Im a 63 year old female diagnosed with Hashimotos and taking 100mcg levothyroxine. Decided to have private blood tests as not feeling too grand, at the moment, and know the NHS won’t do all the tests as a matter of course.
Results are:
CRP HS 0.72 (<5)
Ferritin 16.5 (13-150)
Serum folate 12.28 (>3.89)
B12 81 (37.5-188)
Vit D 54 (50-175)
TSH. 4.43 (0.27-4.2)
Free T3 4.18 (3.1-6.8)
Free T4. 15.2 (12-22)
Thyroglobulin antibodies 66.8 (<115)
Thyroid peroxidase antibodies 588 (<34)
The Medichecks doc recommended an increase in levothyroxine and to supplement with Vit D (400-800iu for 12 weeks). He also suggested to try and up iron levels by my diet but my diet is pretty good and don’t see that making a lot of difference
I’m off to see my GP next week and am wondering do I also need B12 and iron supplements as they are not very high? My diet is pretty good and since being gluten free and taking selenium the antibodies have reduced from over 2000 to 588. I also think that my Free T3 and Free T4 are low
My husband thinks that I should be pushing my GP to see an endocrinologist as I don’t think our GP looks at the whole picture.
Any thoughts would be much appreciated so that I can go fully armed..........
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AMG56
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You must be feeling poorly. Your tsh is too high for someone on levo. It should be 1 or lower. Your ft4 and ft3 are low too. This suggests you need an increase in levothyroxine of 25mcg.
This is very low. It's recommended that ferritin be half way through range (although doctors are content with it just being somewhere in range and your GP may think this is OK).
Ways to improve ferritin through diet are mainly by eating liver, liver pate and black pudding (200g maximum liver per week due to high Vit A content). Other iron rich foods listed here: apjcn.nhri.org.tw/server/in...
However, with ferritin as low as yours that could suggest iron deficiency anaemia so I'd be asking your GP to do a full blood count and iron panel. I don't suggest self supplementing with iron tablets without further testing being done.
Serum folate 12.28 (>3.89)
This is OK.
B12 81 (37.5-188)
This would be classed as OK, Active B12 lower than 70 suggests testing for B12 deficiency. However, if that was my result I'd want it over 100 and I'd be looking at a good B Complex containing methylcobalamin and methylfolate, the methylcobalamin will increase your B12 level and the other B vitamins will keep everything in balance. Consider Thorne Basic B or Igennus Super B, don't go for a cheap one, make sure it says "bioactive" or "bioavailable" and contains the methyl versions as mentioned.
Vit D 54 (50-175) = 21.6ng/ml
Thisi s low, just into the Sufficiency category. The Vit D Council recommends a level of 125nmol/L (50ng/ml) and the Vit D Society recommends a level of 100-150nmol/L (40-60ng/ml).
The dose of D3 recommended by Medichecks is ridiculously small and wont help raise your level, it's barely a maintenance dose for someone who already has a decent level. To reach the recommended level from your current level, based on the Vit D Council's suggestions you could supplement with 3,700iu D3 daily (nearest is 4,000)
As you have Hashi's, you may want to consider an oral spray such as BetterYou which is absorbed through the mucous membranes in the oral cavity and bypasses the stomach. Another good D3 supplement, which some Hashi's patients find also gives good absorption, is an oil based softgel such as Doctor's Best. Avoid tablets and capsules which have poor absorption.
When you've reached the recommended level then you'll need a maintenance dose to keep it there, which may be 2000iu daily, maybe more or less, maybe less in summer than winter, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. You can do this with a private fingerprick blood spot test with an NHS lab which offers this test to the general public:
Doctors don't know, because they're not taught much about nutrients, but there are important cofactors needed when taking D3 as recommended by the Vit D Council
D3 aids absorption of calcium from food and K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems such as hardening of the arteries, kidney stones, etc.
D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds if taking tablets/capsules/softgels, no necessity if using an oral spray.
Magnesium helps D3 to work. We need Magnesium so that the body utilises D3, it's required to convert Vit D into it's active form. So it's important we ensure we take magnesium when supplementing with D3.
Magnesium comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds if taking tablets/capsules, no necessity if using topical forms of magnesium.
Check out the other cofactors too (some of which can be obtained from food).
Having Hashi's causes fluctuations in test results and symptoms and you are currently undermedicated with these results:
TSH. 4.43 (0.27-4.2)
Free T3 4.18 (3.1-6.8)
Free T4. 15.2 (12-22)
Your TSH is over range, your FT4 is only 32% through range and your FT3 is 29% through range.
The aim of a treated hypo patient generally, when on Levo, is for TSH to be 1 or below or wherever it needs to be for FT4 and FT3 to be in the upper part of their reference ranges, if that is where you feel well.
You need an immediate increase in your Levo of 25mcg, retest in 6-8 weeks, repeat increasing/testing every 6-8 weeks until your levels are where they need to be for you to feel well.
If your GP doesn't like your private results, suggest he repeats them all himself. When requesting an increase in dose, if your GP is reluctant then you can use the following information to support your request:
Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (the magazine for doctors):
"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).*"
*He recently confirmed, during a public meeting, that this applies to Free T3 as well as Total T3.
You can obtain a copy of the article by emailing Dionne at
tukadmin@thyroiduk.org
print it and highlight question 6 to show your doctor.
You can also refer to NHS Leeds Teaching Hospitals who say
Thyroxine Replacement Therapy in Primary Hypothyroidism
TSH Level .................. This Indicates
0.2 - 2.0 miu/L .......... Sufficient Replacement
> 2.0 miu/L ............ Likely under Replacement
My husband thinks that I should be pushing my GP to see an endocrinologist as I don’t think our GP looks at the whole picture.
Many members have been very disappointed with their consultations with an endocrinologisit and many of us have been made worse after seeing them. With your results I doubt an endocrinologist would agree to see you even if you do get a referral.
If you optimise your nutrient levels, increase your Levo and find the dose that optimises your hormone levels, then there should be no need to be referred to anyone, so those should be your first steps.
Some members have found that adopting a strict gluten free diet can help, although there is no guarantee.
Gluten contains gliadin (a protein) which is thought to trigger autoimmune attacks so eliminating gluten can help reduce these attacks.
You don't need to be gluten sensitive or have Coeliac disease for a gluten free diet to help.
Thank you SeasideSusie, Slowdragon and lalatoot for your very comprehensive and informative replies. I’ll look at, and digest, all the links you’ve given and the recommendations for vitamins before visiting my GP. I’ll contact Dionne at Thyroid UK and ask her to email Dr Tofts article. Hopefully, my GP will give me a 25mcg increase and I’ll push for full blood count and iron panel to be done too and go from there. Once again, many thanks. It’s absolutely great knowing that we have somewhere to turn for advise.
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