Blood test results - back on Levothyroxine?

[gaellea]

Hi, I have been on Levothyroxine for the last 13 years. I have been diagnosed with both Graves and Hashimoto. 6 months ago I was asked to reduce it and finally stop it due to hyperthyroidism. I am currently on no medication and have received the following test result. Shall I ask to go back on it? I feel constantly tired and brain fog is sky high. Plus putting on weight for no reason. Thank you very much for any advise.

[tattybogle]

basically .. yes .

looking at previous history I doubt it should have been stopped, although reducing it a little may have been needed ... but they should probably have waited longer on lower dose to allow TSH more time to rise rather than reducing again / stopping completely .

did they reduce dose further after august results ? (TSh 0.06 fT4 15.4)... fT4 was back in rnage at this point , so even though tSH was still below range it had already started to rise a little and if they had waited longer on whatever dose you were on then it is likely TSH would have caught up in a few months.

did you feel overmedicated at any point , or was reduction/ stopping just based on blood results ?

[gaellea in reply to tattybogle]

Thank you very much for your reply. The endo asked me to stop taking Thyroxin after the August results. I had high anxiety, tremors, brain fog and general weakness, that’s when I asked for a blood test and was asked to decrease Thyroxine from 100mcg then 75, 50 and finally none.

[greygoose]

How was your Graves' 'diagnosed'? Just by a low TSH? Or did you have high TRAB?

Just having a low TSH does not automatically make you hyper. You could just be having a Hashi's 'hyper' swing, which is temporary. Basically, with Hashi's, you are hypo and will need thyroid hormone replacement for the rest of your life.

[gaellea in reply to greygoose]

Hi greygoose, thanks for your reply. If I remember correctly I had a blood test followed by radioactive iodine and thyroid scan. The endocrinologist asked to reduce and then stop Thyroine based on April results to “see what happens”. Shall I definitely go back on it and on which dosage? Thanks.

[greygoose in reply to gaellea]

If you had RAI then your thyroid is no-longer functioning. Or do you just mean contrast with iodine for the scan? As to blood tests, it's which antibody tests you had that is important.

[gaellea in reply to greygoose]

I did not have RAI, so must have been contrast iodine for the scan. If I remember correctly I was tested for TPO but can not recall if there was anything else.

[greygoose in reply to gaellea]

OK, so I seriously doubt that you have, or ever have had, Graves'. You have Hashi's, and that's the way it behaves. There will be periods when your Free levels go high, but it's only temporary, and the best thing to do is leave off the levo until you feel hypo again, and then go back on it. Problem is, if doctors reduce - or stop - your prescription, they are very reluctant to raise or restart it again. They do not understand Hashi's. So, it's best if you can do that yourself, without involving them.

Anyway, you have now reached the point where you need the levo again. Your Frees are low. So is your TSH but that is because it moves much more slowly that the Frees so always lags behind - just one of the reasons that dosing by the TSH is a nonsense!

[gaellea in reply to greygoose]

Sorry I got confused, TPo was for Hashimoto, Graves was Trab. It is such a struggle to get T3 and T4 tested, I had to request it 3 times before they finally did it, they kept coming back with TS H only. Thank you very much, meeting the GP on Friday and will insist on taking Levo again.

[greygoose in reply to gaellea]

Well, that's just the problem, isn't it. TRAB is not the definitive test for Graves' because you can have raised TRAB with Hashi's, too. And that does not mean that you have both conditions. To be certain about Graves' you need the TSI tested.

Yes, it is a struggle to get FT4/3 tested because they do not know how important they are. They have been taught that the TSH tells them 'all they need to know'. And they are too poorly educated to see just how rediculous that statement is!

[SlowDragon Administrator]

previous post a year ago showed folate and ferritin deficient

healthunlocked.com/thyroidu...

What vitamin supplements are you taking

You need vitamin D, folate, B12 and ferritin levels retested

[gaellea in reply to SlowDragon]

Hi Slowdragon, I am taking vitamin D and B12. Will ask to be retested on folate and ferritin. I was tested as follows in April. Thanks.

Colour diagram

[SlowDragon Administrator in reply to gaellea]

Folate low

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

This can help keep all B vitamins in balance

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...

[gaellea in reply to SlowDragon]

That’s great thank you very much’

[SlowDragon Administrator in reply to gaellea]

cks.nice.org.uk/topics/anae...

Serum ferritin level is the biochemical test, which most reliably correlates with relative total body iron stores. In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency

Never supplement iron without doing full iron panel test for anaemia first and retest 3-4 times a year if self supplementing.

It’s possible to have low ferritin but high 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...

Look at increasing iron rich foods in diet

Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption

List of iron rich foods

dailyiron.net

Links about iron and ferritin

irondisorders.org/too-littl...

davidg170.sg-host.com/wp-co...

Great in-depth article on low ferritin

oatext.com/iron-deficiency-...

drhedberg.com/ferritin-hypo...

This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.

[SlowDragon Administrator in reply to gaellea]

Check back through all your historical blood tests for thyroid antibodies test results

TSI or TrAb antibodies to confirm Graves’ disease

TpO and TG antibodies for Hashimoto’s

[gaellea in reply to SlowDragon]

Thanks sorry I got confused! Tpo was for Hashimoto. Trab was done for Graves. Will double check the results to make sure! Thanks a lot.