I’ve been posting about my latest thyroid results and didn’t know where to post this.
I’ve just had an appointment online with a doctor with my husband’s health insurance. What a waste of time it was. She wouldn’t listen to me.
She said TSH should be 2-3. FT3 isn’t important, only FT4 and it shouldn’t be high range. Dose is worked out 1 x kg body weight, 1.6 is maximum so I shouldn’t be on more than 75. I feel they are all going to say the same. When i said what I’ve researched says TSH should be lower end and FT4 and FT3 high range to feel well, she said she doesn’t read from Google. My symptoms of feeling tired is probably menopause not to do with thyroid.
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Tjqui00
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" When i said what I’ve researched says TSH should be lower end and FT4 and FT3 high range to feel well"
Have you got any links to this research? For some people this is required, after all a range represents 5-95% of a large sample size, and everyone has their own unique narrow range within that which is what their body requires. So some people might be fine on 5% of the range, whilst others 95%.
However, it seems to be regularly said on this forum that people need 70%+ through the ranges, and people then set this as a target, when I can find very little evidence that this is correct, and there's a huge amount of research showing that high T4 and or low FT3/FT4 ratios leans towards less favourable outcomes long term.
hashimoto’s and a year ago my antibodies were >1000.
Are you now on strictly gluten free diet and/or dairy free diet
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
Ideally choose an endocrinologist to see privately initially and who also does NHS consultations so that might eventually transfer to NHS
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
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
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
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) and continue separate B12 if last test result serum B12 was below 500 or active B12 (private test) under 70:
And coeliac blood test BEFORE trialing strictly gluten free diet
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
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
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
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
With loads of vegan dairy alternatives these days it’s not as difficult as in the past
I think it was Prof Toft who said that many people needed FT4 very high in range or even slightly over in order to achieve FT3 high enough in range to feel well. However, since then there has been evidence of high in range FT4 being linked with cancer and dementia. I’m sorry I can’t find the links to the research but jimh111 has posted about this.
You are right that on Levo most people needed a TSH below 1 - I’m sure there’s a reference for that somewhere!
BMA’s booklet, "Understanding Thyroid Disorders", by Dr Anthony Toft,
“many people do not feel well unless their levels are at the bottom of the TSH range or below and at the top of the FT4 range or a little above”.
Dr Toft also stated in a 2010 issue of Pulse Magazine:
“The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.
In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance.
But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.
This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l).”
Toft is an eminent endocrinologist. he’s retired now but was surgeon to the queen when she was in Scotland. His credentials are cast iron.
info is in second paragraph:
healthunlocked.com/thyroidu...
it says:
"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.”
More recent research advocating lower levels of FT4 should also be borne in mind.
If higher in range is your sweet spot I wouldn’t really worry about it. We have to take risks in life and it’s quite possibly a small risk. On the other hand, if you can feel well with slightly less thyroxine, there’s a reason to try a small reduction.
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