Attached is my recent blood test taken at around 8am, fasting (12hours). I'm not vegan/vegetarian.
I hope you can help me answer some of my questions. I'm still subclinical (not medicated) according to my doctors but my symptoms haven't changed for years. I feel like it's getting worse now. My daily symptoms are still there, such as fatigue, difficulty breathing, swallowing, stomach issues, dizziness/balance problem, sinus (blocked/thick mucus although I'm not sick or having cold), cold hands/feet, brain fog, low heart rate, anxiety, jittery. And these are the symptoms that get worse since last 2 months: more fatigue/lethargic, more hair fall, more constipation, sleep disturbances, frequent headache, and generally feel weak as if my body wants to shut down. I can't function normally with these symptoms and feel like I'm better off dead.
My questions are:
1. Am I close to being hypo?
2. Doctors still have no answer to why I have this breathing and swallowing problem. Lung function test is normal, barium swallow test (not with food, just the barium drink) is also normal. Ultrasound shows mild enlarged thyroid. Could this be the cause?
3. I read somewhere that fasting for more than 10 hours will affect iron concentration. Should I be concerned with my iron level?
4. Endo doctor dismissed my symptoms and thought I might be going through perimenopausal and if I would like to try the HRT instead. I'm not sure about this, any advice?
5. If I'm still subclinical, could my symptoms be linked to adrenal issues?
So sorry for such long post. I learn a lot from this forum but I'm at the wits end and don't know what to do. Sadly no doctors help me with proper guidance, my family doesn't help much either.
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Please let me know if anyone thinks perhaps it's better to split my questions to separate posts. I feel like I gain so much helpful informations and tips from all friendly people here in this forum than doctors.
So we can see from the blood test from 8 months ago that you have Hashimoto's - an Auto Immune Disease that can present with erratic own thyroid hormone production as this immune system malfunction systematically sets out to ultimately disable your thyroid.
So this will cause ' swings in symptoms ' and likely high over range hyper type symptoms followed by a crashes back down into hypo type symptoms when this ' swings back ' the other way leaving you totally exhausted and your thyroid further compromised and with reduced function.
Frequently with Hashimoto's there are stomach and gut issues - many find they suffer certain food intolerance and ideally you should get checked out for celiac, gluten, and pernicious anemia while eating your choice food stuffs -
maybe this has already happened - I should have looked back at your Profile page.
Symptoms of hypothyroidism tend to occur when the TSH creeps over 2 and years ago you would be started on thyroid hormone replacement once the TSH as over 3 and especially if showing over range antibodies.
So looking at your T3 it is much too low in the range to enable your body to function well and this will cause a myriad of symptoms -
Currently your T4 is at around 46% with your T3 at just 22% through the range :
A ' euthyroid ' normal functioning ' well ' thyroid gland would show a TSH at around 1/20-50 with a T4 at around 50% and the T3 at around 45% through the ranges.
The thyroid is responsible for the fully synchronisation of your body from your physicality and stamina through to your mental, emotional, psychological and spiritual well being, your inner central heating system and your metabolism -
so yes - I believe you do need some form of full spectrum thyroid hormone replacement to build up your reducing own weakened thyroid hormone production.
The adrenal and thyroid support each other - so yes, you may well find these tiny glands ache ( mine did terribly ) and struggling to ' pick up the slack ' as the thyroid struggles to cope -
Your ' mild ' goitre may well reduce once on thyroid hormone replacement.
Your low white blood count indicative of an AI disease - mine was 4 and the bottom of the range when I eventually received a diagnosis - I have Graves Disease.
I'm not sure of the guidelines to treat where you are currently living -
but in the UK if looking for help within the NHS - I'm afraid you may well be seen as a ' watch and wait ' until such time as your TSH tips over 5 and there are TPO antibodies over range.
No thyroid hormone replacement works well until your core strength vitamins and minerals are up and maintained at optimal levels -
so just for reference I now aim for a ferritin at around 100 - folate around 20 - active B12 around 125 ( serum B12 around 500 ++ ) and vitamin D up at around 125.
Many forum members follow the research and suggestions of Dr Izabella Wentz who writes as thyroidpharmacist.com
2-3 weeks after starting on Vitamin D supplements look at then adding B vitamins starting with separate B12
B12 and folate are low
With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a separate B12 supplement
A week later add a separate vitamin B Complex
Then once your serum B12 is over 500 (or Active B12 level has reached 70), you may be able to reduce then stop the B12 and just carry on with the B Complex.
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 2 per day and/or may need separate methyl folate couple times a week
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
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
High TPO thyroid antibodies confirms autoimmune thyroid disease
Was test done early morning?
Free T4 (fT4) 16.5 pmol/L (11.9 - 21.6)
Ft4 is 47.4% through range
Free T3 (fT3) 3.92 pmol/L (3.13 - 6.75)
Ft3 only 21.8% through range
So first steps
Improving low vitamin levels should help improve Ft3 in relation to Ft4
Your antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).
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
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
There’s no easy answer to that one - because, after all, what is ‘close’? And, it depends which result you look at:
TSH: This is the one the majority of doctors look at because they don’t know anything about the others! Come to that, they don’t know anything about the TSH, either but they believe iit tells them ‘all they need to know’.
Well, it doesn’t. It’s only a rough guide too thyroid status, at best, because it can be affected by so many things - like the time of day! Which they don’t appear to know about. And they don’t know that a euthyroid (normal) TSH would be about 1. Over 2 tell you the thyroid is struggling. Over 3 and you are technically hypo. But they think that as long as the TSH is anywhere within the range, there can’t be a problem and you can’t possibly have symptoms - either totallly ingnorant of the fact, or just ignoring it, that the TSH does not cause symptoms.
The TSH level also depends on two other glands - it’s not a thyroid hormone - the hypothalumus and the pituitary. If either of these is malfunctioning, the TSH will be unreliable. What we call Central Hypo. But they’ve never even heard of that!
So, we have to look at the other numbers to back up what the TSH is telling us:
FT4: T4 is basically a storage hormone, that doesn’t do much until it is converted into the active hormone, T3. But we still need a decent level to be there when needed.
FT4: 16.5 pmol/l (Range 11.9 - 21.6) 47.42%
As you can see, with the results translated into percentages, yours is below mid-range - a euthyroid TSH would be around mid-range, with the FT3 just slightly lower:
FT3: 3.92 pmol/l (Range 3.13 - 6.76) 21.76%
But yours is a lot lower! Much too low. And that is what is causing your symptoms.
So, put all that together and what have you got? The FT4 is saying ‘probably hypo’; the FT3 is screaming ‘hypo, hypo, hypo!!!!!!!!!’ But the TSH is saying ‘nothing to do with me. So, the conclusion has to be, not only are you Hashi’s/hypo but you possibly have Central Hypo as well. The TSH should be a hell of a lot higher than that with that low FT3. But, who is your doctor going to believe? Why, the TSH, of course. He knows nothing about the rest.
2. Doctors still have no answer to why I have this breathing and swallowing problem. Lung function test is normal, barium swallow test (not with food, just the barium drink) is also normal. Ultrasound shows mild enlarged thyroid. Could this be the cause?
More than likely, yes.
My questions are:
1. Am I close to being hypo?
There’s no easy answer to that one - because, after all, what is ‘close’? And, it depends which result you look at:
TSH: This is the one the majority of doctors look at because they don’t know anything about the others! Come to that, they don’t know anything about the TSH, either but they believe iit tells them ‘all they need to know’.
Well, it doesn’t. It’s only a rough guide too thyroid status, at best, because it can be affected by so many things - like the time of day! Which they don’t appear to know about. And they don’t know that a euthyroid (normal) TSH would be about 1. Over 2 tell you the thyroid is struggling. Over 3 and you are technically hypo. But they think that as long as the TSH is anywhere within the range, there can’t be a problem and you can’t possibly have symptoms - either totallly ingnorant of the fact, or just ignoring it, that the TSH does not cause symptoms.
The TSH level also depends on two other glands - it’s not a thyroid hormone - the hypothalumus and the pituitary. If either of these is malfunctioning, the TSH will be unreliable. What we call Central Hypo. But they’ve never even heard of that!
So, we have to look at the other numbers to back up what the TSH is telling us:
FT4: T4 is basically a storage hormone, that doesn’t do much until it is converted into the active hormone, T3. But we still need a decent level to be there when needed.
FT4: 16.5 pmol/l (Range 11.9 - 21.6) 47.42%
As you can see, with the results translated into percentages, yours is below mid-range - a euthyroid TSH would be around mid-range, with the FT3 just slightly lower:
FT3: 3.92 pmol/l (Range 3.13 - 6.76) 21.76%
But yours is a lot lower! Much too low. And that is what is causing your symptoms.
So, put all that together and what have you got? The FT4 is saying ‘probably hypo’; the FT3 is screaming ‘hypo, hypo, hypo!!!!!!!!!’ But the TSH is saying ‘nothing to do with me. So, the conclusion has to be, not only are you Hashi’s/hypo but you possibly have Central Hypo as well. The TSH should be a hell of a lot higher than that with that low FT3. But, who is your doctor going to believe? Why, the TSH, of course. He knows nothing about the rest.
2. Doctors still have no answer to why I have this breathing and swallowing problem. Lung function test is normal, barium swallow test (not with food, just the barium drink) is also normal. Ultrasound shows mild enlarged thyroid. Could this be the cause?
More than likely, yes.
3. I read somewhere that fasting for more than 10 hours will affect iron concentration. Should I be concerned with my iron level?
I’m no iron expert but your iron/ferritin look fine to me. If you’re worried, try eating more iron-rich foods.
4. Endo doctor dismissed my symptoms and thought I might be going through perimenopausal and if I would like to try the HRT instead. I'm not sure about this, any advice?
Idiot! Since when did perimenopause cause high TPO antibodies? 😂
That’s not to say your not going through perimenopause and might benefit from HRT, but did he even test your sex hormones to see what’s going on? That should be the first step.
5. If I'm still subclinical, could my symptoms be linked to adrenal issues?
I would very much dispute the 'subcliniical' label. It's a term doctors use to avoid diagnosing people. Literally, it means 'without symptoms'. You have a lot of symptoms, so how can you be subclinical? They can play with words all they like, but it still comes down to not nothing enough about thyroid. Of course you're going to have symptoms with that low FT3!
Your cortisol is a bit low but that’s only to be expected with that low FT3. I don’t think it would be causing your symptoms. 🙂
What do need addressing, though are your low vit D and B12. But I’m sure @SlowDragon will have explained all that in her responses.
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Could be be hypothyroid/subclinical?
Cortisol normal could it still be adrenals?
Barium Swallow
Hypo and Hyper symptoms possible adrenal problem
Hashimoto treatment
