Medichecks results, please advise: Hi Everyone... - Thyroid UK

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Medichecks results, please advise

PotatoFan profile image
10 Replies

Hi Everyone, posting my 1st ever private blood tests. Please can anyone comment, I'm quite new to this. The results came with a Dr's overview, so I'll be taking Vit D supplements but the other results appeared 'normal'. What do you think? And do the autoimmunity antibodies indicate Hashimoto's or am I misunderstanding? I've just started to read The Thyroid Patient's Manual but I'm not confident I understand it!

Inflammation CRP HS 0.854 mg/L (Range: < 3)

Iron Status Ferritin 94.60 ug/L (Range: 30 - 264)

Vitamins Folate - Serum 32.2 nmol/L (Range: > 7)

Vitamin B12 - Active 77.2 pmol/L (Range: 37.5 - 188)

Vitamin D X 30.7 nmol/L Total 25(OH) vitamin D 50 nmol/L is sufficient in most individuals. Total Vitamin D level >250 nmol/L - indicates potential for toxicity. (Range: 50 - 250)

Thyroid Hormones TSH 3.220 mIU/L (Range: 0.27 - 4.2)

Free T3 4.7 pmol/L (Range: 3.1 - 6.8)

Free Thyroxine 15.7 pmol/L (Range: 12 - 22)

Autoimmunity Thyroglobulin Antibodies X 134.00 kIU/L (Range: 0 - 115)

I got diagnosed with underactive thyroid back in July, and am now on 75mg of levothyroxine. Unfortunately I feel worse not better than before the medication, and my GP is not keen to hear it!

I have a GP appointment on Friday, and hoped to go armed with results and information to back them up.

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SlowDragon profile image
SlowDragonAdministrator

Was test done as recommended

Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test

assuming yes

You need next dose increase in levothyroxine

FT4: 15.7 pmol/l (Range 12 - 22)

Ft4 only 37.00% through range

FT3: 4.7 pmol/l (Range 3.1 - 6.8)

Ft3 slightly better at 43.24% through range

When adequately treated your Ft4 (levothyroxine) is likely to need to be at least 70% through range

TSH should be under 2 as an absolute maximum when on levothyroxine

gponline.com/endocrinology-...

Graph showing median TSH in healthy population is 1-1.5

web.archive.org/web/2004060...

Comprehensive list of references for needing LOW TSH on levothyroxine

healthunlocked.com/thyroidu....

onlinelibrary.wiley.com/doi...

If symptoms of hypothyroidism persist despite normalisation of TSH, the dose of levothyroxine can be titrated further to place the TSH in the lower part of the reference range or even slightly below (i.e., TSH: 0.1–2.0 mU/L), but avoiding TSH < 0.1 mU/L. Use of alternate day dosing of different levothyroxine strengths may be needed to achieve this (e.g., 100 mcg for 4 days; 125 mcg for 3 days weekly).

Which brand of levothyroxine are you currently taking

PotatoFan profile image
PotatoFan in reply to SlowDragon

SlowDragon, thank you very much.

Yes, all recommended requirements undertaken. My TSH was 1.1 when I last had a blood test at GP in November, but that is all they measure, and I was unaware of the recomendations. All this was before I discovered this forum!

I actually have 2 different brands at the moment - Mercury Pharmaceuticals 25 ug and accord 50ug. The brands are different each time.

SlowDragon profile image
SlowDragonAdministrator

Your antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).

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.

Assuming you aren’t yet on gluten free diet……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 as per NICE guidelines

nice.org.uk/guidance/ng20/c...

1.1 Recognition of coeliac disease

1.1.1 Offer serological testing for coeliac disease to:

people with any of the following:

persistent unexplained abdominal or gastrointestinal symptoms

faltering growth

prolonged fatigue

unexpected weight loss

severe or persistent mouth ulcers

unexplained iron, vitamin B12 or folate deficiency

type 1 diabetes, at diagnosis

autoimmune thyroid disease, at diagnosis

irritable bowel syndrome (in adults)

first‑degree relatives of people with coeliac disease

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

With loads of vegan dairy alternatives these days it’s not as difficult as in the past

Post discussing gluten

healthunlocked.com/thyroidu...

PotatoFan profile image
PotatoFan in reply to SlowDragon

My goodness! I've a lot to do! No, I'm not yet gluten free, or lactose free although I've never been a milk drinker & always have oat or nut milk.

I paid for allergy blood tests this week, also cortisol/aldosterone, I'm awaiting results. I decided this new year I can't wait for the NHS decide what's going on, that I need to take charge. The symptoms I'm suffering appear to be rather like B12 deficiency, both the nurses at my blood draw, and the physio I went to for diagnosis re muscle weakness & pains in my hands/arms suggested that. However, there seems to be a lot of overlap of symptoms, covering many illnesses/deficiencies.

I shall take all this info to my GP Friday & see if she will permit tests & up my Levothyroxine, wish me luck!

Many thanks SlowDragon

SlowDragon profile image
SlowDragonAdministrator

vitamin D

NHS Guidelines on dose vitamin D required

ouh.nhs.uk/osteoporosis/use...

GP will often only prescribe to bring vitamin D levels to 50nmol.

Some areas will prescribe to bring levels to 75nmol or even 80nmol

leedsformulary.nhs.uk/docs/...

GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)

mm.wirral.nhs.uk/document_u...

But with Hashimoto’s, improving to around 80nmol or 100nmol by self supplementing may be better

pubmed.ncbi.nlm.nih.gov/218...

vitamindsociety.org/pdf/Vit...

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

Test twice yearly via NHS private testing service when supplementing

vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function.

There’s a version made that also contains vitamin K2 Mk7.

One spray = 1000iu

amazon.co.uk/BetterYou-Dlux...

It’s trial and error what dose we need, with thyroid issues we frequently need higher dose than average

Vitamin D and thyroid disease

grassrootshealth.net/blog/t...

Vitamin D may prevent Autoimmune disease

newscientist.com/article/23...

Web links about taking important cofactors - magnesium and Vit K2-MK7

Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Interesting article by Dr Malcolm Kendrick on magnesium

drmalcolmkendrick.org/categ...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

PotatoFan profile image
PotatoFan in reply to SlowDragon

Once again, SlowDragon, many thanks for all your work here. I can see what I'm doing tomorrow!

SlowDragon profile image
SlowDragonAdministrator

one other guideline

Dose by weight

Unless extremely petite this is likely to help persuade GP to increase dose up to 100mcg daily

Even if we frequently start on only 50mcg, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose

pathlabs.rlbuht.nhs.uk/tft_...

Guiding Treatment with Thyroxine:

In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months.

The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).

The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range.

……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.

The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.

NICE guidelines on full replacement dose

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

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

Also here

cks.nice.org.uk/topics/hypo...

PotatoFan profile image
PotatoFan in reply to SlowDragon

Thank you SlowDragon, I'm currently around 73kg, I gained over a stone last year with no additional eating involved, so the 75ug I'm currently taking is too low. I'll press for 100ug & see what happens. It's good to have NICE guidelines as leverage. I'll let you all know how I get on.

rosael56 profile image
rosael56

Your Vitamin D is very low. Could easily be causing a lot of symptoms. Your B12 is also not optimal at all. I would work on trying to improve those.

PotatoFan profile image
PotatoFan in reply to rosael56

Thank you rosael56, I've ordered Vit D, and wasn't sure re B12. The nurses who took my blood said my symptoms sounded B12 deficient, but the results were in range. I'm sure it will help to up them a bit tho' :)

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