Introduction and some initial questions

[LifeintheMed]

Hi folks,

I've ended up here as I was given some routine blood tests when I started with my health insurance (I'm British but I live in Spain) and it was discovered (rediscovered?!) that I have Hashimotos'.

I was first diagnosed with this maybe 15 yrs ago when my kids were little. I was breastfeeding, not really sleeping, alone with two small children - all the usual! - and the doc at the time said my vit D levels were low (I lived in the Calder Valley, if you know it, you'll understand!), and that I was borderline hypothyroid with antibodies making it Hashimotos...

At the time I was exhausted and the levothyroxine didn't help. In the end, I decided to just eat even more 'cleanly' than I was , start running etc etc and I stopped taking the meds.

I thought I was better, I have generally felt ok even through travelling with kids in a van for a year, settling in Spain, managing all the physical labour of an olive orchard and extensive veg garden...I have occasionally felt that 'thyroid' exhaustion but on the whole I figured I was good. I'm also three years into a medical herbalist professional training and I thought I was mega-healthy.

Until I got these recent blood tests. High cholesterol, low B12, low vit D and clear Hashimotos. They also found a nodule on my thyroid - it's not a concern apparently at the moment. Anyway, I'm a bit knocked by it all...obviously I'm taking the levothyroxine now but other than sluggish digestion/constipation, I haven't really got any 'symptoms'...

What I'd really like to understand is the relationship between the Hashimoto's and the low levels of B12/D and the high cholesterol. Will these normalise after I've been taking the levothyroxine for a while? Does the low thyroid/Hashi's cause the issues with vitamin levels or is it the other way around?? My endocrinologist seems to think it'll all be ok when my thyroid levels are sorted.

So yeah, any insights into these relationships would be great.

Thanks!

[Treesong2023]

Hello, I am new in here and I saw your post as i trawl the posts of the past.

But if I heard your say low B12...? Then, I would suggest you think seriously about supplementing it right up - maybe via oral supplements sub ling. I fear your tiredness will get deep and longer if you dont...

Some folks in here use self injection if their B12 is on the floor. You cant do any harm getting you B12 up ...but its a vital metabolic componnent. My Endo told me to dose up on B12 to raise mine, despite attendant issues of low TSH and T4.

Bye for now...the adults who know much much more than me will be along soon!

[helvella]

Low B12 levels are commonly found in those with Hashimoto's - and (I think) any other form of hypothyroidism.

I think the causes are either the hypothyroidism itself, or its impact - such as an impact on stomach acidity and generally poorer ability to absorb vitamins.

Low B12 levels become more common in general as we age, even without thyroid issues.

So long as it is clear you do not have Pernicious Anaemia, it seems entirely sensible to me to supplement with B12. I do.

I suspect that it is unlikely that B12 levels will return to good levels - even if they improve a bit. B12 is fairly low cost. And it is very widely available in oral forms. And safe.

[greygoose]

Hi LifeintheMed, welcome to the forum.

Did you get your thyroid labs done at the same time: TSH, FT3, FT4? If so, post them here, with the results, and let's have a look at them.

High cholesterol usually indicates low T3. Cholesterol is made in the liver - because the body needs it - and the liver does its best to keep levels stable by making more the less you ingest, and vice versa. However, when T3 - the active thyroid hormone needed by every single cell in your body to function correctly - is low, the body cannot process cholesterol correctly, and it tends to build up in the blood. Nothing to worry about, just an indicator that something is off. And as your FT3 level rises, the cholesterol level should drop.

Hypos tend to have low levels of nutrients because low T3 also means low stomach acid. And that causes difficulty digesting food, and therefore difficulty absorbing nutrients. Unfortunately, they problably won't sort themselves out even when on the correct dose, so most hypos take quite a few supplements for life.

[LifeintheMed in reply to greygoose]

Ah, just saw you put FT3 and Ft4 so i'm guessing that's 'free'

T3 is 4.59 pmol/L (2.99 pg/ml)

T4 10.70 pmol/L (0.83 ng/dl)

Hope that makes sense to someone!

[greygoose in reply to LifeintheMed]

Yes, it's the Free - FT3 - T3 we're interested in. And the Free T4.

So, no, your results don't make a lot of sense - well, the numbers in brackets don't; Normally it's the so-called 'range' in brackets, but a range has to have two numbers, a top and a bottom. For example we often see 12-22 for FT4, and 3.1-6.8 for FT3; But they vary from lab to lab, which is why we have to have them to be able to interpret the results.

[LAHs in reply to greygoose]

That's really interesting, makes sense of a lot of things.

[LifeintheMed]

Thanks for the helpful replies so far! It's so weird being on the back foot with this stuff as I'm so usually up on health info.

Ok, so I'm looking at my results...

Looks like TSH is 11.76 uiu/ml

I'm not sure what I'm looking for with T3 and T4 - is it total or 'free'?

[Obsdian in reply to LifeintheMed]

Your t3&4 results should have a range, posting that alongside helps everyone understand the results better and give better advice.

[LifeintheMed in reply to Obsdian]

Thank you! Bit new to all this

[Obsdian in reply to LifeintheMed]

It's been a year for me and still feel ill informed despite obsessive reading.

[LifeintheMed in reply to Obsdian]

It's complex eh? Got any useful reads to share?

[LifeintheMed in reply to Obsdian]

Actually, doesn't look like they've given a range? Maybe it's how they do it here in Spain...?

[GlowCoach Administrator]

Welcome to the group.

Low thyroid levels cause low stomach acid which means you dont absorb vitamins well from your food. Once optimally replaced on Levo your absorption will improve somewhat but likely you will always need to supplement.

For Levo to work well we need OPTIMAL levels of 4 key vitamins - ferritin, folate, B12 & D3.

Are you vegan or vegetarian?

Exactly what were your vitamin results and what supplements are you taking for them now?

What are your most recent thyroid results along with the reference range for each test - numbers in brackets after your result.

It's ideal if you can always get the same brand of levo at every prescription.

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.

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.

Do you do tests as per the protocol recommended here?

Recommended blood test protocol: Test at 9am (or as close as possible), fasting, last levo dose 24hrs before the blood draw & no biotin containing supplements for 3-7 days (Biotin can interfere with thyroid blood results as it is used in the testing process).

Testing like this gives consistency in your results and will show stable blood levels of hormone and highest TSH which varies throughout the day. Taking Levo/T3 just prior to blood draw can show a falsely elevated result and your GP/Endo might change your dose incorrectly as a result.

[LifeintheMed in reply to GlowCoach]

Thanks Jaydee - I've seen you send this response before, it's very helpful for us 'newbies'.

I'm not sure what everyone means by the 'range' unless it means the other info in the box?

So, for eg, my free T3 is 4.56 pmol/L but underneath this, they have written 'v.referencia' 3.50-6.50 pmol/L .

On all the other test results, this other range is the one given for 'normal'...(So again, for example my Vit E is 39.80 umol?L, but the range given for adults over 19 is 11.60-42.00.) If this is the case, wouldn't it make my T3 levels normal?

My vit D is 60.36 nmol/L (reference range 'insufficient' 50-74.00, 'deficient' lower than 50)

Vit B12 is 220 pmol/L (reference range 'marginal' 148-221 pmol/L)

I'm not vegan or veggie and eat red meat once or twice a week, chicken/fish once or twice a week...i also eat loads of eggs (we have chickens) and a teeny bit of dairy.

[GlowCoach Administrator in reply to LifeintheMed]

So, for eg, my free T3 is 4.56 pmol/L but underneath this, they have written 'v.referencia' 3.50-6.50 pmol/L .

Thats exactly what I mean. Sometimes the numbers are in brackets. Each lab has their own reference range so its important to quote the range for the lab that you used.

Just because your result falls within the range (better not to call it 'normal' because it really isnt that at all) it doesnt mean your result is good or right for you.

Theres a huge difference between having a result at the bottom of the range to if it were at the top. GPs arent taught this though so think that any old number falling within the reference range is good. As patients we know better.

We use this calculator to work out the % through range and use that as a guide along with symptoms. thyroid.chingkerrs.online/

I know the Spanish use a different system of measurement for vit D so I'm unsure if your result is optimal.

Do you know which type of B12 you had? Theres a serum test & active B12.

It looks to me like your B12 is pretty low though falling in the marginal category. Suggest you ask them to test you for pernicious anaemia. If they wont do that then you need some high dose supplementation to raise your level.

So do you have thyroid results with reference ranges and are you starting Levo again.

Likely last time you didnt get enough Levo + hadnt addressed the low vitamin levels.

[LifeintheMed in reply to GlowCoach]

Thanks so much for taking the time to reply. Looks like B12 is serum. Do you know how they test for pernicious anaemia? My doctor friend suggested I get tested for coeliac disease, which I'm doing, but again I don't feel like I really have any coeliac symptoms.

Do you know what the implications are of a B12 level like mine? Again, i feel pretty well but from a little reading it seems like lower levels should be showing up in some sort of symptomatic way.

Regarding supplementation - I'm planning on doing this but maybe after my next bloods.

[GlowCoach Administrator in reply to LifeintheMed]

theb12society.com/signs-and...

Getting tested for coeliac is a great idea because that can cause terrible vitamin absorption. Once you've been tested try going strictly gluten free which may help and is worth a try.

There are several tests for PA including an MMA test but none of them are definitive so a lot depends on your doctor. You have a very low level though especially as you do eat meat & eggs.

You also need folate & ferritin tested.

No thyroid hormone will work well unless all key vitamin levels are at OPTIMAL.

[LifeintheMed in reply to GlowCoach]

Thanks to your info and help I've gone back to look at the tests my endo has ordered for me and I can see that along with the coeliac test she has asked for paritel call and intrinsic factor tests too - so looking for pernicious anaemia. This is very reassuring that she's on the ball!

Your answers have been very helpful. Thanks so much

[LifeintheMed in reply to GlowCoach]

Oh and yes, i've started back on Levo

[tattybogle]

Hi , so : yes your fT3 levels are 'within the normal range' but , the fact that it is 'somewhere in range' does not mean it is the right level for any individual ... individuals with properly working thyroid glands have fT4 & fT3 levels which stay within a narrow band within this whole population ref range. so eg, for someone who's fT3 level when healthy was normally staying between 50-75% , then 36% would be 'too low for that individual'. but for someone whose fT3 was normally staying between 30-50% when healthy , then 36% would be 'normal for them'

fT3 is 4.59 , reference range is [3.50-6.50] meaning your fT3 is 36% 'through the range'. ( % calculator here : thyroid.dopiaza.org/ )

fT4 10.70 [what is fT4 range ?]

[LifeintheMed in reply to tattybogle]

Thanks, I think I'm starting to get it...

The FT4 range is a bit confusing...it has 'eutiroidismo' 11.50- 22.70, the hipotiroidismo/hypothyroid lower than 11.50. As you say, mine is 10.70

[GlowCoach Administrator in reply to LifeintheMed]

Can you post a photo of these results? I can use Google lens to translate them. You need to write a word or 2 to get an image to upload.

[tattybogle in reply to LifeintheMed]

yes , 11.5-22.7 will be the '95% population reference' range for fT4 , so yours was below range .

it's usual for T3 to still be in range in early hypothyroidism ~ the failing thyroid struggles to make enough T4 and T3......... the T4 level usually falls first ...... causing TSH to rise (the higher TSH is 'asking' the thyroid to try and make more T4/T3 .. higher TSH also ask thyroid to make relatively more T3 than usual ...

so in early hypo , you usually get high TSH . lower T4, while T3 is still in range.

The body tries hard to keep T3 levels up, because T3 is the immediately active form of thyroid hormone (T4 is basically a transport/ storage form of T3)

[LifeintheMed in reply to tattybogle]

Thanks for this explanation