Hey,I'm 45 diagnosed with under active thyroid after birth of my first child age 34. I've taken 50mg of accord Levothyroxine every morning since then.
I've had on and off gut issues for years now, bloating, tiredness being the main concerns and have been referred for a colonoscopy and and endoscopy- which I'm extremely nervous about.
I've heard about the links between T3 on gut issues and got some blood test results. However I'm not sure that they are indicating this and was looking for some advice.
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Please add reference ranges for each test - numbers in brackets after your result number. Ranges vary between labs.
Your TSH is only just under 2 and most people feel well when it is at 1 or just under 1. So you have room for a dose increase most likely.
How are you taking your blood tests? Recommended timing is 9am or earlier which gives highest TSH.
Leave 24 hours from last dose of Levo to blood test so that stable blood levels of T4 are measured as opposed to what you have just taken.
Have you had any vitamin tests run and if so what were the results?
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. Have you recently or could you ask your GP to test levels of ferritin, folate, B12 & D3? Private tests are available, see link for companies offering private blood tests & discount codes, some offer a blood draw service at an extra cost.thyroiduk.org/testing/priva...
There is also a new company offering walk in& mail order blood tests in London, Kent, Sussex & Surrey areas. Check to see if there is a blood test company near you. onedaytests.com/products/ul...
Only do private tests on a Monday or Tuesday to avoid postal delays.
Many with autoimmune thyroid disease aka Hashimoto's benefit from a gluten free diet. A smaller percentage of those also need to remove dairy from their diet to feel well. These are intolerances and will not show up on any blood test.
reception.
It's ideal if you can always get the same brand of levo at every prescription. You can do this by getting GP to write the brand you prefer in the first line of the prescription. Many people find that different brands are not interchangeable.
Always take Levo on an empty stomach an hour away from food or caffeine containing drinks & other meds. Many people find taking it at bedtime works well for them.
Thanks a mill, so much helpful advice. Added more details to my original enquiry. Definitely the last blood test wasn't under optimum circumstances so will do again.
Depending on when you last took Levo, actually even if you took it not long before the test you still have plenty of room for a Levo increase.
Doctors can be very conservative and need pushing for increases as its not them suffering the symptoms!
In the NICE guidelines it mentions a calculation of dosing by weight (which isnt really accurate but can be used as a guide for final dose).
1.6 x weight in kilos = final Levo dose.
Do the calculation and see how different it is to you current dose. Explain to the GP about this.
Your vitamins are looking pretty good. Are you taking a supplement at all?
Ferritin could be higher.
Ferritin should be around 90 - 100 for best use of thyroid hormone. Suggest increasing iron rich foods in diet and eating them often. Chicken livers, pate, red meat etc
Testing for coeliac is only one condition caused by gluten. Its possible to still benefit from a strictly gluten free diet even if coeliac test is negative. Well worth trying.
So retest if you feel it wasnt under optimal circumstances and things might look different again.
Ask GP for trial increase. This is less intimidating for them.
Can you put the ranges with those results, please? Ranges vary from lab to lab so we always need those that came with your results.
That said, your FT3 does look low in range, whilst your FT4 looks high. That means that you are a poor converter of T4 to T3. T4 is basically a storage hormone that doesn't do much until it is converted into the active hormone, T3.
Poor conversion can be due to low nutrients. And if you're having digestive problems - caused by low stomach acid due to low T3 - then your nutrients are probably low, if not deficient. You therefore need to get your vit D, vit B12, folate and ferritin tested, and supplement according to the results.
Did you know you have Hashi's? Your high antibodies are saying you do. So, it could also be the Hashi's causing your poor conversion, and there's not much you can do about that, I'm afraid.
So, in answer to your question: yes, your lab results do indicate that you have gut problems in that your FT3 is low, so your stomach acid will be low, causing bloating. Low T3 would also account for your fatigue.
Yes, so, as I thought, your conversion isn't brilliant, and your FT3 is low. And that's what causes symptoms. However, worth trying an increase in levo before considering anything else.
For the rest, you've had good advice from everyone else.
50mcg levothyroxine is only standard STARTER dose, so you are highly likely on inadequate dose levothyroxine
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
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)
Gut issues
GP should have tested you at diagnosis of autoimmune thyroid disease for coeliac disease
Did this happen
If not, assuming you’re not already on strictly gluten free diet, get tested
Plus request/ politely insist GP test vitamin D, folate, B12 and ferritin
What vitamin supplements are you currently taking, if any
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.
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 as per NICE Guidelines
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
With loads of vegan dairy alternatives these days it’s not as difficult as in the past
Thankyou! Added more info to the enquiry, I did go gluten free for a bit but can't say it made a huge difference at the time but probably worth doing again.
Always test early morning, ideally before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test
Levothyroxine is an extremely fussy hormone and should always be taken on an empty stomach and then nothing apart from water for at least an hour after
Many people take Levothyroxine soon after waking, but it may be more convenient and perhaps more effective taken at bedtime
No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.
Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away
(Time gap doesn't apply to Vitamin D mouth spray)
If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test
If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal
Guidelines of dose Levo by weight
approx how much do you weigh in kilo
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
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.
TSH should be under 2 as an absolute maximum when on levothyroxine
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).
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.
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).
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blood test results.
New with Hashimotos. Need help interpreting results.
JUST got my results PLEASE PLEASE HELP !! ???
Please help with blood test results
Please can someone help with my blood results.
