good evening all , I would appreciate any advice with my latest test results before I see the doctor. I’m currently taking 62.5mg of Levo , which I upped from 50mg about 6 months ago , I’ve been feeling ok , recently had a bout of dry eyes , a bit of itchy skin , and I’ve recently finished a course of antibiotics and wondered if this would have had an impact on any of the results. My TSH has gone up a little bit since the last blood tests when I was only taking 50mg. Many thanks in advance
Vitamin D (25 OH) nmol/L
67
50 - 200
Optimal 75-200
Adequate 50-<75
Insufficient 25 -<50
Deficient <25
Magnesium mmol/L
1.0
0.7 - 1.0
CRP mg/L
1.3
<5.0
Ferritin µg/L
268
30 - 400
Serum Folate nmol/L
11.10
8.83 - 60.8
Active B12 pmol/L
100
37.5 - 150
TSH mIU/L
2.12
0.27 - 4.20
Free T4 pmol/L
13.7
12.0 - 22.0
Free T3 pmol/L
4.7
3.1 - 6.8
T4 Total nmol/L
79.0
66 - 181
H
Anti-Thyroglobulin Abs IU/mL
156
< 115
Anti-Thyroidperoxidase abs IU/mL
>600.0
<34
Sample Dated: 20-03-2025 09:15
Clinical Details:
TEST RESULT NORMAL RANGE CHEMISTRY / IMMUNOASSAY
Cortisol (Random) 305.0
4pm - 8pm 73.8 - 291
UNITS
73.8 - 507.0
nmol/L
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Burgerballs
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Thank you SlowDragon for your comprehensive reply, I am currently around 85kg in weight , and must admit that I haven’t been supplementing any vitamins until about a week ago when I started with vitamin D+K2 and a chewable vitamin C. I know I need to do more but on the days when I feel ok I seem to forget that I have this condition 😊. I just looked at the results I posted 11 months ago and wondered why I feel a little better today with slightly worse test results ? I will be talking to the doctor about an increase this week for sure , and discussing the results and further testing with them. Are there any parts of the results that I should be more concerned about ? Many thanks
GP should have been testing thyroid levels every 3 months after starting you on 50mcg Levo
Dose is increased slowly upwards over 6-18 months until on full replacement dose
approx how much do you weigh in kilo
Even if we frequently start on only 50mcg, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or somewhere near full replacement dose (typically 1.6mcg levothyroxine per kilo of your weight per day)
Adults usually start with a dose between 50 micrograms and 100 micrograms taken once a day. This may be increased gradually over a few weeks to between 100 micrograms and 200 micrograms taken once a day.
Some people need a bit less than guidelines, some a bit more
If symptoms of hypothyroidism persist despite normalisation of TSH, the dose of levothyroxine can be titrated further to place the TSH in the lower part of the reference range or even slightly below (i.e., TSH: 0.1–2.0 mU/L), but avoiding TSH < 0.1 mU/L. Use of alternate day dosing of different levothyroxine strengths may be needed to achieve this (e.g., 100 mcg for 4 days; 125 mcg for 3 days weekly).
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
At the beginning, your thyroid might still be producing some hormones, but as time goes by and as you start replacement therapy, this will cease. In the early days, once you are titrating up to your replacement dose (generally 1.6 mcg per kg of body weight) you can have some days when you feel good and days when you feel quite bad. This is a normal process and the better days will increase when you get closer to the dose your body needs.
As slowdragon has mentioned, your Vitamin D and folate are still low. I know it is easy to forget when you are busy with other things, but perhaps get a little daily pill dispenser, where you put all the supplements you take for the day. This way, you can check if you have taken them and you can be more consistent. After a while you might not need it anymore, as you have developed a routine, but especially at the beginning it is good to have the reminder so your deficient levels can be build up and support your thyroid hormones.
Are you taking a good Vitamin B complex? This will ensure you get a good amount of B12 and folate and it also keeps the other B-vitamins balanced. Many people also take a good magnesium supplement, as it helps with energy and assists with the absorption of the B-vitamins as well as the vitamin D.
I think as well that you need an increase in medication, the normal course of action at the beginning should be that you get tested every 6-8 weeks, so the dose can be adjusted (usually in 25mcg steps). If the surgery is not calling you in, you should try to be proactive and reminding them to set up a blood test. Only this way you can be sure that you get the increase you need, otherwise you are on too low a dose for too long, which can leave you under-replaced and symptomatic.
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