Hypothyroid again

[Natasha76]

Good afternoon. My recent bloods show TSH of 1.99 - reference range 0.27 to 4.20. Serum freeT4 level is 9.6 ref range 11.99-21.60. Serum ferritin 89. Liver profile ok, haemoglobin slightly raised by one point only . I had complete thyroidectomy in 2016. Since last year on T4 100 mcr daily and 30 mcr of T3 slit inn3 doses over the day . Also on adrenal cortex - 8 a day slit in 2 doses. As well as desogestrel( progesterone) 75 mcr daily. Symptoms are tiredness, needing a nap late afternoon again, join pain, tearfulness , irritability. I have just seen my functional doctor last month as he prescribed the T3 and he advised to see him in 3 months initially with a complete thyroid panel test. My Gp requested blood tests recently to prescribe T4 and the results are above. I can’t really afford a considerable amount of money for an extra appointment ( as suggested by him when I asked for advice). I have bleed for almost 2 full months over the last 4 months - awaiting on hysterectomy, so I supplemented with dextran iron injections as my gut doesn’t do well on oral supplement. I haven’t had vit d, zink, selenium for a while now and stoped being gluten free as thought that that bread is full of other unnecessary things. I really don’t want to make an other private appointment to be told to increase my T 4 by a little bit . Any suggestions from you please ? I will see the functional doctor in 2 months and have the full thyroid panel too .. what can I do until then? Thank you

[SlowDragon Administrator]

Well if you are on T3 it’s essential to actually test Ft3

Exactly what vitamin supplements are you taking

When were vitamin D, folate and B12 last tested

You need full iron panel test to see where iron levels are

What was reason for thyroidectomy

For full Thyroid evaluation you need TSH, FT4 and FT3 tested

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease - Graves or Hashimoto’s

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)

T3 ….day before test split T3 as 2 or 3 smaller doses spread through the day, with last dose approximately 8-12 hours before test

is this how you did your test

Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins

Post all about what time of day to test

healthunlocked.com/thyroidu...

Testing options and includes money off codes for private testing

thyroiduk.org/testing/

Medichecks Thyroid plus BOTH TPO and TG antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes BOTH TPO and TG antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

Only do private testing early Monday or Tuesday morning.

Link about thyroid blood tests

thyroiduk.org/testing/thyro...

Symptoms of hypothyroidism

thyroiduk.org/signs-and-sym...

Tips on how to do DIY finger prick test

support.medichecks.com/hc/e...

Medichecks and BH also offer private blood draw at clinic near you, or private nurse to your own home…..for an extra fee

Just TSH, Ft4 and Ft3 test - £32

monitormyhealth.org.uk/thyr...

10% off code here

thyroiduk.org/testing/priva...

Monitor My Health also now offer thyroid and vitamin testing, plus cholesterol and HBA1C for £65

(Doesn’t include thyroid antibodies)

monitormyhealth.org.uk/full...

10% off code here

thyroiduk.org/testing/priva...

[Natasha76 in reply to SlowDragon]

Thank you for your reply. Thyroidectomy due to cancer ( 2016). Been on levo since 2006, always feeling crap. Started t 3 last year in April . Had my vit D, folate , B12 tested in January as well as the usual cholesterol , diabetes nhs test. Had TSH , TPO and Tyro-globulin antibodies tested in April when discharged from oncology and referred to endo. I am assuming my ferritin was elevated by iron injections as my ferritin was 37 in January , and the full iron test on nhs was ok then ( although 37 is not optimal). I know that low iron always messes up my thyroid tests . I had the T4 with 10 mcr of T3 at 6.30 am the day before , adrenal cortex at the same time , then 10 mcr of T3 at 11.30 am and 10 mcr of T3 at 5-6 pm all before the day of the test . The blood test was at 11.30 next morning - fasting , had the thyroid meds after left the surgery. Thank you

[Natasha76 in reply to Natasha76]

Also talking B vit complies here and there, p5p and magnesium too. Used to take them regularly but I seem to react to something, maybe to the shell - used mainly clean brands but did mix sometimes

[SlowDragon Administrator in reply to Natasha76]

and 10 mcr of T3 at 5-6 pm all before the day of the test . The blood test was at 11.30 next morning - fasting

So last dose T3 was over 17 hours before test …..too long

Last dose 8-12 hours before test

Test (ideally) before 9am

[Natasha76 in reply to SlowDragon]

Thank you. Usually tested early in the morning , booked online for Saturday , so not missing time from work. Gp insisted to do it with them, must get paid extra for it so booked for lunch break. I have symptoms though like when I was iron deficient plus join pain. So it seems there isn’t a way around , will have to fork £250 ish on extra appointment and tests. Thank you

[SlowDragon Administrator in reply to Natasha76]

ALWAYS get tested BEFORE considering booking consultation

If vitamins are low working on improving is next step

And ALWAYS test early morning, ideally before 9am, only drinking water between waking and test and last dose levothyroxine 24 hours before test

Last dose T3 8-12 hours before test

[gabkad]

Natasha76, you have no info on your profile. We don't know approximately how old you are

or why you need a hysterectomy. If you are premenopausal, perimenopausal, or postmenopausal. Progesterone is given in milligrams not micrograms. If your endometrium is thickened (ultrasound diagnosis) then the dose for progesterone is at least 200 milligrams (not micrograms) per day. It can also go as high as 300 milligrams. This will reduce the thickness of the uterine lining and stop excess bleeding.

If you are taking 75 milligrams, then that dose is too low.

If you've got fibroids, then it's a different story but progesterone will help there also because fibroids prevent the uterus from contracting effectively. I hope they've done thorough diagnostic testing of your uterus. IMO hysterectomy should be a last resort. Even fibroids can be treated without removing the uterus.

I would assume anyone who is bleeding for two months out of four would be affected as you report.

It would have been better if fT3 was tested since you are taking T3. Your T4 dose is very low. Consider that we absorb approximately 80% of thyroxine at best. You probably need the dose raised.