Unsure about thyroid results/next steps

[KQuail]

Hi,

I was wondering if anyone could help me understand my thyroid results.

TSH 3.5 (0.35 -5.5)

FT4 14.7 (11.9 -21.6)

FT3 5.14 (3.1 -6.8)

Anti-TPO 253 (<34)

Anti-Tg 120 (<115)

The Anti-TPO seems high, what should be my next steps?

Thanks 🙏

[Buddy195 Administrator]

Welcome to the forum KQuail

So we can offer better advice, can you please add ranges in brackets for:

TSH

FT3

FT4

Plus antibody tests ( as these can vary between laboratories)

Next steps would be to test key thyroid vitamin (ferritin, folate, vitamins D and B12)

If your GP is unable to complete these you could look to do this privately, as many forum members do, for a better picture of your thyroid health:

thyroiduk.org/help-and-supp...

[KQuail in reply to Buddy195]

Thanks Buddy, I've updated ranges now.

Folate 8.8 (4.5 -20)

Ferritin 53.8 (23.0 -393)

B12 235 (206 -1000)

[Buddy195 Administrator in reply to KQuail]

I like my levels to be:

Vitamin D (100-150nmol/L)

Vitamin B12 (Total B12 at top of range or for Active B12 100 or above)

Folate (at least half way through range)

Ferritin (half way through range) Although some point to 90-110ug as optimal.

I improved ferritin by following advice on Daily Iron.dailyiron.net/

I improved my folate and B12 taking Thorne Basic B.   SlowDragon will be able to provide comprehensive links for improving vitamins, so will tag her on.

Did you test vit D?

[Buddy195 Administrator]

TSH should always be under 2, so this is indicative that your thyroid is struggling and high antibodies confirm you have an auto immune thyroid condition (aka Hashtimotos). Unlikely that you will be offered thyroid medication (Levothyroxine) until TSH is higher. A patient to patient tip is to ensure next blood test is early morning, prior to 9am, when TSH is highest.

Do you currently have any adverse symptoms?

Have you ever tested key thyroid vitamins? These are often low with Hashimotos. Please don’t supplement without testing levels first.

Have you ever trialled a gluten free diet? (Many with Hashimotos, myself included benefit from this).

[Hollins in reply to Buddy195]

Hi

I don't want to muddy the water but why should TSH always be under 2?

[Buddy195 Administrator in reply to Hollins]

Healthy thyroid levels are under 2, so a slightly elevated level shows yours is struggling a little; likely this is the reason for your adverse symptom flare. I would focus on improving key thyroid vitamins as a first step to supporting your thyroid health.

Have you ever had a coeliac test? This will show if you have a gluten allergy. Im not a coeliac but (like many with Hashimotos) am gluten intolerant. I benefitted hugely from a 3 month GF trial (all digestion issues resolved plus lowered my thyroid antibodies significantly- although they are still over range!) and I wouldn’t eat it again.

[KQuail in reply to Buddy195]

Yes, I appear to have a lot of symptoms. Especially fatigue,issues with immunity and having issues with temperature regulation.

I seem to be constantly getting ill with new infections since last Summer.

No I haven't done any other tests yet.

[SlowDragon Administrator]

Anti-TPO 253 (<34)

Anti-Tg 120 (<115)

These confirm autoimmune thyroid disease

Low vitamin levels tend to lower TSH

Improving low vitamin levels essential first steps

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

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

Or buy a test online, about £20

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...

[SlowDragon Administrator]

Folate 8.8 (4.5 -20)

B12 235 (206 -1000)

B12 is very low

Are you vegetarian or vegan?

Low B12 symptoms

b12deficiency.info/signs-an...

methyl-life.com/blogs/defic...

NICE guidelines on B12 and testing

healthunlocked.com/redirect...

With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a separate B12 supplement

A week later add a separate vitamin B Complex 

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

Highly effective B12 drops

natureprovides.com/products...

Or

B12 sublingual lozenges

uk.iherb.com/pr/jarrow-form...

cytoplan.co.uk/shop-by-prod...

B12 range in U.K. is too wide

Interesting that in this research B12 below 400 is considered inadequate

healthunlocked.com/thyroidu...

Low folate

supplementing a good quality daily vitamin B complex, one with folate in (not folic acid)

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 supplements

thyroidpharmacist.com/artic...

B vitamins best taken after breakfast

Igennus B complex popular option. Nice small tablets. Most people only find they need one per day. But a few people find it’s not high enough dose

Post discussing different B complex

healthunlocked.com/thyroidu...

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

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...

helvella.blogspot.com/p/hel...

[SlowDragon Administrator]

You need to test vitamin D

NHS private testing service

vitamindtest.org.uk

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 when supplementing

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...

Recipe ideas

bbc.co.uk/food/articles/mag...

Interesting article by Dr Malcolm Kendrick on magnesium

drmalcolmkendrick.org/categ...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

[KQuail]

Thanks for all the replies so far.

Yes, I am vegetarian.

I'm hesitant to supplement for anything on relation to iron at the moment as I am waiting on test results for hemochromatosis.

I'll look into the other vitamin supplements in the meantime ( thanks for all the recommendations)

Additionally, I'll get a coeliac test ordered to rule that out/in