Poor Conversion or over medicated? Or something else perhaps.

[Mazza44]

I've been reading the forum for several months now, having been chronically ill since Easter.

My story - I have been prescribed thyroxine for 25 years and have been mostly very stable. I have previously tested positive for antibodies so I assumed it was Hashis.

Last Sept I suffered shingles, close unexpected bereavement (sister) and major professional pressure... all at the same time. I struggled to shake the shingles which made a resurgence in December (& again in April btw) and still under major work stress.

Come Easter weekend I got what I thought was a flu and have never been well since... whilst improved somewhat.

I have had long spells bedbound feeling awful. Dizziness, nausea, major fatigue, flank pain, alternating loose/slow bowels, headaches, completely fuzzy brain ... to name a few! I have managed to get back to reduced working hours but it is a struggle to keep the fine balance to meet my responsibilities.

I have had umpteen tests and scans all coming back normal, bar a positive ANA test in June that didn't point to anything specific. Other than that, only my thyroid stuff had been out - unfortunately T3 wasn't tested until I started reading this forum and requested it. In December my GP thought I was over medicated as T4 very slightly above range and Tsh below range. (I now think this may have been start of poor conversion?)

I have been working in eating well, getting Vit D up, etc , as advised in this forum.

I have a private endo appointment on Saturday and he has agreed, in principle, to do a 3 to 6 month trial of t3 and t4 - I am a bit nervous to be honest but I really need to get better! Worried I will lose the headway I've managed to make. He will need a little convincing probably as he had stated that I was perhaps OVER medicated. My case will be chronic illness and stress has affected my ability to convert.

Do you guys think this is reflected in my (limited) results?

29 May

T4 20.8 (12 - 22)

TSH 0.16 (0.27 - 4.20)

T3 4.7 (3.1 - 6.8)

5 Aug

T4 19.8

TSH 0.19

T3 3.9

30 Oct

T4 20.8

TSH 0.04

T3 4.3

Vit D 149 (0 - 50)

I have older iron numbers from April, amongst others... but would be interested to read your initial impressions?

I followed your testing protocols for Aug and Oct.

Thank you in advance of any guidance. I don't want to convince him to give the trial if its going to make me worse.

[TiggerMe Ambassador]

Welcome aboard

Are the results all from the same Lab?

[Mazza44 in reply to TiggerMe]

Hello

I put the range in the first result - all subsequent tests are the same range. NHS.

Thank you!

[TiggerMe Ambassador in reply to Mazza44]

So the last results show poor conversion which has worsened since the first test

Free T4 (fT4) 20.8 pmol/L (12 - 22) 88.0%

Free T3 (fT3) 4.3 pmol/L (3.1 - 6.8) 32.4%

T4:T3 Ratio 4.837 

[Mazza44 in reply to TiggerMe]

Thank you.

Can higher T4 suppress T3?

[TiggerMe Ambassador in reply to Mazza44]

Compared to your first results...

Free T4 (fT4) 20.8 pmol/L (12 - 22) 88.0%

Free T3 (fT3) 4.7 pmol/L (3.1 - 6.8) 43.2%

T4:T3 Ratio 4.426 

Your conversion could have suffered due to low B12, folate, ferritin... your Vit D is good

[TiggerMe Ambassador in reply to TiggerMe]

Adding a small amount of T3 would be a good idea but don't let them drop your T4 dose before as adding T3 will drop your fT4, titrate T3 slowly to allow your body to adjust so no more than 5mcg increments

[Mazza44 in reply to TiggerMe]

That first one was a bit of a bounce back... I think my adherence to taking the T4 wasn't great when I was floored end of March.

APR

T4 19.6

TSH 5.78

(no t3 to compare)

Dec 23

T4 23.5 (above range)

TSH 0.21

(no t3 to compare)

(all same lab ranges)

I will look up B12 follate and ferritin which were done around May. My ferritin was well over range though and I was told that this was an indication of inflammation. So I'm not sure how to read that.

[TiggerMe Ambassador in reply to Mazza44]

APR

T4 19.6

TSH 5.78

Is that the April before? With a TSH this high with a good level of T4 would also suggest poor conversion

You do say you have Hashi's which can cause fluctuations but your general trend is of low fT3

Yes ferritin not so much use, really need a full iron panel

[Mazza44 in reply to TiggerMe]

This was this April when I had been floored and my T4 compliance wasn't good. The good T4 confused me!

[TiggerMe Ambassador in reply to Mazza44]

Illness quite likely triggered a Hashi flare

[Mazza44 in reply to TiggerMe]

Can my thyroid still do anything after 25 years? Endo said atrophied... I just thought that meant it couldn't do anything

Quietly pleased it has "some" life left in it!

[TiggerMe Ambassador in reply to Mazza44]

Hard to know isn't it... the raised ANA showing autoimmune inflammation would upset things, have you tried dropping dairy and or gluten?

[greygoose in reply to Mazza44]

My ferritin was well over range though and I was told that this was an indication of inflammation.

Well, it might be. But then again, it might not. It could just be that you have too much iron in storage. Therefore, they should have tested an inflammation marker, such as CRP, at the same time.

You probably do have inflammation but the test should be done to make sure.

[Mazza44 in reply to greygoose]

Hello... thanks for the reply... in Apr (when the proverbial well and truly hit the fan)

Plasma CRP 2.1 ((0 - 5.0)

IRON 16.8 (5.8 - 34.5)

TRANSFERRIN 2.1 (2.0 - 3.6)

SATURATION 34.4% (20 - 55)

FERRITIN 229 (13 - 150)

SERUM TIBC 48.9 (50 - 90)

B12 629 (197 - 771)

FOLATE 9.1 (3.0 - 26.9)

[greygoose in reply to Mazza44]

Well, your inflammation isn't high, so your high ferritin level is due to high ferritin. Although your serum iron is low. Frankly, I don't know what to make of that. Maybe write a new post asking just about that?

B12 is good, but folate is low.

[Mazza44 in reply to greygoose]

Thank you for taking the time to look. When I asked, they just said it was an inflammatory marker. I will try and get folate up

[greygoose in reply to Mazza44]

But it isn't. Not if your CRP is lowish, like yours. It needs investigation.

[Mazza44 in reply to greygoose]

OK- good call. I will push them on it, pointing out the CRP one (well... ask them to explain, so I don't rub them up the wrong way... lol )

[SlowDragon Administrator in reply to Mazza44]

your iron levels are on low side despite high ferritin …..suggesting ferritin is high because of inflammation

Perhaps look at increasing iron rich foods in your diet

Iron 16.8 ug/L (5.8 - 34.5) 38.3%

Low TIBC

ucsfhealth.org/medical-test...

Lower-than-normal TIBC may mean:

Anemia due to red blood cells being destroyed too quickly (hemolytic anemia)

Lower-than-normal level of protein in the blood (hypoproteinemia)

Inflammation

Liver disease, such as cirrhosis

Malnutrition

Decrease in red blood cells from the intestines not properly absorbing vitamin B12 (pernicious anemia)

Sickle cell anemia

[SlowDragon Administrator]

What’s your diet like

Are you vegetarian or vegan

Are you on gluten free diet and/or dairy free diet

What vitamin supplements are you taking

Please add B12 and folate results

Iron/Ferritin

How old are you…..pre or post menopause

Have you got recent FULL iron panel test

It’s possible to have high ferritin with inflammation and low iron

Test early morning, only water to drink between waking and test. Avoid high iron rich dinner night before test

If taking any iron supplements stop 5-7 days before testing

Medichecks iron panel test

medichecks.com/products/iro...

vitamin D a bit high

How much vitamin D are you taking

Are you taking a separate magnesium supplement too

[Mazza44 in reply to SlowDragon]

Hello there.... additional results above (need repeating now)

Not vegan or dairy free or gluten free - have a good diet (particularly so this last 5 months)

I use Better You D3/K2 - I was doing 8000 IU to get it up (and have) rolling back to maintainance dose now.

I take a daily berrocca which is a general immune support.

I test per your full instructions.

I am 56, post men, HRT (no oral oestrogen - just low dose gel)

[SlowDragon Administrator in reply to Mazza44]

I take a daily berrocca which is a general immune support.

B12 629 (197 - 771)

FOLATE 9.1 (3.0 - 26.9)

Suggest you replace with good vitamin B complex

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 maintain B12 levels too

Difference between folate and folic acid

healthline.com/nutrition/fo...

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 and may need separate methyl folate couple times a week

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 5-7 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)

Post discussing how biotin can affect test results

healthunlocked.com/thyroidu...

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

[Mazza44 in reply to SlowDragon]

Thank you... I will have (another) read through all of those.

I will get my folate up which will hopefully push my conversion along.

As an aside, from what I've written, do you think my conversion is low and that T3 is a good way to go?

[Mrst1982]

you need a 9 am cortisol test to test your cortisol levels.

Have you been on any steroids at all?

I have adrenal insufficiency it sounds very similar x

[Mazza44 in reply to Mrst1982]

Thank you.... this was done too... grrrr

9am cortisol 440 (133 - 537)

Endo said it was fine and ruled out adrenal issues.

[caledoniancat]

I agree with Mrst1982. It would be worth asking the endo about adrenal function testing (cortisol levels).

[Mazza44 in reply to caledoniancat]

Yes - I thought this and so it was checked and ruled out (result 440, range 133 -537)

[Mrst1982 in reply to Mazza44]

I would get it repeated when you are unwell as your symptoms sound like when I have low cortisol x

[Schilddruse]

In addition to looking at your thyroid, you should also consider Long Covid given that the "flu" you suffered was almost certainly Covid-19. This doesn't show up on conventional blood tests, but it does cause the symptoms you mention.

[Mazza44 in reply to Schilddruse]

This is certainly a possibility, even though I did 2 lateral flow tests which were negative.

[Schilddruse in reply to Mazza44]

Yes, unfortunately the tests are only estimated to be 67% accurate nowadays and that often only after 4-5 days of symptoms.

[Dawney63]

I'm sorry I can't give you any advise what did interest me on your post was, has your stress/illness affected your ability to convert, can this actually happen ? as I have had so much grief and stress over the ladt few years.

[Mazza44 in reply to Dawney63]

It was the endo that told me that chronic illness can affect conversion, causing the T4 to rise and back up (looking like you're 'over'). That's why I think it started around December after 3 months of head and neck shingles and my first 'higher' T4 reading.

I didn't know it either... after 25 years

[joey82]

I've repeatedly read in the thyroid community from patients and practitioners that stress can cause major issues with thyroid function and conversion of T4 - T3. I personally think that's what caused the initial issues with my thyroid.

I hope you get back to some form of good health soon. Good luck. 👍

[Mazza44 in reply to joey82]

Thank you

[janeroar]

Hello as you say there’s good reason to suggest that grief, sadness and work stress triggered a big immune response. Therefore alongside the advice about medication / diet etc perhaps some therapeutic support might be something to consider if you haven’t already. Adding in yoga and breathing exercises will help calm the mind and body and process what’s been an awful time for you on all levels . I can share more details of this approach if you want to PM me. (Someone mentioned the possibility of long covid and this is what is being recommended by specialist NHS clinics.)

Gabor Mates interview on radio 4 on the podcast Young Again talks v interestingly about mind-body link and about immune response to grief / distress Tried to paste it here but for some reason it doesn’t allow me to!

Good luck

[Mazza44 in reply to janeroar]

Thank you... I am game to try anything!