Hi have suffered from an under active thyroid for at least 4 years. Have been on levothyroxine over the years starting at 25mg and currectly on 150mg.
Everytime i get my thyroid checked it comes back normal, even though i still experience symptoms such as fatigue, coldness, depression, insomnia and most recently which i am attributing to my thyroid memory problems and some confusion. I am a 54 year old male.
Recently convinced my doctor to test my free t3 level and my thyroid peroxidase antibody level.
below are my results.
Thyroid hormone tests Code (s)
442W Serum TSH Level Value 0.43 mU/L normal range 0.27-4.20
Free T3 Level
Code (s) HH 43Gd Value 4 pmol/L Normal range 3.1 -6.8
Thyroid peroxidase antibody level VALUE 539 IU/ML Normal range 0.0 -34.0
Comment note Positive thyroid antibodies as previously identified. Repeat testing of anti -TPO is not indicated.
Any help in determining these results would be most appreciated, have an appointment with a specialist shortly on the 23 November.
Thank you
Written by
gerrycrilley1
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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)
Ft3 is too low …..so either inadequate dose levothyroxine
Need Ft4 result
Or, if Ft4 is high …..and Ft3 is low …..this is poor conversion
Poor conversion of Ft4 (levothyroxine) to Ft3 (active hormone) is very common with Hashimoto’s
Did you know the cause of your hypothyroidism is autoimmune thyroid disease also called Hashimoto’s …as shown by high TPO thyroid antibodies
About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high 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.
Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease
ESSENTIAL to test vitamin D, folate, ferritin and B12 at least annually
When were these last tested
Request GP retest
What vitamin supplements are currently taking
To improve conversion rates of Ft4 to Ft3 we must maintain GOOD vitamin levels
With Hashimoto’s that usually means taking daily vitamin D, magnesium and vitamin B complex continuously
Had the tests done on the 01/082023 at 13.35. Had my Vit d done previously came back normal and my b12 was high not sure if my folate, ferritin have been done. Am currently only taking Vit C. Do you think it would be practical to ask the specialist i am going to see to add t3 to my regime aswell as the vitimins you suggested. Will get my thyroid t4 checked again soon.
Given my test results do you think that my thyroid issues could be affecting my memory.
When your thyroid hormones are optimal you would expect Ft3 to be at least 60-70% through range minimum
Diet and Hashimoto’s
What’s your current diet?
Are you vegetarian or vegan
Only change one thing at a time or you can’t tell what’s helping
Do you always get same brand levothyroxine at each prescription
If not, work out which suits you best then only get that brand
Test thyroid and vitamin levels 8 weeks after being on constant unchanging dose and brand levothyroxine
First steps
1) increase levothyroxine if Ft4 is below 20-21 (range 12-22)
2) test vitamin levels and improve to OPTIMAL levels
3) 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 or buy test online for under £20, just to rule it out first
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
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
Thanks for the valuable information. My current diet is not very good lots of processed foods and dairy. Will take onboard your diet suggestions and research all your links concerning gluten diet and the such. Usually have the same brand of levothyroxine at each prescription. Will definately get my ft4 increased if below optimine levels. Same with my Vitimin levels.
Medics are often clueless about interpreting thyroid labs.
When they say normal they just mean the result is within reference range.
What we aim for is the exact point in the range where symptoms are relieved.
That is not happening for you because you are still wrongly medicated
Your FT3 is miserably low so not surprising you feel underpar
You should have a better response to 150mcg LT4
So we need to look at your system's abilty to convert T4 to T3.
You don't give an FT4 lab but I'm guessing it is high in range which is resulting in a low TSH.
And...High FT4 with low FT3 = poor T4 to T3 conversion.
Medics tend to wrongly rely on TSH which is a pituitary, not a thyroid hormone. It reflects the overall level of hormone in the blood but does not indicate the level of each hormone...and that is important.
They see a low TSH and conclude that medication is adequate....or worse, that you are overmedicated and they reduce your dose making you feel worse!
Beware of that one!
For good health every cell in the body must be flooded with T3 by way of a constant and adequate dose...you dont have enough T3 in your serum to achieve this.
T3 is the active thyroid hormone but it must reach the nuclei of the cells and attach to T3 receptors before it can fulfill it's function.
Low cellular T3 = poor health
Optimising vit D, vitB12, folate and ferritin is vital to support thyroid functions/ conversion
However you may need to add some T3....if you can find an endo with the nous to understand this.
Raised antibodies indicate thyroid autoimmune disease/ Hashimoto's....this doesn't alter the medication you require but a gluten free diet and optimal nutrients usually help
When T3 is low one's metabolism becomes slow....and we suffer fatigue and impaired body functions....eg cold, constipation
Thanks DippyDame. What you say makes complete sense need to get all my levels optimal. Hopefully see a good endo who will consider addition of T3.Thanks for the reply.
Igennus B complex popular option too. Nice small tablets. Most people only find they need one per day. But a few people find it’s not high enough dose
IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 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)
Post discussing how biotin can affect test results
Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption
Have gathered all my information in one post also manage to get my last t4 results. Your input has been invaluable, please feel free to recommend anything else you think will be benefical.
tsh 01/08/2023 at 13.37 value 0.43 mU/L
free t4 17/01/2023 at 08.25am value 15.4
free t3 01/08/2023 at 13.37 value 4 pmol/L
Thyroid peroxidase antibody level 539 iu/ml
Vitamin b12 20/07/2023 at 14.10pm Value 1339pg/mL
Vitamin D 20/07/2023 AT 14.10 pm Value 61 nmol/L
Serum folate 20/07/2023 at 14.10pm value 4.12 ng/mL
Serum ferritin value 53.9 ng/mL
The only vitamin i am taking is 1000mg twice a day.
My diet mainly consists of processed foods. Used to take a lot a cereal mainly Rice Crispies dont know if they have a lot of iron in them.
We really need to see a T3 and T4 result/ range drawn from the same blood test :
T4 is a storage hormone and pretty much inert - and is the converted in body into T3 the active hormone which runs all our bodily functions from our physicalility through to our mental, emotional, psychological and spiritual well being, our inner central heating system and our metabolism - with the brain and heart using the lions share of the T3 we produce.
Without a range I'm guessing your TPO antibodies are over range and indicative of Hashimoto's - an auto immune thyroid disease -
and it is likely that you will need to look to first healing your gut - and resolving any absorption issues you may have and this will also involve getting checked for intolerances to certain food stuffs that you may have enjoyed eating.
Many forum members follow the reserch and suggestions of Dr Izabella Wentz - thyroidpharmacist.com
For optimal conversion of T4 into T3 - the active hormone tht runs the body - we need ioptimal coe strength vitamins and minerals and I now aim for a ferritin at around 100 -folate around 20- active B12 75 ++ ( serum B12 500++) and vitamin D at around 100.
Everywhere I read when I fell into this forum researching low ferritin suggests no thyroid hormone replacement works until ferritin is over 70 -and as a man I would think you have be looking at a good 50% through whatever NHS range is detailed - as some ranges are too wide to even be sensible.
Hi SlowDragon meant to say taking vit C 1000mg twice daily. Have ordered advanced thyroid blood test from Medichecks and have apointment to carry out the test this Thursday at 9.30 earliest i could get. will keep you updated thanks for everything.
Absolutely agree that nutrients must be optimised. But, is it known by what percentage, for example, that might improve conversion.? I've never really had to look into that.....just accepted "optimal"!
gerrycrilley1 is already taking150mcgT4 and his FT3 is still only 24.32% through ref range....I was thinking he'd flogged T4 enough to indicate it wasn't up to the job. And we know high dose T4/ high FT4 increases the risk of developing cancer... so thought since it's going to take a great deal more T4 totry and raise his FT3 that adding T3 might be the safer option.
As a bloke….. gerrycrilley1 may simply need increase in dose
Obviously vitamin levels need improving
Retest early morning, fasting and last dose levothyroxine 24 hours before test …6-8 weeks after adding vitamin B complex and increasing iron rich foods in diet
You asked “Any recommendations as to the dosage of Vit D”
There is a calculator to work this out but I don’t have a link to it.
My partner had similar vit D result to yours and successfully raised it over a couple of months with the Holland and Barret Vita-something choosing the 4,000 daily dose. Now his result is 125 so he stopped taking it in the summer and is now finishing off the packet by taking one or two a week.
A dose between 3,000 - 5,000 should be safe to take for a couple of months, then test, then find a lower maintenance dose to keep your result between 100-150. We are all different when it comes to dosage.
I take Doctors Best softgels 4,000 but only twice a week as I’ve been supplementing for a while. I’ve added magnesium and k2 but realised there are two popular k2 preparations mk4 and mk7 and I don’t have the correct one!
Getting vitamin D up definitely reduced some symptoms for me.
Hi BearoThanks for the info concerning Vit D just received D3000+k2 daily oral spray by BetterYou. Will give this a go and hopefully my levels will be up in a few months.
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