Hypothyroid - advice after endochronologist visit

[Kai1977]

Sorry for the long post but I really need some advice and the Healthunlocked forum post hasn't had much traffic.

I've been referred to an endo after ongoing symptoms relating to hypothyroidism (fatigue, coldness, restless sleep, periodic light-headedness and dry skin patches). I'd like some advice as he's suggesting quite a broad range of things.

GP blood tests already done. Fasting glucose 4.4, Hb was low-normal at 119 gm/L, MCV 86, total cholesterol 6.5, non-HDL cholesterol 4.2, TSH 2.75, free T4 17.2 but the most recent thyroid function test taken on the 8th May showed a TSH of 0.19 miu/L, free T4 19.4 pmol/L and free T3 low normal at 3.7 pmol/L with her taking Levothyroxine 100mcg o.d. LFTs were normal and at the time of the blood test I was taking pre-conception multivitamins and this showed an elevated folate greater than 20 and a B12 of 1382 pg/ml. LFTs were normal, vitamin D was suboptimal at 69 nmol/L despite her taking vitamin D3 1000/2000 units daily. I'm 39, BMI of 19.

He wants to eliminate cortisol deficiency (though he thinks chances are low he says patients have been found to have polymorphisms affecting the methylation pathways. The elevated folate might point to this (due to an inability to activate folate efficiently).

He also wants to look at whether I'm converting T3 and T4 (but I'm trying to conceive so there are issues around treating this as i understand it, is that right)?

He is recommending I go on the Atkins diet in the short term to see if symptoms relating to blood sugar improve and he wonders about the possibility of reactive hypoglycaemia. There might be an element of gluten sensitivity/gut dysbiosis. Related to thyroid autoimmunity, which include gluten sensitivity and gut dysbiosis, suboptimal vitamin D levels.

He also wants me to go on:

1. Womens multi essentials once daily (makes the urine bright yellow).
2. Ultra-potent C 1000 one tablet daily. Take in the morning with multiessentials.
3. Advanced EPA Eskimo oil fish oil capsules one twice daily with meals.
4. Probiotix 5 live one daily in the morning.
5. Vitamin D3 2000 units one daily
6. Plant source antioxidants one daily in the morning.

He is also testing me again for:
Pre 9am cortisol
Gluten profile
3DL8RMIN
Thyroid antibodies
Free T3
Active B12 and red cell folate
HbA1c

Any thoughts or advice welcome - it seems a lot and there will be quite a lot of costs relating to all the supplements he's suggesting too.

Thanks

I can't offer much but i do agree tbat your D3 would benefit with supplements and
Your FT3 is very very low. Def looks as though you have a conversation problem. Have your antibodies been tested for Hashimotos?

Just saw you are being tested for antibodies! I wonder if he'll prescribe T3 meds? That's what i take due to similar conversion issue.

I've been hypothyroid for over twenty years and in the last 2 years I've gone completely gf. It's made a huge difference to the way I feel and kerotosid pilatis has improved immensely. No advice about supplements though as I'm yet to find anything that helps.

My post disappeared!

Thanks both. He doesn't want to give anything for T3 at mo as I am ttc and he said it can be risky in pregnancy apparently?

My instinct says both T3 and going low gluten will help but we'll see!

Thanks

Have a look at the Wheat Belly books, total health is a good one... they are by Dr William Davis and lots of people with thyroid problems have had fantastic results.... it's primarily about going grain and sugar free but ensuring you get your systems back working properly too at the start with appropriate supplements (but not indefinitely)

There is a Facebook group for the 10 day detox and they are so supportive and non-judgemental

I agree with others that this looks like a conversion problem - FT4 high and FT3 low in range. The usual treatment would be to lower your thyroxine (T4) and add in some liothyronine (T3).

I think I would be asking for references to show that T3 is 'risky' in pregnancy, given that a good level of T3 is essential for good health generally.

Thanks so much. Re T3 I think he was saying the jury is out on the risks for actually treating the issue of non-conversion. But I will ask him for more info.

T3 doesn't cross the placenta so baby can be hypothyroid even if Mums bloods look okay. That's why only T4 recommended for pregnancy / prepregnancy.

Thank you. Bit confused, my understanding is that if my T4 isn't converting to T3 whilst preganant, they can't give me anything to stop this because there is debate about the effects on the baby?

T4 crosses the placenta and the baby will do its own conversion. T3 very risky in pregnancy and not advised.

Has anyone got a reference for this?

I'd hate to think it was another thyroid myth.

Certainly women who take natural desiccated thyroid extract, which contains T3, seem to have little trouble conceiving and delivering healthy babies. I would have thought not raising your FT3 to an optimal level was actually putting your future pregnancy at risk.

However, I'm a historian, not a doctor.

I have posted on HealthUnlocked as well and I'm getting mixed information so I would say the jury is out and it may depend on individual medical opinion...

I'm not getting many sources for any of this though, which would be helpful.

From American Thyroid Association guidelines 2017.

TSH and synthetic thyroxine biased.

I'm not seeing any mention of those who will always need T3 because they have a gene mutation which means they will not convert.

I still think OP needs to get her FT3 up, either by raising her dose of thyroxine and hoping for the best, or by dropping it a little and adding T3 in some form.