Updated thyroid results - asking for advice

[Lmcb2024]

Hi everyone, I got my updated TFT result and my tsh has lowered from 7 at 75 mg to 2.03 (this is on 100mg) I still have some symptoms and was going to suggest a trial of 112.5 or even 125 but I don't know if that would send my tsh too low?? Has anyone got any experience of this?m for some reason there were no other results apart from tsh. Have drs appt for 2 weeks time to discuss

[Buddy195 Administrator]

I’m a fan of ‘low and slow’ changes so would try an additional 12.5mcg as a first step. Ensure that thyroid bloods are repeated 6-8 weeks after being on a new dose.

Do ask for FT3 and FT4 to be tested, but as many members here find, you may have to look to do this privately, as if TSH is within range GPs may not be able to access these tests.

Have key thyroid vitamins been checked (ferritin, folate, vit D, B12)?

[SlowDragon Ambassador]

Looking at previous post you have only been on 100mcg 4 weeks?

which brand is 100mcg

Retest again in another 6 weeks INCLUDING Ft4, Ft3 and vitamin levels

Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine

For full Thyroid evaluation you need TSH, FT4 and FT3 tested

Also both TPO and TG thyroid antibodies tested at least once to see if your hypothyroidism is autoimmune

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease

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.

Significant minority of Hashimoto’s patients only have high TG antibodies (thyroglobulin)

NHS only tests TG antibodies if TPO are high

20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis

In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)

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

What vitamin supplements are you taking

VERY important to test TSH, Ft4 and Ft3 together

What is reason for your hypothyroidism

Autoimmune?

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)

Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins

Post all about what time of day to test

healthunlocked.com/thyroidu...

Testing options and includes money off codes for private testing

thyroiduk.org/testing/

Medichecks Thyroid plus BOTH TPO and TG antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes BOTH TPO and TG antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

Medichecks and BH also offer private blood draw at clinic near you, or private nurse to your own home…..for an extra fee

Only do private testing early Monday or Tuesday morning.

Tips on how to do DIY finger prick test

support.medichecks.com/hc/e...

If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal

[Lmcb2024 in reply to SlowDragon]

Hi no it's been just over 6 weeks now x

[SlowDragon Ambassador in reply to Lmcb2024]

So get full thyroid and vitamin testing in couple of weeks

What were last vitamin levels

What vitamin supplements are you taking

[SlowDragon Ambassador]

Looking through all your previous posts

Are you still having sinus issues

Can’t see any vitamin test results

Has GP done coeliac blood test yet

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

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

Or buy a test online, about £20

Assuming test is negative you can immediately go on strictly gluten free diet 

(If test is positive you will need to remain on high gluten diet until endoscopy, maximum 6 weeks wait officially) 

Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse

chriskresser.com/the-gluten...

amymyersmd.com/2018/04/3-re...

thyroidpharmacist.com/artic...

drknews.com/changing-your-d...

Non Coeliac Gluten sensitivity (NCGS) and autoimmune disease

pubmed.ncbi.nlm.nih.gov/296...

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

nuclmed.gr/wp/wp-content/up...

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

restartmed.com/hashimotos-g...

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

Sinus issues often linked to dairy intolerance

With loads of vegan dairy alternatives these days it’s not as difficult as in the past

Post discussing gluten

healthunlocked.com/thyroidu...

Recent research in China into food intolerances with Hashimoto’s

healthunlocked.com/thyroidu...

More interesting Chinese research on Hashimoto’s and leaky gut

nature.com/articles/s41598-...

[greygoose]

There's not such thing as a too low TSH. If your Frees are good then the TSH is irrelevant - except to doctors but what do they know! In real life, the TSH is only a very rough guide to thyroid status and shouldn't be used to dose by. If you feel you need an increase in dose then you probably do, regardless of the TSH. Do not succumb to the Tyranny of the TSH!

[Lmcb2024 in reply to greygoose]

😂 thank you! For some reason the frees went in my result only tsh? I will ask the Dr when she rings. Thanks everyone for the replies x

[greygoose in reply to Lmcb2024]

Did they test the Frees? They rarely do.

[Yellowdaffodil22]

I've always asked for a trial of higher dosage when feeling unwell. Often the doctor has advised alternate days for the new dosage. I've eventually found I need tsh to be around 0.4 to feel 'normal'. Wishing you well.