Updated results

[Peril1504]

Morning all,

I posted some results a while ago and followed the very wise advice I was given but as I still felt rubbish I got into my GP who was very helpful and ordered lots of tests for me. When I posted towards the end of last year I was struggling and my B12 was low, ferritin dire at 16 and some private tests showed I wasn’t converting T4 to T3 so I added in 12.5mcg of T3 daily. I have just received these results this morning and I got a shock. Have I gone too far the other way? I have to say I feel much better than I did last year having ditched the iron tablets off the doc and buying some Three arrows iron from the States which I have only been taking one a day for about 3 weeks.

Just to give you all the info, I had a gastric bypass around 20 years ago and despite that have gained around 3 stone over the last 3 years which I am desperate to shift. I eat a healthy diet but don’t follow a strict very low calorie diet, I just eat healthy with lots of fruit and veg, lean meat and make sure I’m well hydrated. I’m struggling with swollen ankles and feet which my doc has given me furosemide for but he thinks it may be myxedema.

These are my results this morning:

Ferritin: 24

B12: 700

Folate: 13.7

Free T3: 5.2

Se thyroid peroxidase: 241

Free T4: 11.7

Serum TSH: 0.04

Have I overshot please and how do I fix it? My GP is referring me to an endo.

Thanks for your advice.

[greygoose]

Well, you haven't given the ranges, but I doubt if there's anything to fix.

Are you saying you've gone too far because of the low TSH? Well, that's always going to be low when taking T3 because that's what T3 does. And it's low because you don't need it. But can't say too much about the thyroid hormone levels without the ranges, which vary from lab to lab.

I had a gastric bypass around 20 years ago and despite that have gained around 3 stone over the last 3 years

So, you're probably under-medicated. Hypo weight-gain has little to do with your diet, it's to do with a reduced metablolism, and is probably water-weight, not fat.

[Peril1504 in reply to greygoose]

Thank you greygoose.

I have repeated the results below together with reference ranges. Yes I was referring to the very low TSH which worried me but if that’s normal if I am taking T3 then I won’t worry. When you say I am probably undermedicated are you referring to T4 please? I’m worried about taking too much in case it converts to reverse T3.

Ferritin: 24 (15 - 150)

B12: 700 (191 - 663)

Folate: 13.7 (3.89 - 26.8)

Free T3: 5.2 (3.1-6.8)

Se thyroid peroxidase: 241 (0-34)

Free T4: 11.7 (10-22)

Serum TSH: 0.04 (0.30-4.50)

Thank you 😊

[greygoose in reply to Peril1504]

That's better.

So, ferritin is still very low.

B12 is good.

Folate could be higher.

FT3 is only 56.76% through the range, so plenty of room for an increase.

High antibodies. Did you know you have Hashi's?

FT4 14.17%! Hardly likely to convert to rT3! Plenty of room to increase. But, in any case, rT3 is a red herring. It doesn't do anything. There are many, many reasons for having high rT3, and only one of them has anything to do with thyroid, and that's when you're a poor converter and your FT4 is too high. So, many people without thyroid problems are walking around with high rT3 and no idea that they have it. It's a safety valve, and not something to be worried about.

And, in any case, whilst you have T4 in your body, some of it is always going to be converted to rT3, that's just the way it works.

But, the thing is, if you still have hypo symptoms, then your are under-medicated for your particular needs. We're all different and all have different needs, and need different levels of thyroid hormones. So, you could try increasing your levo, and see if it increases your FT3, and if it makes you feel better.

[Peril1504 in reply to greygoose]

Thank you so much!

How is the best way to increase folate please? Is there a good supplement to take?

I’m going to keep taking the Three arrows iron for now and I certainly feel better since taking it and stopping the nasty ferrous sulphate that I just couldn’t tolerate! My ferritin has increased from 16 to 24 in about 3 months so it’s a slow gain but hopefully I’ll get there eventually. I’m taking 125mcg levo daily. Do you think I should increase to 150mcg or could I increase the T3?

[greygoose in reply to Peril1504]

To increase your folate you would be best taking a B complex with 400 mcg methylfolate - Thorne Basic B is a good one, or Igennus.

I think the best thing to do would be to increase levo to 150 and see what effect it has on your FT3.

Most doctors have no idea what Hashi's is! But, the patient needs to know so that he can adjust dosage himself.

Hashi's is an autoimmune disease, where the immune system systematically destroys the thyroid by constant attacks, mistaking it for the enemy. And during the attack, the dying cells leak their stock of thyroid hormone into the blood so that levels of FT4 and/or FT3 suddenly rise for no apparent reason. This is when doctors talk about 'abusing thyroid hormone' and want to slash the dose. But, these 'hyper' levels are only temporary, so levels will eventually reduce by themselves. And they you will be hypo again, and need your full dose of levo/T3. So, if you start to feel hyper, the best things to do is to reduce, or stop, the levo yourself, without involving the doctor, until you feel hypo again. That is why it's important to know.

But, Hashi's is just the reason for your hypothyroidism, it's not anything that needs to be treated differently. In any case, there aren't any different treatments, just thyroid hormone replacment of one kind or another.

[Peril1504 in reply to greygoose]

Wow! I have never heard it explained like that before, thank you!

I work for the NHS and finding it increasingly difficult to manage on a daily basis just because of extreme fatigue. Is there anything that can help me overcome this as I’m not sure how much longer I can carry on working while feeling like this and I love my job. I don’t think it would qualify me for retirement on ill health grounds anyway.

Of note, I seem to be running a very low resting heart rate which is common in hashi’s I’ve read. Other than buying something off a guy in a pub (which I would never do), is there any way to speed up your heart rate?

[greygoose in reply to Peril1504]

That low ferritin will be causing extreme fatigue, quite apart from the low-ish FT3. The only way to over-come it is to optimise bith nutrients and thyroid hormones. There's no other way, no magic bullet.

Low resting heart-rate is common for most hypos. And, once again, the only way to over-come it is to optimise your nutrients and thyroid hormone levels.

[Peril1504 in reply to greygoose]

Thank you I will do that though it’s so difficult after gastric surgery with suffering with malabsorption. It’s such a slow process. I might up my dose of three arrows iron to see if that helps though it’s annoying that I have to pay for something as basic as iron supplements when the NHS should be helping. They won’t consider an iron infusion due to my Hb being in the normal range though at the lower end of normal. It seems ironic that I work in haematology too!

Ill get some folate supplements too. Once again thank you so much for your help. You’ve been amazing! If only the docs were as clued up as you!

[greygoose in reply to Peril1504]

If only!

But, not folate supplements: a B complex. All the B vits work together so need to be kept balanced. No point in just taking one isolated B. It might raise levels in the blood, but it won't do anything for you.

Can you not have your gastric bypass reversed?

[Peril1504 in reply to greygoose]

No I I don’t think it’s possible. I knew that when I did it and at age 59, it’s probably not worth it now. I will just have to try and make the best of things and using the advice I get from this forum, get myself into the best shape I can. I’m waiting for a knee replacement and want to be in good shape for that and also, myself and my husband are driving across Europe for 3 weeks later this year in my MX5 and if I don’t manage to lose at least a couple of stone, it won’t be the pleasurable experience it should be though it’s on my bucket list and after years of covid and having to postpone it, I’m determined it’s going to happen this year.

[greygoose in reply to Peril1504]

Well, that's something to look forward to! Pity about the gastric bypass, though because as well as affecting absorption of nutrients, it will also affect absorption of thyroid hormones. So, you do need to increase your dose to have any hope of losing that weight. As I said, it's not about how much you eat, it's about increasing your metabolism and losing the water retention. So, whatever you do, don't go on a low calorie diet! You need those calories and you're probably not getting enough.

Lucky you having an MX5! I'd love one, but even if I could get in it, I probably wouldn't be able to get our again! lol Far to near the ground. I did have a Honda Prelude once, and that was bad enough - felt like I was sitting in the road. But, someone stole it, so I no-longer had that problem.

Anyway, I hope you have a wonderful holiday - it sounds great!

[Peril1504 in reply to greygoose]

Aww that’s terrible. You can’t have anything nice these days 😥

I wanted an MX5 from my 30’s and would jokingly ask my dad to buy me one. “You can have one when I snuff it” was his reply haha so when he died and left me quite a bit of money, I thought why not? I’m onto my second one now and I love it!

I won’t go on any low calorie diets don’t worry. It was due to being on one and not losing any weight that prompted me to go see the GP and that’s when it was discovered. That was well over a year ago and I’m a stone heavier now than I was then! It just seems to creep up a little at a time. My life should be good, I love my job, have a wonderful husband and family but getting on top of this seems to consume me sometimes and I feel like I can’t do it anymore. I do though, keep plodding on and getting up for work everyday, putting a brave face on things

[greygoose in reply to Peril1504]

Yes, I know what you mean. I'm long retired, now - 78 - but my life is not the way I planned it to be on retirement! I too wanted to travel, but have difficulty getting to the supermarket now. And the idea of braving an airport fills me with horror! But I did do a lot of travelling when I was younger - including a brief road-trip through part of Europ with my son. But we only had a week. We live in France, so we drove through France into Belgium, then Holland, and went right up to the tip of Holland. It was great!

But, since then there's been covid which seems to have made everything worse. I'm having a hard time recovering from that.

Anyway, I've just had a thought, that is a bit off-the-wall, but could just work - as they say. Given your problems with absorption, which affects T4 more than T3, have you ever considered taking T3 only? That is more easily absorbed. And I only really started to lose weight when I went onto T3 only. So rather than messing around with your levo dose, just cut it out and increase the T3. I don't know what you endo would think about that, but it has to be worth a try, don't you think?

[Peril1504 in reply to greygoose]

I have thought about trying t3 only but wouldn’t know what dose to take. I haven’t an endo yet, just in the process of being referred by my GP. One of the reasons I went back to my GP was that my feet were so swollen I could barely get some trainers on let alone regular shoes! It’s just as well I’m allowed trainers to work. What dose of T3 would you recommend please?

We will be driving from the north east of England, down through France and into Spain to my brothers apartment in Los Alcazares on the mar menor, 10 days there approx and then 9 days back through Belgium, Switzerland, Italy maybe Germany and to Holland to get on the ferry back to England. It’s been a long time in the planning and I’m so looking forward to it 😊

[greygoose in reply to Peril1504]

Well, I wouldn't recommend an abrupt chang-over, but gradually decrease your levo whilst slowly increasing your T3. I would start by reducing the levo by 25 mcg, and a couple of weeks later increase the T3 by 5 mcg.

Then, six weeks from reducing the levo, reduce by another 25 mcg, and a couple of weeks later, increase the T3 by 5 mcg. Then, when all the levo has been phased out, hold for six weeks and retest, then continue slowly increasing the T3 until you reach your sweet spot.

Sounds like an exciting trip! With my ex, we drove down through Spain a couple of times to Portugal. We loved Portugal, but not so keen on Spain. All those endless arid plains! Strangely, now I think about it, I've never been to Switzerland. But I just love Belgium! I don't know why I'm not living there right now, instead of France. But probably because I couldn't possibly keep my windows clean enough! Holland is something else. Very quirky. But I like it very much. There's so much of the world to see and so little time. But I'm content that before I die I will have seen Jerusalem. A visit I'll always keep in my heart.

[Peril1504 in reply to greygoose]

Thank you I will follow those instructions and see where it takes me. What levels am I looking for or is it more a ‘feeling’ than a level?

You make Europe sound wonderful, I’m so looking forward to it! I’ve only been to France and Spain previously so it’ll be an adventure. Where my brothers apartment is is nice as it’s on the coast and quite green. Still Spanish enough to not be too commercialised but enough English pubs and restaurants to keep a fussy eater happy!

Jerusalem? That sounds like an adventure and I’m so pleased you got to fulfill something off your bucket list too, I can imagine it being deeply meaningful. I’m not particularly religious but even to me, some places have a powerful impact and make me feel very humble.

[greygoose in reply to Peril1504]

It's much more a feeling than a level, yes. Blood tests are just a rough guide.

You don't have to be religious to find Jerusalem meaningful. I'm not at all. But that place got to me like no other place has ever done. It felt like coming home. And then I had to leave, knowing I would never see it again. And I cried all the way back to Tel Aviv.

[FancyPants54 in reply to Peril1504]

I would increase your 3 Arrows dose. Going by the web site, you can increase quite a long way. I've started using it recently and I too have been taking 1 capsule a day with vitamin C. I am thinking of moving up to 2 capsules around now so that I can give my iron levels their best chance.

[Peril1504 in reply to FancyPants54]

Thank you I will do that. I had better get some more ordered as I only got 1 bottle until I saw whether or not it had an effect.

[Peril1504 in reply to greygoose]

Can I ask if a diagnosis of Hashi’s makes a difference from hypothyroidism please? Is there any difference in management of the 2 conditions and do the endo’s acknowledge any difference between the two?