all the comprehensive guidance from the forum regarding testing and the venous sample was taken fasting and at 8.30am

CRP HS 1.55 mg/L (range <3)

Ferritin 107 ug/L (range 30-150)

Folate - serum 12.6 nmol/L (range 8.83-60.8)

B12 – active 79.2 pmol/L (range 37.5-188)

Vitamin D 137 nmol/L (range 50-250)

TSH 12.5 mIU/L (range 0.27-4.2) = 311% through range

Free T3 3.6 pmol/L (range 3.1-6.8) = 13.5% through range

Free thyroxine 15.2 pmol/L (range 12-22) = 32% through range

T4:T3 ratio = 4.22

Thyroglobulin antibodies 14.7kIU/L (range 0-115)

Thyroid peroxidase antibodies 30 kIU/L (range 0-34)

Can you help me interpret, please?

My reading is that my folate and B12 are probably too low, despite being in the ‘normal’ range, and I should supplement to improve them.

TSH is very high, which seems to indicate that my thyroid is failing despite being in ‘normal’ range for T4 and T3. Both seem low in the normal range so my reading is that my pituitary is desperately trying to get a response from my thyroid which cannot hear it very well.

I also suspect I am not converting T4 to T3 very well from my ratio, but do not know enough to interpret this.

I may have Hashimoto’s as TP antibodies are relatively high despite still being in ‘normal’ range, although the TG seems low.

I am currently only supplementing with 1g Vitamin C daily and Vitamin D (Better You spray, 3000IU, daily) and as this was extremely low about 5 years ago and I was treated with cholecalciferol to good effect and was advised to continue to supplement vit D daily.

I have a gluten free diet due to my IBS.

I am not being medicated with thyroxine or T3 etc and I am wondering if there is anything I can do to help me avoid the need to go onto medication – I can see how difficult it is to manage for many people and was a pharmacist in a previous career, so I am well aware of the issues titrating doses and obtaining the correct brand consistently etc.

Has anyone had a good result with functional medicine at all and if so, are there any recommendations for this?

My picture is complicated by complex trauma (from childhood) and a bevy of associated issues such as long-term IBS-C/D all of my adult life, previous leaky gut and SIBO (both treated effectively in the past via functional medicine/nutritionist input), long standing axillary hyperhidrosis and chronic pain. I have always attributed most of these problems to the ongoing effects of trauma and nervous system (autonomic) dysregulation (note: I have had a lot of therapy and bodywork etc for this). Now I seem to have the added bonus of potential autoimmune disease affecting my thyroid – what fun! I do not have many symptoms just yet apart from some joint pain, tiredness and brain fog, but I am also recently in menopause, so I have tended to attribute these to the trauma effects and menopause, but perhaps it is my thyroid. I am on HRT (Oestrogel and Utrogestan).

Any input from you wonderful and knowledgeable people would be gratefully received.

Thanks!

Eggs for lunch 💖

[HealthStarDust]

I’m sure the very knowledgeable admins will arrive shortly to help you with this. I am just curious about how your previous leaky gut and SIBO were treated effectively?

We’re there particularly foods you avoided or consumed more of?

[eggsforlunch in reply to HealthStarDust]

Thank you. It was a right old fandango to treat both tbh. The leaky gut was treated with a nutritionist in the mid-2000s (I think we would now call them a functional medicine practitioner) and involved 6 months of a soft food diet (nothing uncooked at all and quite restrictive) and many, many supplements to heal the gut. Uncooked foods were reintroduced very slowly. The SIBO I treated myself about ten years later following the specific carbohydrate diet (SCD) for around 6 months+. All the information for SCD came from a blog ‘SCD lifestyle’ which I found on the web at the time. It was the two guys who now run healthygut.com and were blogging about SCD and SIBO around ten years ago. I followed the (hugely restrictive) diet for around six months or more and used all the supplements they recommended including taking single strain acidophilus for around three years (that was a mission to obtain in UK) before I could tolerate any ‘regular’ probiotics or eat any fermented foods – I can do this now with no problems. Neither protocol was easy to follow but I was desperate on both occasions, really committed and they both worked well for me. I eat a FODMAP diet and am gluten free these days but think I maybe need to do another round of functional medicine to tweak my gut as it would not surprise me if my gut was involved in this potential Hashimoto’s

[GlowCoach Administrator]

Welcome to the group and thank you for completing your helpful profile.

It's not ideal getting bloods done in the middle of the day but your TSH then of 7.96 should be enough to raise suspicion of an issue. Your TSH would have been higher had you had the blood test done at or just before 9am.

NICE guidelines state that you just need 2 consecutive NHS TSH results above range to get a diagnosis and begin treatment with Levothyroxine. There are some GP's who don't realise this and are sticklers for the other way of diagnosis which is 1 TSH result above 10.

It might be an idea for you to ask your GP reception for back copies of your thyroid results as it would appear you may have already qualified for a diagnosis and treatment. You may need to see a different GP who is more helpful or open minded.

If you have recently had the required 2 TSH above range I would be pushing for immediate treatment.

Your antibodies are currently negative although they do vary widely and this result is just a snap shot. Also, a small percentage of Hashimoto's patients never have positive antibodies. I would recommend retesting when possible.

Conversion isn't really considered until you are on levothyroxine as it replaces your own thyroid hormone production and is T4 only. Your body then needs to convert it to the active hormone T3. You can make a better assessment once you are on treatment and very close to your optimal dose.

Your TSH is far too high and free hormones FT4 & FT3 too low. There are no supplements that would make you well or normalise your thyroid numbers. Just Levothyroxine.

long-term IBS-C/D all of my adult life, previous leaky gut and SIBO + chronic pain, joint pain, tiredness and brain fog

All of the above may well be due to your low thyroid hormone levels and treating with Levo you may not recognise yourself. To attribute so many physical symptoms to previous trauma is not being fair to yourself.

You are right that your folate & B12 are too low. When hypo we get low stomach acid which means we cannot absorb vitamins well from our food, regardless of a great diet. For thyroid hormone to work well we need OPTIMAL levels of vitamins.

I'd recommend starting a good methyl B complex to keep all the B's in balance. This B complex has all the right vitamins at a not unreasonable cost for 90 days supply. amazon.co.uk/Liposomal-Soft...

Ferritin & Vit D are good.

[eggsforlunch in reply to GlowCoach]

Thanks so much for responding. I have been through three different GPs with this issue arising periodically and not a single one has suggested to me that I am even subclinical hypothyroid or referred to NICE guidelines etc. However, I am frankly not surprised, which is both shocking and sad. I have had two TSH above range in less than a year and still the GP tells me to just re-test in six months. I think I have absolutely lost faith in them, hence ignoring this issue myself, and taking matters into my own hands with the private test now I have finally pulled my head out of the sand. Frankly, I am scared of taking thyroxine! It just feels so final, but I guess I need to face up to and accept the fact that its game over for my poor thyroid. I will start the B complex asap and get my vitamins in line and go back to the GP armed with NICE guidelines. At least I am able to argue the toss with them due to my pharmacy training. Thanks so much for your help – I really appreciate this forum and the time taken by everyone to share such useful information and provide support

[GlowCoach Administrator in reply to eggsforlunch]

Looks like you're going to have to put yourself int he driving seat which is where most thyroid pateints find themselves.

In a way beginning Levo is a final step, but one that will only be deferred whilst you suffer in the mean time if you (and your GP/s)keep putting it off.

nice.org.uk/guidance/ng145/...

[eggsforlunch in reply to GlowCoach]

Thank you. To be honest, hypothyroid would explain a lot of health issues that have been rumbling on for many years and I agree that I need to be more proactive and take control of the situation. All I can say is thank goodness I found this forum!

[SlowDragon Administrator]

as GlowCoach said

With 2 NHS tests with TSH over 5 and symptoms you should be starting on levothyroxine

Testing early morning, ideally just before 9am, only drink water between waking and test ……should give highest TSH

Starting levothyroxine - flow chart

gps.northcentrallondonccg.n...

20% of Hashimoto's patients never have raised antibodies

healthunlocked.com/thyroidu...

Paul Robson on atrophied thyroid - especially if no TPO antibodies

paulrobinsonthyroid.com/cou...

As you are already on gluten free diet high thyroid antibodies are less likely

Have you tried dairy free diet too?

Definitely look at adding daily vitamin B complex to improve low folate and B12

This can help keep all B vitamins in balance and will help improve B12 levels too

Difference between folate and folic acid

healthline.com/nutrition/fo...

Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid.

thyroidpharmacist.com/artic...

B vitamins best taken after breakfast

Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule)

Thorne currently difficult to find at reasonable price, should be around £20-£25. iherb.com often have in stock. Or try ebay

Other options

healthunlocked.com/thyroidu....

IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate folate supplement (eg Jarrow methyl folate 400mcg) and continue separate B12

Post discussing how biotin can affect test results

healthunlocked.com/thyroidu...

I am wondering if there is anything I can do to help me avoid the need to go onto medication – I can see how difficult it is to manage for many people and was a pharmacist in a previous career, so I am well aware of the issues titrating doses and obtaining the correct brand consistently etc.

There’s around 2 million people in U.K. on levothyroxine…..they aren’t all on this forum…..many thousands are happily getting on with their lives

As you understand the importance of never missing a dose, and slow titration and brand issues you should be absolutely fine on levothyroxine

[eggsforlunch in reply to SlowDragon]

Thank you, SlowDragon, I appreciate your thorough response and all the references/links to follow up. I have not gone dairy free in many years (not since the last gut healing/SCD diet episode around ten years ago) as I rely heavily on fermented diary (kefir, yoghurt, and cheese mainly) in my diet due to the FODMAP restrictions and as a source of fermented foods which work well for my gut. I would struggle to give it up, but maybe I just need to commit to going dairy fee again. It is weird that my folate is low as I have a strange and inexplicable addiction to brussels sprouts (no-one understands this, least of all myself) and eat them almost daily, alongside cabbage, kale and spinach – they are the only greens I can manage on FODMAP. Maybe I have the MTHFR issue, and I will read more of Isabella Wentz’s material on this – thanks for the link and for the reminders about vitamin B/biotin supplementation and testing – I feel in safe hands with all of your incredible knowledge in this area. Thank you for the encouragement about going on levo – I am not sure why I am so reluctant. I think it just feels like the end of the line, although I appreciate your point, as well as Jaydee1507’s, that I might actually feel a whole lot better on it than I do now.

[janeroar]

There’s research that selenium deficiency may be related to thyroid autoimmunity which causes both hypothyroidism and hyperthyroidism.

There’s a good chance you’re deficient due to gut absorption issues you’ve experienced. Alongside getting your folate up, I would suggest taking a good bioavailable selenium supplement.

[eggsforlunch in reply to janeroar]

Thank you, I will look into this and will supplement

[JAmanda]

For the vast majority of people taking levothyroxine is easy - you’re only reading in here the few who have issues with it. There’s every reason to start taking it with your levels as they are - and chances are you’re feel a whole lot better after a few months. You can certainly tweak your diet and vitamins but you are hypothyroid so you lack thyroid hormone - so it needs to be replaced.

[eggsforlunch in reply to JAmanda]

Thank you, JAmanda.