6months in since becoming hypothyroid after my second thyroid ablation

[CirceBaby]

Hello,

I posted sometime ago. I live in Spain where I had a second thyroid ablation because of hyperthyroidism/Graves’ disease back in March 2024, the first being a year earlier. I then became hypothyroid some time in June/July and started at 75mgs of eutirox which was increased to 88mgs @ end August. I saw a 2nd doctor in Spain at end September who said she thought I may have developed hashimotos as well. She said she needed to see more blood tests before deciding on whether to start me on a combination therapy of T3 and T4 meds. Unfortunately I had to wait 8 weeks before I could get another appointment with her. Below are my latest test results from 8 Nov in prep for that appointment . Taken at 8.50 which was the earliest I could get, on an empty stomach, stopping the eutirox med 24 hrs before. I have added other results from two previous tests so you can see the trajectory. I have put in bold where the results are out of range and underlined where I think they are borderline in range. There were many more tests but I’ve just selected what I thought you might need to see.

When I actually had the appointment yesterday, I was given a different doctor. I have been feeling really fatigued, with headaches, the start of thrush, and body aches, especially in the last 3 weeks, which I have partly put down to not eating enough iron. She didn’t see a problem with my test results for iron though, and said I should get an appointment with a haematologist as she thought some of my results needed further investigation by a specialist in that field. She didn’t understand when I asked her about combination therapy, just said that my results looked better and to test in another 6 weeks. She has dropped the prescription to 75mgs. Sadly, it looks like the doctor I saw previously was just standing in for her. Can you please give me your opinion on the results and her treatment? I am taking magnesium citrate daily for chronic constipation and will start taking D3 and K2 again. I have asked for a coeliac test in my next blood panel. The doctor has requested all the same tests as above for six weeks time, wih the addition of a coeliac test which I’ve asked for. I’m currently on a low gluten diet, so will reintroduce gluten in prep for that test.

Thanks in advance for any advice or insight you can give.

Kind regards

Recent blood test results

T3 total 15 Jul/ 0.23 /(0.35-1.93) 8Nov/ 1.02 / (0.35 -1.93)

Free T3 27 Aug/ 1.38/ (2.0-4.4) 8 Nov/ 3.07/( 2.3-4.2)

Free T4 27 Aug/ 0.89 (0.94-1.68) 8 Nov/ 1.61 /( 0.70 - 1.48)

TSH 27 Aug/ 22.80/ (0.27-4.20) 8 Nov/ 0.09 / (< 0.35 - 4.94)

TPO 27 Aug/ 894.6 8 Nov/ 1,224.2. (<60)

TSH 27 Aug/ 22.80/(<0.27-4.2) 8Nov/0.09/ (0.55 - 4.78)

TSI 27 Aug/ 40 / (<1.75) 8 Nov/ 32.0 ( <0.55 )

Anti - Tiroglobulina 27 Aug/ 153.4/ (<115) (2nd generation test)8 Nov/4.3(<4.5 )

8 Nov

Ferritin 49.70 (10.00-291.00)

Folic acid 17.88 (>5.38)

Transferrin 199. (250-380)

TIBC 254. (250-425)

Bilirubin indirect 0.22. (0.30-0.85)

Hematocrit 15 July / 36 8 Nov / 37.5 (36-51)

Hemoglobin 15 July/ 12.30 8 Nov / 12.5 (11.5-16)

Glucose 84 (74-106) 8 Nov

8 Nov

Cholesterol 184 (<200)

HDL cholesterol 78 (>40)

LDL Cholesterol 98 (<100)

Zinc 84 (67-120)

Vit D 27.09 (30.00-100.00)

Magnesium 1.97 (1.60 -2.60)

Leukocytes 15 July/ 3.340.00 8 Nov/ 2.930/ (3.800-11.500)

Linfocytes % 15 July 54.20% 8 Nov 47%. (20.00-45.00)

Monocytes % 15 July 8.10%. 8 Nov/ 12% (0.20-10.00)

Total Neutrofils % 15 July 31% 8 Nov 38%. (45.00 - 75.00)

Total Neutrofils 15 July/ 1.035.40 8 Nov/ 1.132.4 (1,710 - 8,575)

[pennyannie]

Hey there again ;

Your T4 now looks to be slightly over range at around 117% with your T3 at around 42% so looking a lot better than the previous set of results :

Your TSH is still very low and you seem to have very high levels of both TPO and TSI antibodies which can happen after RAI thyroid ablation but if the ablation has worked and the RAI burnt through and fully disabled your thyroid - you may not be aware of any side effects from these high antibody readings

How are you feeling ?

So your dose is to stay at 75 mcg T4 daily and a further blood test in 6 weeks time :

It may take some time to find a dose of thyroid hormone replacement that works well for you - I'm not sure there are treatment options, such as T3 or Natural Desiccated Thyroid in Spain.

I don't pretend to know much about any of these other blood tests and just for reference I now try and maintain my ferritin at around 100 - folate around 20 - active B12 125 ( serum B12 500 ++ ) and vitamin D at around 125.

[CirceBaby in reply to pennyannie]

Hello PennyAnnie, thank you for your reply. It’s good to have a reason for my high antibodies, as the three doctors I’ve seen here have not been able to give me any reason. I was a bit worried about that.

So, I was advised by the second doctor @ end September to go back to the 88mg dose. Now the third doctor is putting me on 75mcg, which is what one of you advised in the past.

I was feeling relatively okay, until about three weeks ago when fatigue started creeping back and pain across my shoulders and back. I had started to relax my diet a little, introducing very small amounts of gluten, dairy , coffee and sugar. I also skipped red meat and liver for the last three weeks, which is why I thought low iron was the culprit. I had seen a doctor on YouTube saying that to check iron levels properly you needed to look at four or five different tests. Especially as ferritin could appear higher than it is due to long-term autoimmune disease. As the transferrin was out of range, I looked it up and it says “Transferrin functions as the most critical ferric pool in the body. It transports iron through the blood to various tissues, such as the liver, spleen, and bone marrow. It is an essential biochemical marker of body iron status.” TIBC is another marker, but I really know next to nothing about tests. The Spanish doctor just said that I’m not anaemic, and I’m within range. She wasn’t concerned at all about the transferrin or TIBC results, and actually didn’t seem to know what they were for. The concept of “optimal” and “ low in range” was something I couldn’t get across to her 😄 Anyhow, Thank you for sharing your optimal ranges with me. I will make changes to my diet to hopefully get back on track if that is the problem.

The second Doctor I saw who said she would consider combined therapy for me, said there is no problem in prescribing it, but I might have access finding the meds, and would probably have to go online to find them myself. But now I don’t think I’ll be seeing her again anyway 😔 In your opinion , at what stage should I consider trying to find a doctor to prescribe T3? Should I be paying more attention to the test results or how I’m actually feeling? Like many doctors I’ve heard of in the UK and USA, all three that I’ve seen here never asked how I’m feeling. I’ve seen a number of doctors on YouTube that say after ablation you are absolutely going to need T3 meds, but there are as many saying that it may not be necessary 🤦🏼‍♀️ I only wish that most doctors would do the same amount of research that many on this forum do! Thank goodness for all of you out there and the free help and care you give!

[pennyannie in reply to CirceBaby]

Everywhere I researched suggested that ferritin needs to be over 70 for any thyroid hormone replacement to work well :

Your vitamin D is much too low and I can't see a B12 nor folate :

All 4 of the core strength vitamins and minerals need to be maintained at optimal levels as if low in the ranges will compound your ill health further than necessary.

It took me over a year supplementing all the above to get to OK levels with the ferritin taking 18 months to tip over 70 -

It is true ferritin can show as a false high due to inflammation and an iron panel a logical first step - I don't know enough to advise as to these results - but there are others here who can explain this for you if you care to share these results and ranges -

My ferritin came in much lower than yours at 22 - and I had to undergo a colonoscopy and endoscopy before I started supplementation-

Your ferritin level isn't dire - but needs building up - especially to assist in the conversion of T4 into T3.

You must be dosed and monitored on your Free T3 and Free T4 readings and not the TSH :

We generally feel best when the T4 is up in the top quadrant of its range at around 80% with the T3 tracking just behind at around 70% through its range.

I think it would make sense to try and see a doctor who is open to treating you with whatever option works best for you - but if it means you need to self source these medication - it makes a mockery of the medical system in place and similar to what is going on here in the UK..

I had RAI thyroid ablation for Graves back in 2005 and became much more unwell some 10 years later - I was refused both T3 and NDT on the NHS in 2018 and I couldn't afford or travel far to see someone privately so after finding this forum and reading up I started self medicating and am much improved looking after myself and take Natural Desiccated Thyroid.

A fully functioning working thyroid would be supporting you on a daily basis with trace elements of T1. T2 and calcitonin + a measure of T3 at around 10 mcg + a measure of T4 at around 100 mcg.

Some people can get by on T4 only:

Others find T4 seems to stop working as well as it once did and that by adding in a little T3 - Liothyronine - likely at a similar dose to that their thyroid once supported them with - they are able to restore T3/T4 thyroid balance.

Others can't tolerate T4 and need to take T3 only - as you can live without T4 but you can't live without T3 ;

Whilst others find their health restored better taking Natural Desiccated Thyroid which contains all the same known hormones as that of the thyroid gland and which is derived from pig thyroids, dried and ground down and then made up into tablets, referred to as grains with a measured dose of T3 and T4 in each grain and the orginal successful treatment for hypothyroidism for over 100 years before Big Pharma launched their synthetic T3 and T4 treatment options - on the back of NDT - in the middle of the last century.

The most rounded of all I researched is that of Elaine Moore - books and now website elaine-moore.com

Sorry - it's way past my best before time of day and I hope this all makes some sense:

[CirceBaby in reply to pennyannie]

Dear PennyAnnie, thanks for taking the time out to answer yesterday evening. I did request B12 and folate, but was told by the testing house that couldn’t do all the tests requested. They didn’t give me the option to choose which either! Just said I’d have to wait another month and a half for those. They said it was something to do with the insurance, but my Spanish wasn’t good enough to question them more about it.

Can you tell me please how you increased your ferritin level? I’m cautious about taking iron supplements, for fear of worsening my constipation. Which D3 supplement do you take, is it tablet or spray? Anyhow B12 is on the next blood test request - how long before that test should I stop taking my B12 supplement? For my last test I asked for folate, but it seems the doctor tested me for folic acid instead. I am trying to get folate added to the form.

My next task is to find an ophthalmologist for Gray’s eye disease, and a haematologist to check out those other results.

Thanks so much for your help. Any suggestions of supplement brands will be gratefully received!

[pennyannie in reply to CirceBaby]

OK - so yes if you are already tending towards constipation - iron tablets will likely compound this issue -

You could start by taking vitamin C to bowel tolerance - for the ongoing issue with constipation - I take 1000 mg every day - I'm not aware that excess of vitamin C can harm you :

I found the basic iron tablets upset my stomach and nothing else was forthcoming and so I started Solgar Gentle Iron x 3 capsules a day - which did what it said - but any product sold as an iron bisglycinate will be ok -

I also took 4 x liquid iron Spatone sachets daily - and ate liver twice a week.

As for the other supplements for vitamin D - I now use a maintenance dose of

1 x Doctors Best vitamin D3 x 5000iu + 1 x Healthy Origins vitamin K2-MK7 - both tiny gel capsules containing just the vitamin suspended in extra virgin olive oil - ( K2 is needed to direct the vitamin D to teeth and bones rather than heart and arteries ) - considering your level I think I'd look to start at a higher dose than I'm currently taking.

I now use 1 x Ingennus Super B complex for B12 and folate as a maintenance dose.

Depending what your reading of B12 and folate are - initially you may need to take these independantly at higher levels :

How are your eyes ?

RAI is known to trigger Thyroid Eye Disease and / or make eye issues worse :

Please ensure all treatment options are Preservative Free - we have several OTC options available here - I don't know what options you have over there :

P.S. - do they have integrated physicians - or functional medical practitioners in Spain - as someone not totally ' mainstream with all that that means ' -

eg : like this doctor who can prescribe you T3 but leave you to source it yourself ??

will be more able to prescribe thyroid hormone treatments not ' recognised ' by mainstream medical in your country ??

[CirceBaby in reply to pennyannie]

My eyes aren’t too bad at the moment. They aren’t as dry as they have been, and I’m not using drops very often now .When I do I use either Visco tears or a Spanish version, both of which have no preservatives. My right eye is noticeably bigger than my left though, and the second doctor said I should see an ophthalmologist for a scan. How are yours? Did they settle after awhile or did you need treatment? When I first moved here, I found a functional medicine doctor in Barcelona, but there was a five and half month waiting list. So eventually a friend of a friend arranged an appointment with an endocrinologist about two hours away who could see me within the month. I found that wait times for appointments are a minimum of seven weeks and much much longer where I live as there are a fewer doctors to choose from. The journey time and costs involved of seeing the functional doctor in Barcelona probably mean this isn’t a long-term option for me. Unfortunately, my insurance doesn’t cover me for functional medicine practitioners. Maybe I will need to lean on this forum for advice on dosing, and contacts for sourcing of T3 meds or NDTs too 🤷‍♀️It’s terrible that huge numbers of people are left to scrabble around like this, because professionals are basically writing us off.

I’ll get started with the vitamin supplements as soon as I can, and will post my next results hoping for some feedback, before my next appointment with the endocrinologist.

I hope you yourself are doing well with your health issues, and will continue to do so. Thanks for the recommendations. I get very overwhelmed by everything at the moment, made worse by trying to do it all in my beginners’ Spanish.

[pennyannie in reply to CirceBaby]

It is overwhelming even in your native tongue - believe me :

Interesting that the functional doctor has such a long wait list - says it all really :

Yes, we can help you with sourcing medication etc but I'd not suggest anything at the moment as we need first to build up the vitamins and minerals and first see how you get on with T4 monotherapy as it is the easiest treatment option for you to manage.

My eyes were deemed ' not bad enough ' for surgery - and the psychological issues of not recognising myself in the mirror have, for the most part passed - but I can't cope with sunshine as my eyes light sensitive.

It is awful - we are a minority of people and there has been little improvement in treatment options for 100 years - as I read - there's no money in it - and for Big Pharma the numbers don't stack up.

[CirceBaby in reply to pennyannie]

Dear pennyannie,

Me again!

I finally got back my B12 result.

VITAMIN B12 / SERUM. 1.234 1 pg/mL. (211-911)

It looks very low, even though I’ve been taking methylcobalamin 1000 µg for four months. I take this before bed with magnesium citrate. Do you know of anything I can do to raise my levels quickly? I suspect I may not be absorbing it well. I’ve been feeling exhausted for about 3 or 4 weeks now.

You said Folate should be @ 20. I asked for a folate test but it said folic acid (FOLATE) on the report. I’m hoping this is the right test.

FOLIC ACID (FOLATE) / SERUM 17,88 µg/L. (>5.38)

It really touched me when you said about the psychological effect of your change in looks. For two years whilst being “treated” for hyperthyroidism with lithium I was too apathetic to care about my appearance and barely looked in a mirror. After what you said, I realised that now I’m hypo I’ve been keeping ‘mirror’ time to a minimum because of the rapid changes occurring to my eyes and face shape. It’s shocking when I see myself in photos now, as I did this weekend. It’s obviously something I haven’t begun to process yet.

[pennyannie]

Hey there :

Am I missing something ??

Your serum B12 result is 1234 and well above the range and as I understand it excess

B12 is urinated out - and in my suggestion for serum B12 I suggested 500++ -

so it seems the B12 supplement has worked well and maybe now it needs reducing a little ?

Your folate is up at just under 18 - and my suggestion was around 20 - so again -

the folate supplement has worked and now a possible maintenance dose makes sense -

Maybe you could now switch to 1 tablet to cover both the B12 and Folate as I detailed above I buy Ingennus Super B complex.

I hid behind sunglasses for a few years - your eyes will settle and recover a little - given enough time - but now I'm resigned - for the most part.

[CirceBaby in reply to pennyannie]

Hello, thanks for your reply. Maybe I’m misreading the result, but it says 1. 234 not 1234? So I thought that meant less than 2?!

[pennyannie in reply to CirceBaby]

Oh - I was reading that as 1,234 one thousand two hundred and thirty four :

Since you have been supplementing and looking at the range - I presumed your reading just over the range - as if it were under 2 - you would feel horrible - or more horrible than you do now - and surely your doctor would have said something ?

[CirceBaby in reply to pennyannie]

No I don’t feel good at all.

The problem was with the testing house. It’s a long story but they didn’t get all the results to me on time for my consultation. I will try to get an appointment with her sooner, but at the moment I’m waiting for an appointment date with her @ 22nd January, after I take my tests on 23 Dec. Because of the holidays, the tests I’m taking in 23rd Dec won’t be ready till 20th Jan earliest.

Maybe I should go to a local GP instead with these results. I might need injections, in which case I won’t have to travel so far.

[CirceBaby in reply to CirceBaby]

Actually, you may be right 😂!. I just remembered that in Spain they use a comma instead of a point. I’ll check tomorrow with someone. I will have the ingenus supplements tomorrow in any event.

So if my b12 and folate are ok, the only thing I can see is low vit D and lowish ferritin. Yet I’m totally exhausted compared to a month ago. I will see a haematologist as recommended by the endocrinologist.

Thanks for your help