Hashimotos

[Samy1988]

I've been told I've got Hashimotos and I take T4. My symptoms are still causing me problems and I'm iron deficient. I have a medication review in a week's time because my TSH isn't yet around 1 as my endocrinologist has said she wants it to be but I've had other vitamin and mineral levels done and I've been told they look ok but are they ok enough without supplementing? I currently supplement with D3 3000IU so do I need to continue this one and start any others? Thank you.

Symptoms:

Dry skin
constipation
dry eyes
weight loss
fatigue
insomnia
difficulty swallowing
headaches
itchy skin
heavy periods
irregular cycles
foul smelling stools
urinary incontinence
pins and needles
tired muscles
hair loss
dark circles under eyes
acid reflux
gas
abdominal pain
spots on face
pale skin

Folate: 5.3 (4.6-18.7)
Vitamin B12: 543 (180-900)
Vitamin D: 74 (25-75)
Ferritin: 18 (30-400) this is being addressed with iron tablets3 times a day
Selenium: lab notes: regret, insufficient specimen. Sample sent to another haematology department for zinc analysis.
Zinc: result still pending (this was taken 2 weeks ago and doctor has not received this result. Haematology is not answering my calls)

Thyroid:

TSH: 2.87 (0.2-4.2)
FT4: 18.7 (12-22)
FT3: 4.8 (3.9-6.7)

[Samy1988]

Thanks for reply.

I take 100mcg T4. I would like to try adding T3 but I understand that my doctor does not know anything about T3 replacement.

Am I likely to be on more T4 replacement when I get the new thyroid results? I have no idea if my TSH is any lower considering my symptoms but they could be mostly due to iron deficiency.

Can peripheral neuropathy affect muscles in my throat? I had a thyroid ultrasound done 4 years ago which showed a vascular thyroid but one done this year has shown nothing. This was because of difficulty swallowing.

[Barb135]

If your doctor is simply trying to get your TSH to a certain level, she's trying to shoot a moving target, because TSH is affected by so many variables, it's very unstable... In addition, it doesn't accurately reflect actual thyroid hormone status.  She needs to start paying attention to your Free T4 and Free T3... those are telling quite a story that she's totally missing.

Your Free T4 is at 67% of its range; rule of thumb is for Free T4 to be about mid range, yours is higher than it needs to be.  On the other hand, your Free T3 is only at 32% of its range and the rule of thumb is for Free T3 to be in the upper half to upper third of its range.  

Free T4 isn't used directly by the individual cells; it's a storage hormone and must be converted to Free T3, which is used by the individual cells.  Since your Free T4 is high in the range and your Free T3 is low in the range, this tells us that you aren't properly converting the FT4 to FT3, so you're still hypo, which is causing your symptoms AND keeping your TSH higher than it should be.  

What dose of T4 medication are you taking?  You should talk to your doctor about adding a small dose of a T3 medication to it in order to increase your Free T3 levels.  You can do this with the addition of cytomel or its generic version, liothyronine.  When adding a T3 med, it's customary to decrease the T4 med by about 20 mcg/day for every 4 mcg T3 added.

Your vitamin D level is probably good enough... I'd probably drop down to a maintenance dose of about 1000-2000 IU/day.  

Your vitamin B-12 could stand to be higher in the range.  Some countries consider anything under 500 to be deficient and my lab puts a note on my reports that anything under 500 can cause symptoms, so I'd consider yours as borderline deficient.  I have Pernicious Anemia and I have to keep my levels at the very top of the range in order to keep symptoms (mostly fatigue) at bay.  Also if you are deficient in B-12 for a long period, it can damage nerves, leaving you with peripheral neuropathy.  B-12 is not toxic and it's water soluble, so excess goes out in the urine.

Even though you don't have a selenium result, it won't hurt to supplement selenium.  Selenium has been shown to help in the conversion of FT4 to FT3.  200 mcg/day is the standard dose.  Discuss this with your doctor.