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Hashimotos feedback welcome
Hi I have Hashimotos diagnosed in 2014. I take 150mcg levo and 10mcg T3, just wondering if my results could do with an increase? Symptoms are: sore throat, pressure on right side of neck, tiredness, dry skin, constipation, migrating aches and pains, eyebrow and eyelash loss, brain fog, puffy eyes. Endo is reluctant to increase.
Thank you
Serum TSH - 3.81 mIU/L (0.2 - 4.2)
Serum free T4 - 19.7 pmol/L (12 - 22)
Serum free T3 - 4.8 pmol/L (3.1 - 6.8)
Thank you
Serum TSH - 3.81 mIU/L (0.2 - 4.2)
Serum free T4 - 19.7 pmol/L (12 - 22)
Serum free T3 - 4.8 pmol/L (3.1 - 6.8)
Your ferritin is adequate, your B12 could be a bit nearer the upper limit, and your Vitamin D is good.
Regarding your thyroid hormone tests, I meant to ask if you defer your morning dose until after the blood draw for tests? If not, you can get false high results that can wrongly influence the doctor. So be sure to always defer thyroid med until after blood draw.
I found some reference ranges in nmol/L that showed about 171-536 for an early morning test. Cortisol levels change quite a bit from a high about 8 in the morning until midnight lows. So, assuming that your test was done in the early morning, then your result from two years ago would have been below mid-range, but considered sufficient. Since symptoms are also important in evaluating cortisol sufficiency, I think it would be good to try and get a followup morning serum cortisol test. And from what I suggested above, I would try and get a Reverse T3, a Free T3, and a Free T4 as well.
And of course you need to try and get the doctor to treat clinically, as described above or find a good thyroid doctor that will do so. Since you are in the UK that is frequently very difficult due to directions from the NHS. Could you go private if the doctor resists these tests and continues to dose you based on TSH, instead of clinical treatment? In fact now that I checked your location, it is unusual for a UK patient to be tested for Free T4 and Free T3 when TSH is within range, and even more unusual to be prescribed T3 med. Are you already seeing a private doctor?
Regarding your thyroid hormone tests, I meant to ask if you defer your morning dose until after the blood draw for tests? If not, you can get false high results that can wrongly influence the doctor. So be sure to always defer thyroid med until after blood draw.
I found some reference ranges in nmol/L that showed about 171-536 for an early morning test. Cortisol levels change quite a bit from a high about 8 in the morning until midnight lows. So, assuming that your test was done in the early morning, then your result from two years ago would have been below mid-range, but considered sufficient. Since symptoms are also important in evaluating cortisol sufficiency, I think it would be good to try and get a followup morning serum cortisol test. And from what I suggested above, I would try and get a Reverse T3, a Free T3, and a Free T4 as well.
And of course you need to try and get the doctor to treat clinically, as described above or find a good thyroid doctor that will do so. Since you are in the UK that is frequently very difficult due to directions from the NHS. Could you go private if the doctor resists these tests and continues to dose you based on TSH, instead of clinical treatment? In fact now that I checked your location, it is unusual for a UK patient to be tested for Free T4 and Free T3 when TSH is within range, and even more unusual to be prescribed T3 med. Are you already seeing a private doctor?
It appears that your Endo is one of those that adjusts thyroid med dosage just enough to get the TSH back within range. That does not work. A good thyroid doctor will treat a hypo patient clinically by testing and adjusting Free T4 and Free t3 as needed to relieve hypo symptoms, without being constrained by resultant TSH levels. Symptom relief should be all important, not just test results. Note the following quote from a good thyroid doctor.
"In tests done about 24 to 28 hrs after their last daily dose, most people on adequate NDT therapy have a suppressed TSH. They usually have FT4 levels that are 1 to 1.3ng/dL, and free T3 levels that are rather high in the range or even slightly above the range. The higher FT3 level compensates
for the lower FT4 levels on NDT."
You are not on desiccated thyroid med, but you are taking both T4 and T3, so it still applies. Instead of those levels, your Free T4 is at 77%, but your Free T3 is only at 46% of its range. So an increase in T3 med and a slight decrease in T4 med would seem to be in order. The whole purpose of treatment should be symptom relief. In addition there are several other tests that should be done, specifically a Reverse T3 and a Free T3 from the same blood draw, morning serum cortisol, Vitamin D, B12 and ferritin. You can read about the importance of those in the following link. I highly recommend reading at least the first two pages and more if interested in the discussion and scientific evidence supporting the 6 suggestions. Giving a copy of the paper to your doctor might also change how you are treated. If not then you need to find a good thyroid doctor that will treat clinically, as described above.
http://www.thyroiduk.org.uk/tuk/TUK_PDFs/diagnosis_and_treatment_of_hypothyroidism_issue_1.pdf
"In tests done about 24 to 28 hrs after their last daily dose, most people on adequate NDT therapy have a suppressed TSH. They usually have FT4 levels that are 1 to 1.3ng/dL, and free T3 levels that are rather high in the range or even slightly above the range. The higher FT3 level compensates
for the lower FT4 levels on NDT."
You are not on desiccated thyroid med, but you are taking both T4 and T3, so it still applies. Instead of those levels, your Free T4 is at 77%, but your Free T3 is only at 46% of its range. So an increase in T3 med and a slight decrease in T4 med would seem to be in order. The whole purpose of treatment should be symptom relief. In addition there are several other tests that should be done, specifically a Reverse T3 and a Free T3 from the same blood draw, morning serum cortisol, Vitamin D, B12 and ferritin. You can read about the importance of those in the following link. I highly recommend reading at least the first two pages and more if interested in the discussion and scientific evidence supporting the 6 suggestions. Giving a copy of the paper to your doctor might also change how you are treated. If not then you need to find a good thyroid doctor that will treat clinically, as described above.
http://www.thyroiduk.org.uk/tuk/TUK_PDFs/diagnosis_and_treatment_of_hypothyroidism_issue_1.pdf
1 Comments
Hi gimel, thanks for answer.
Ferritin - 81 ng/L (15 - 150)
Vitamin B12 - 467 pg/L (191 - 663)
Total 25 OH vitamin D - 64.1 nmol/L (> 75 adequate)
Morning cortisol was last measured 2 years ago - 340 nmol/L. I don't know the range sorry.
Ferritin - 81 ng/L (15 - 150)
Vitamin B12 - 467 pg/L (191 - 663)
Total 25 OH vitamin D - 64.1 nmol/L (> 75 adequate)
Morning cortisol was last measured 2 years ago - 340 nmol/L. I don't know the range sorry.
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