My SIL has Hypothyroidism (had it a number of years) is on 100mcg. She had a private blood test the results are, TSH 0.034 (0.27-4.2), Free T3 4.4 (3.1) and Free Thyroxine 27.1 (12-22), Thyroglobulin 19.2 (0 - 115), Thyroid Peroxidase Antibodies 191 ( 0- 34).
She has Arthritis and Lichen Planus and Alopecia (getting worse). She takes Vitamin D +K2 5,700iu and Omega 3 1200mg.
The report
Your thyroid stimulating hormone is low and you have high free thyroxine which suggests that your levothyroxine dose may be too high. If you are free of symptoms then you may prefer to simply retest this in 3 months. If you are experiencing symptoms of an overactive thyroid then I recommend discussing this result with your doctor.
Having very low levels of thyroid stimulating hormone for several years has been associated with the development of osteoporosis. If your thyroid stimulating hormone always tends to be substantially below the normal range then it may be worth discussing with your GP whether a bone density scan is advised to monitor for the development of osteoporosis. You do not need to worry about the occasional low reading, only if you get repeated very low levels.
Your thyroid peroxidase antibodies remain elevated. This antibody can be associated with autoimmune thyroid disease. It is frequently seen in conditions such as Hashimoto’s disease (where the thyroid becomes underactive) but confusingly can also be seen in Grave’s disease (where the thyroid becomes overactive).
As your thyroid function is normal, your result means your risk of developing future thyroid disease is increased compared to someone who has normal levels of these antibodies, but reassuringly this risk is still considered to be low (3-5%.) You may however wish to monitor your thyroid function annually.
With her hair falling out she hardly goes out now, she can’t wear the wig she bought as her scalp itches all the time. She gets very depressed and I’m worried about her.
Can anyone advise on this please? Thanks in advance.
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greenfingers
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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)
Is this how she did test?
Next step is further testing
High thyroid antibodies confirms cause is autoimmune thyroid disease, also called Hashimoto’s
About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high TPO and/or high TG thyroid antibodies
Autoimmune thyroid disease with goitre is Hashimoto’s
Autoimmune thyroid disease without goitre is Ord’s thyroiditis.
Both are autoimmune and generally called Hashimoto’s.
Essential to test vitamin D, folate, ferritin and B12
Lower vitamin levels more common as we get older
For good conversion of Ft4 (levothyroxine) to Ft3 (active hormone) we must maintain GOOD vitamin levels
700iu vitamin D is low dose ……quite likely insufficient to maintain good vitamin D level
Hair loss suggests low iron/ferritin
Cheapest option to test vitamin levels here
Monitor My Health (NHS private test service) offer thyroid and vitamin testing, plus cholesterol and HBA1C for £65
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
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Can someone has Hashimoto's and Grave's at the same time?
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