Puzzled why I’ve been requested to test TTG, HbA1c and cortisol

[Noelnoel]

I received this unexpectedly today so I rang to enquire and was told that as well as reducing Metavive dose I’m also advised to test my:

TTG

Cortisol

HbA1c

I’m struggling to understand the thought process around the required tests in connection to lab results but do I understand why I’ve been requested to reduce dose of thyroid replacement. However, I disagree and won’t be reducing it

TSH has long been suppressed and FT4 currently 46%

Medichecks test at roughly same time gives slightly different values

Thoughts appreciated

Thank you

[ Image removed because it contained a professional's name. You could crop the image or simply type the basic details of the test including result and reference interval. ]

[SlowDragon Administrator]

Ft3 is at 100% through range which is high

Was test done as recommended

Early morning

Did you split Metavive into 2 or 3 smaller doses day before test with last dose 8-12 hours before test

Have vitamin D, folate, ferritin and B12 been tested recently

[Noelnoel in reply to SlowDragon]

Thanks for prompt response

Yes to all

Core nutrients middle to high in range

[SlowDragon Administrator in reply to Noelnoel]

So you may benefit from SMALL reduction in dose

[Noelnoel in reply to SlowDragon]

At the moment I’m experimenting with less porcine and more bovine to see if I can raise FT4 as I’d love to know what it feels like and how my body responds to FT4 being about 70% with FT3 high. definitely don’t like FT4 as high as it’s been in the past and although I feel good with my current levels, there’s still room for improvement regarding quality of sleep and a bit more weight loss

So, as I said, if I can get it to 65-70% I think that would be enough

Sorry if I didn’t explain very well but what I want to know is why the tests are deemed necessary. What’s the relevance and connection between my current thyroid level and TTG and HbA1c. I understand why adrenal status might be interesting to know in my scenario but I don’t understand why coeliac or diabetes status would be interesting for my GP. After all, she’s unlikely to make the connection with hypothyroidism and reaping improvements by going GF 😂😂😂

[SlowDragon Administrator in reply to Noelnoel]

guidelines clearly state coeliac test should be done at diagnosis of Hashimoto’s

nice.org.uk/guidance/ng20/c...

Obviously no point testing if already on GF diet

HBA1c is affected by hypothyroidism

thyroid.org/patient-thyroid...

Cortisol levels are frequently affected by thyroid levels

[Noelnoel in reply to SlowDragon]

Well it will be interesting to hear her conclusion then once she has collated it all because she really doesn’t have a deep understanding of thyroid disease

For my part, it’s a waste of NHS money because l feel certain she won’t know what to do with the information but(!) it seems she’s trying at least

Thank you SD and if Christmas is something you celebrate, I hope you have happy one

[arTistapple in reply to SlowDragon]

HbA1c paper very interesting. It takes no stretch of the imagination of how hypothyroidism creates this effect. It’s quite often reported in here by Forumites who are perturbed by an increase in HbA1c levels when commencing thyroid treatment - especially noted when commencing T3.

However one can imagine the response of ‘uneducated’ doctors, seeing those results in absence of enough knowledge of hypothyroidism.

Noelnoel have this information on hand when you get your results.

I have found the raise in HbA1c is temporary.

[Noelnoel in reply to arTistapple]

Thank you, your reply has reminded me to read SlowDragon links. Thank you SD

So yes, it’s very interesting. I’ll keep it in case test shows anything untoward but am I to understand that it’s saying the commencement of thyroid replacement reduces HbA1c after being falsely raised by hypothyroidism? If that’s the case I should expect a normal reading, right? Or not? It seems to be open to interpretation as it’s not very well written

[arTistapple in reply to Noelnoel]

I think mostly on the intro of T3 it’s been mentioned on the Forum, from what I have seen. However medics don’t know nearly enough about hypothyroidism or its treatment. Progress has utterly stalled treatment wise. If someone has a satisfactory response to T4 only med, the same thing may be happening. Who is really checking? And even if they did, patients might just be being banged on diabetes medication. No connection seems to be recognised that diabetes is a known Co-morbidity of hypothyroidism. Nor is CHD given any acknowledgement for its role via hypothyroidism. However diabetes is correlated as a major contribution to CHD. As usual it’s the ‘not enough attention’ paid to anything hypothyroid. I would say the patients have noticed this before the medics. It’s gratifying some researchers are picking it up. However the researchers are always way ahead of the practice. About thirty years.

[Bearo in reply to SlowDragon]

Thanks for these links, Slow Dragon. I read the link relating to HbA1c and didn’t understand it!

Can anyone explain the conclusions in simple terms?

[SlowDragon Administrator in reply to Bearo]

In simple terms….if hypo more likely to have high HBA1C and this may reduce once on correct level of thyroid replacement

[Bearo in reply to SlowDragon]

Thanks…I think it was mention of a false high that confused me. I will stick with your summary!

Unfortunately my HbA1c hasn’t come down (it’s 41-43) despite having some months of over replacement and now - hopefully - being on the correct amount.

[SlowDragon Administrator in reply to Bearo]

Looking at your results you have low Ft3

Very poor conversion of Ft4 to Ft3

Likely to need addition of T3 prescribed alongside levothyroxine

Here’s link for how to request Thyroid U.K.list of private Doctors emailed to you, but within the email a link to download list of recommended thyroid specialist endocrinologists who will prescribe T3

Ideally choose an endocrinologist to see privately initially and who also does NHS consultations so that might eventually transfer to getting T3 on NHS

thyroiduk.org/contact-us/ge...

[Noelnoel]

Which also reminds me, having just read the guidelines, SlowDragon I’ve been gluten free. Should I eat a meal (or several) containing gluten the day before the test?

[RedApple in reply to Noelnoel]

'Guidelines recommend that you eat some gluten in more than one meal every day for at least six weeks before testing.' coeliac.org.uk/information-...

[SlowDragon Administrator in reply to Noelnoel]

You would need to be eating significant levels of gluten at least twice a day for 6 weeks for coeliac blood test ….know as the gluten challenge

No point getting tested if already gluten free

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

[Noelnoel in reply to SlowDragon]

Thank you

I can’t imagine anyone would eat significant amounts of gluten twice a day, so no wonder hardly anyone tests positive

[FallingInReverse in reply to Noelnoel]

SlowDragon is “significant amount” quantifiable?

[SlowDragon Administrator in reply to Noelnoel]

Cereal and Toast for breakfast,……sandwich for lunch …..pastry on a quiche or a steak or chicken pie and/or a sponge pudding or similar for dinner …..easily what many people would eat normally