Hi everyone. I’m a bit confused by recent Medichecks result. In myself I’ve been feeling great (re tiredness, brain fog etc) but I have had a couple of migraines recently and have put on a couple of pounds. I should mention I’ve had some stomach problems going back a few months as well (reflux and allegedly high stomach acid, though I know low acid is more typical). I was on PPIs for 6 weeks last autumn, but when stomach symptoms returned in the spring I didn’t do that, I just took Gaviscon at bedtime and it seemed to settle.
I’m taking 3 x 100mcg & 4 x 87.5mcg levo per week. This is my result, taken Monday, early morning on an empty stomach.
TSH 0.169 mIU/L (0.27 - 4.2) -2.6%
Free T4 (fT4) 25.2 pmol/L (12 - 22) 132.0%
Free T3 (fT3) 3.9 pmol/L (3.1 - 6.8) 21.6%
T4:T3 Ratio 6.462
In January fT3 was only 10% through range, now 21.6, but I’m a bit worried about fT4 being over range.
Also some surprising vitamin results:
B12 = 59.2 pmol/L [37.5 - 188]
Vitamin D = 119 nmol/L [50_250]
Ferritin = 182ug/L [30 - 650]
I have been taking 50mcg of D all through the summer, as well as out in the sun quite a lot.
B12 has dropped from 91 pmol/L in January
I don’t know what to do now really. If I speak to the Dr she is likely to reduce my levo, so I don’t want to risk that. I think I need T3.
I’ll increase my vitamin D, and please advise what B12 is best. Any other suggestions welcome.
Thank you
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Ukie
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With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a separate B12 supplement and add a separate vitamin B Complex after a week
Then once your serum B12 is over 500 (or Active B12 level has reached 70), you may be able to reduce then stop the B12 and just carry on with the B Complex.
If Vegetarian or vegan likely to need ongoing separate B12 few times a week
Igennus B complex popular option too. Nice small tablets. Most people only find they need one per day. But a few people find it’s not high enough dose
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
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
Thanks SlowDragon. Test was 7:30 a.m. and last levo was about 27 hours before. Only water before the blood draw. I don’t always get the same brand of levo, but it doesn’t seem to make any difference to me. They most often give me Teva.
Supplements:
- 1000mg Omega 3
- 400mcg Folic acid (I’ll try to find Folate from now on)
- 1000mg Vitamin C
- 50mcg Vitamin D (summer dose, I take more in the winter)
- Probiotic tablet
- 700mg Glucosamine with 300mg Chondroitin (for arthritis)
This last one only recently. I take all supplements after breakfast, at least 3 hours after levo, usually longer.
I didn’t respond yesterday because I have yet another migraine, still in post-drome now. I will work through all your info when I’m feeling better. Thank you so much for your help.
Thank you so much for your comprehensive replies! I’ve ordered B12, B complex and folate. B12 first as advised, then B complex. How long do you think I should leave it before getting another blood test?
I’m not gluten or dairy free atm. I thought I would see how I get on with the new supplements first. One of the main symptoms that bothers me is constipation, and I find it helps to eat Weetabix every morning, with flax seeds and chia seeds. I have just started to have oat milk with my Weetabix though, because I probably do have too much dairy tbh. When I’m settled in the new supplement regime I’ll give gluten free a try. Thanks
If you left 24 hours between your last dose and the blood draw, then you are over medicated and need to reduce your dose.
As DD has said over-range FT4 isn’t recommended as thought to be a cancer risk, but it also stops working so positively when you exceed your sweetspot, eg T3 conversion reduces the higher you go, and you might find you achieve better FT3 levels with FT4 a bit lower.
Also regarding gut issues, many hypos suffer from low gastric acid that doctors don’t recognise. If you haven’t got stomach ulcers, you could try betaine + pepsin to help with nutrient absorption and this might make thyroid hormones meds work a bit better also.
Hi Radd, thanks for response. In January 2023 I was on 2 x 100mcg & 5 x 75mcg per week, and T3 was only 10% through range. T3 has apparently improved on the higher T4 dose. As you say though, it’s not good to be over range on T4, so I probably do need to reduce it again. Going forward I think I need to increase my vitamin levels, then maybe try to source some T3. SlowDragon has given me a lot of info which I plan to work through when I’m feeling better (another migraine). Thanks for gut suggestions as well.
Optimising iron and nutrients give Levothyroxine very best chance of working well, and then should FT3 drop and remain low with a Levo reduction, that's the time to consider adding a little bit of T3 meds.
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
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
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
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
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