Re: Blood Test Analysis; PLEASE

[Guest guest]

Hello Alan,

Can somebody please explain the significance of the Thyroid Peroxidase and Thyroglobulin antibody tests?You have tested positive for both, TPO and TgAB – this means that your thyroid condition is of auto-immune origin and called "Hashimoto's disease". Those thyroid autoantibodies will – in the fullness of time – destroy your thyroid gland and there is nothing you can do to prevent this from happening. The actual number of both AA's (autoantibodies) will fluctuate and is of secondary importance. When AA's launch an attack on your thyroid gland, their numbers will be high, when they go into remission, they will be low. But notwithstanding that, they are present and all you can do about that is to take your medication regularly and reduce or stop gluten intake. A gluten-free diet will reduce the AA attacks, because the gluten molecule is almost identical to the thyroid molecule and the AA's will mis-identify and attack gluten in the same way they attack the thyroid gland – which will result in chronic inflammation in your body. This is possibly already happening, as your ferritin level (stored iron) is relatively high (ideal would be around 100). I might be an idea to have your other iron parameters also checked to make sure that your ferritin level is true and not down to chronic inflammation. You'd need `serum iron' and `Transferrin saturation%' checked to see what your ferritin figure actually means. If your iron level is genuinely a good level, then so will be the other two parameters, but if your ferritin level were indicating inflammation, it is possible that your total iron levels might be depleted and you would need to do something about it.

I am currently on 100mcg of Levoxyl because I seem to tolerate it better than125mcg which puts my TSH into the "normal" range. That is when I had troublewith the "pounding heart" problem which makes sleeping difficult (as if I had too much caffeine).Those symptoms are not necessarily caused by too much thyroxine. It is more likely that the pounding heart was indicating that your T4 is cursing around your veins aimlessly, making you thyrotoxic. Your thyroid results show that hardly any thyroid hormone is actually making it inside the cells. This could have a number of reasons... you could have a conversion problem, or -

If, for instance, your iron levels were lower than the ferritin suggests, that would prevent thyroid hormone from getting utilized.

Furthermore your Vit B12 levels are much too low. They should be around the 900-1000 mark. You need to supplement – best are Solgar's B12 nuggets 1000 iu, which are taken sublingually... 1 a day. http://www.solgar.co.uk/product/vitamin-b-12-1000ug-nuggets-100-E3229.html

Perhaps you biggest problem is a lack of Vit D3. You need to rectify that PDQ. I would suggest you take 4000- 5000 iu of Vit D3 per day during the winter months and during the summer months perhaps half of that, provided you get a reasonable amount of exposure to sunlight.

Your am cortisol level looks ok, so hopefully your adrenals are working fine. If you think you might have adrenal problems, then it would be wise to do a salivary cortisol test, which measures your cortisol levels 4 times a day and gives a much better picture.

In any case, your thyroid results are not brilliant. They suggest that your body is starved of thyroid hormone; something is not working. Your TSH should be down to between 0.something and 1.0.... yours is much too high and suggests that not much (if any) of the hormone you are taking is actually arriving in the cells. There are many reasons as to WHY – so below is a list of things that can go wrong and prevent thyroid hormone from getting utilized... You already know now that your B12 and D3 are much too low, but there may be others and you need to go through the list and eliminate one by one.- The following below was taken from our files – go through it with a toothcomb...

Sorry for the lengths and all. It is probably not what you wanted to hear, but if it's any consolation, you are not alone. We are all in the same boat.

Wishing you and everyone a healthy and peaceful Christmas.

There are MANY reasons and many medical conditions associated with thyroid disease that stop thyroid hormone from getting into the cells, where it does its work. I mention these over and over and over again - ad nauseum - people must be bored with the same old, same old but as each new member joins us, they need to know. The main condition responsible for stopping thyroid hormone from working, is, quite simply, a patients thyroxine dose is too low because the doctor or consultant refuses to increase it, because the serum thyroid function test results appear OK. Sometimes, the thyroxine dose is too high, yet patients still don't feel well. They continue to suffer. Some reasons for this:

They may be suffering with low adrenal reserve. The production of T4, its conversion to T3, and the receptor uptake requires a normal amount of adrenal hormones, notably, of course, cortisone. (Excess cortisone can shut production down, however.) This is what happens if the adrenals are not responding properly, and provision of cortisone usually switches it on again. But sometimes it doesn't. If the illness has been going on for a long time, the enzyme seems to fail. This conversion failure (inexplicably denied by many endocrinologists) means the thyroxine builds up, unconverted. So it doesn't work, and T4 toxicosis results. This makes the patient feel quite unwell, toxic, often with palpitations and chest pain. If provision of adrenal support doesn't remedy the situation, the final solution is the use of the active thyroid hormone, already converted, T3 - either synthetic or natural

Then, we have systemic candidiasis. This is where candida albicans, a yeast, which causes skin infections almost anywhere in the body, invades the lining of the lower part of the small intestine and the large intestine. Here, the candida sets up residence in the warmth and the dark, and demands to be fed. Loving sugars and starches, candida can make you suffer terrible sweet cravings. Candida can produce toxins which can cause very many symptoms of exhaustion, headache, general illness, and which interfere with the uptake of thyroid and adrenal treatment. Sometimes the levels - which we usually test for - can be very high, and make successful treatment difficult to achieve until adequately treated.

Then there is receptor resistance which could be a culprit. Being hypothyroid for some considerable time may mean the biochemical mechanisms which permit the binding of T3 to the receptors, is downgraded - so the T3 won't go in. With slow build up of T3, with full adrenal support and adequate vitamins and minerals, the receptors do come on line again. But this can be quite a slow process, and care has to be taken to build the dose up gradually.

And then there are Food allergies. The most common food allergy is allergy to gluten, the protein fraction of wheat. The antibody generated by the body, by a process of molecular mimicry, cross reacts with the thyroperoxidase enzyme, (which makes thyroxine) and shuts it down. So allergy to bread can make you hypothyroid. There may be other food allergies with this kind of effect, but information on these is scanty. Certainly allergic response to certain foods can affect adrenal function and imperil thyroid production and uptake.

Then we have hormone imbalances. The whole of the endocrine system is linked; each part of it needs the other parts to be operating normally to work properly. An example of this we have seen already, with cortisone. But another example is the operation of sex hormones. The imbalance that occurs at the menopause with progesterone running down, and a relative dominance of oestrogen is a further case in point – oestrogen dominance downgrades production, transportation and uptake of thyroid hormones. This is why hypothyroidism may first appear at the menopause; the symptoms ascribed to this alone, which is then treated – often with extra oestrogen, making the whole thing worse. Deficiency in progesterone most especially needs to be dealt with, since it reverses oestrogen dominance, improves many menopausal symptoms like sweats and mood swings, and reverses osteoporosis. Happily natural progesterone cream is easily obtained: when used it has the added benefit of helping to stabilise adrenal function.

Then, we must never forget the possibility of mercury poisoning (through amalgam fillings) - low levels of ferritin, vitamin B12, vitamin D3, magnesium, folate, copper and zinc - all of which, if low, stop the thyroid hormone from being utilised by the cells - these have to be treated. Should your GP or endocrinologist try to tell you that there is no association between low levels of these specific minerals and vitamins and low thyroid status, print off the information at the bottom of this message to show him just some of the references to research/studies to show that there is.***

As Dr Peatfield says "When you have been quite unwell for a long time, all these problems have to be dealt with; and since each may affect the other, it all has to be done rather carefully.

Contrary to cherished beliefs by much of the medical establishment, the correction of a thyroid deficiency state has a number of complexities and variables, which make the treatment usually quite specific for each person. The balancing of these variables is as much up to you as to me – which is why a check of morning, day and evening temperatures and pulse rates, together with symptoms, good and bad, can be so helpful.

Many of you have been ill for a long time, either because you have not been diagnosed, or the treatment leaves you still quite unwell. Those of you who have relatively mild hypothyroidism, and have been diagnosed relatively quickly, may well respond to synthetic thyroxine, the standard treatment. I am therefore unlikely to see you; since if the thyroxine proves satisfactory in use, it is merely a question of dosage.

For many of you, the outstanding problem is not that the diagnosis has not been made – although, extraordinarily, this is disgracefully common – but that is has, and the thyroxine treatment doesn't work. The dose has been altered up and down, and clinical improvement is variable and doesn't last, in spite of blood tests, which say you are perfectly all right (and therefore you are actually depressed and need this fine antidepressant).

The above problems must be eliminated if thyroid hormone isn't working for you.

Should your GP or endocrinologist tell you that there is no connection between these minerals or vitamin levels and hypothyroidism, then copy the following links out to show him/her

Good luck!

***Low iron/ferritin: Iron deficiency is shown to significantly reduce T4 to T3 conversion, increase reverse T3 levels, and block the thermogenic (metabolism boosting) properties of thyroid hormone (1-4). Thus, iron deficiency, as indicated by an iron saturation below 25 or a ferritin below 70, will result in diminished intracellular T3 levels. Additionally, T4 should not be considered adequate thyroid replacement if iron deficiency is present (1-4)).

1. Dillman E, Gale C, Green W, et al. Hypothermia in iron deficiency due to altered triiodithyroidine metabolism. Regulatory, Integrative and Comparative Physiology 1980;239(5):377-R381.

2. SM, PE, Lukaski HC. In vitro hepatic thyroid hormone deiodination in iron-deficient rats: effect of dietary fat. Life Sci 1993;53(8):603-9.

3. Zimmermann MB, Köhrle J. The Impact of Iron and Selenium Deficiencies on Iodine and Thyroid Metabolism: Biochemistry and Relevance to Public Health. Thyroid 2002;12(10): 867-78.

4. Beard J, tobin B, Green W. Evidence for Thyroid Hormone Deficiency in Iron-Deficient Anemic Rats. J. Nutr. 1989;119:772-778.

Low vitamin B12: http://www.ncbi.nlm.nih.gov/pubmed/18655403

Low vitamin D3: http://www.eje-online.org/cgi/content/abstract/113/3/329 and http://www.goodhormonehealth.com/VitaminD.pdf

Low magnesium: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC292768/pdf/jcinvest00264-0105.pdf

Low folate: http://www.clinchem.org/cgi/content/full/47/9/1738 and http://www.liebertonline.com/doi/abs/10.1089/thy.1999.9.1163

Low copper http://www.ithyroid.com/copper.htm

http://www.drlwilson.com/articles/copper_toxicity_syndrome.htm

http://www.ithyroid.com/copper.htm

http://www.rjpbcs.com/pdf/2011_2(2)/68.pdf

http://ajplegacy.physiology.org/content/171/3/652.extract

Low zinc:http://www.istanbul.edu.tr/ffdbiyo/current4/07%20Iham%20AM%C4%B0R.pdf and http://articles.webraydian.com/article1648-Role_of_Zinc_and_Copper_in_Effective_Thyroid_Function.html

Ferritin levels for women need to be between 100 and 130 for women (for men around between 150 and 170)

Vitamin B12 needs to be at the top of the range.

D3 levels need to be top of the range.

Magnesium levels need to be at the top of the range, it's one thing that often gets missed.

[Guest guest]

Hi !

You are marvelous. Thank you for explaining all that.

In the past 10 years, I have been to three endos and two GPs.

We live in USA (Washington, D.C. area).

Here's my story...

GP found slightly elevated TSH about 10 years ago. No big deal, put me on Synthroid.

I really never had any typical thyroid symptoms, other than perhaps fatigue.

Once taking T4 for awhile, it was as if my system came to rely on it.

But oddly, I would go months with no serious problems.

Then I'd have a period when I could not sleep. My heart was pounding at night, although my BP and heart rate were not unusually elevated, they must have been above what I am when I'm asleep (too bad I do not know my BP and heart rate when I sleep).

When I stopped taking the T4, my pounding heart problem would gradually disappear after about a week or two. I went through this cycle three or four times and I am convinced there is a connection -- but my endos say "no."

I would remain off T4. But after a month or two, I would experience problems that suggested I could not function well without T4 (sluggishness, fatigue). So I start the cycle again.

My GP gave me a low dose of Armour as a starting dose to try. That too sent me into the "pounding heart" problem after a few days.

I actually functioned better without T4. But now my system has become so dependant on it... perhaps my thyroid is deteriorating and I simply need it more.

The irony is, all three endos primarily looked only at TSH and perhaps T4. That is it!

The only reason I was tested recently for all the other T's, RT, FRT, was because I insisted that it be included on my blood test. My endo called them "useless tests."

The endos have changed my dosage of T4 several times... down and up and down and up. And also the brand name -- I'm on Levoxyl now. Same crap.

The most recent endo was trying to make the case that I'm suffering from anxiety and should consider a shrink. I'm never going back to him.

I'm frustrated with these "experts" and how they do not understand my problem.

I'm going to try another endo that is supposed to be a thyroid expert.... many of these other endos do diabetes mostly.

Any thoughts?

Thanks.

Alan

[Guest guest]

Hello Alan,

Here's my story...

GP found slightly elevated TSH about 10 years ago. No big deal, put me on Synthroid.

I really never had any typical thyroid symptoms, other than perhaps fatigue.

But oddly, I would go months with no serious problems.

This is not unusual, Alan. The destruction of the thyroid gland takes many years and many people have no significant problems during this time – or rather, no significant problems that they associate with Hypothyroidism. They might get more fatigued (and think it's age), they might get more infections and take longer to recover (and think they are overworked or simply run down), they might get ailments they never thought could have anything to do with low thyroid – for example: gallbladder infections/stones, kidney stones, UTI's, skin conditions, cruciate ligament injuries, digestive problems, heart disease .... I could easily carry on filling the page without even having to think too hard.

Once taking T4 for awhile, it was as if my system came to rely on it.

Well.... yes, it would.... that is the idea . The thyroid gland of a hypothyroid person is gradually no longer able to produce thyroid hormone in sufficient amounts; hence we have to supplement thyroid hormone for the rest of our lives and make up the shortfall.

Then I'd have a period when I could not sleep. My heart was pounding at night, although my BP and heart rate were not unusually elevated, they must have been above what I am when I'm asleep (too bad I do not know my BP and heart rate when I sleep).

Yes, many of us experience palpitations - this can have different reasons. Often it is due to a lack of Magnesium. Studies have given reason to suspect that hypothyroid patients may have a defective "magnesium transport system", which leads to low magnesium levels - low mag causes palpitations.

But a pounding heart could have other reasons... T4 toxicity for instance. If there were a conversion problem and the body were unable to convert T4 into T3, then the T4 would build up in the bloodstream (and show "normal" or even elevated FT4 figures) but the cells would still `go empty'.

When I stopped taking the T4, my pounding heart problem would gradually disappear after about a week or two. I went through this cycle three or four times and I am convinced there is a connection -- but my endos say "no."

Shame on your endo...

I would remain off T4. But after a month or two, I would experience problems that suggested I could not function well without T4 (sluggishness, fatigue). So I start the cycle again.

My GP gave me a low dose of Armour as a starting dose to try. That too sent me into the "pounding heart" problem after a few days.

That's interesting! .... Do you remember the dose you started with and how long you took it for?

I actually functioned better without T4. But now my system has become so dependant on it... perhaps my thyroid is deteriorating and I simply need it more.

I understand you saying that, but you you suffer from an auto-immune disease (Hashimoto's) and you do need thyroid hormone, daily, and for the rest of your life - we just have to find a way of getting it into your body without you getting those palps. Without thyroid hormone you will slowly but surely get more and more sick, your immune system would be falling through the floor and open the floodgates for a few more autoimmune diseases or cancer or what-have-you. The only question is – which thyroid hormone is the right one for you, and are there any underlying issues that need addressing... and yes, there are – your D3 is rock bottom, your B12 is low and you need to find out if your Ferritin level indicates good iron levels or chronic inflammation (so you need serum iron and transferrin saturation% tested).

Furthermore you need to look into the possibilities of food intolerances and Candida albicans infection. Please check the files and read up on Candida. If there were a chance that you might have intestinal yeast overgrowth, that too would explain why your thyroxine is not working as it should. Go through the list I sent you and consider each and every point that Dr. Peatfield makes. It may seem trivial, but something as 'simple' as a wheat allergy could account for all your troubles for instance.....

The irony is, all three endos primarily looked only at TSH and perhaps T4. That is it!

Yep – that does not surprise me.

The only reason I was tested recently for all the other T's, RT, FRT, was because I insisted that it be included on my blood test. My endo called them "useless tests."

The endos have changed my dosage of T4 several times... down and up and down and up. And also the brand name -- I'm on Levoxyl now. Same crap.

Sounds familiar... Perhaps it is now time to take your health into your own hands?

The most recent endo was trying to make the case that I'm suffering from anxiety and should consider a shrink. I'm never going back to him.

That sounds familiar too... it's the typical response.... if they can't find what's wrong, it must be in your head!

I'm frustrated with these "experts" and how they do not understand my problem.

I'm going to try another endo that is supposed to be a thyroid expert.... many of these other endos do diabetes mostly.

Good luck. Hopefully you will come across a good one someday. They do exist, only they are few and far between. But meanwhile go to work and find the cause that blocks your body from utilizing the thyroid hormone. Start with bringing up D3 and B12. Cut out sugars and grains, wheat in particular.... try to eat gluten-free. When you get those palpitations, take about 400 mg (or more) of Magnesium (chelated form is best) – that should stop the palps.... – and please give more info on your experiment with Armour. Even if Armour did not suit you, that does not mean that some other NDT would not suit you either. I, for instance, can't tolerate Erfa, but do brilliantly on a generic Armour from Thailand.

And then there is also the possibility that you truly have conversion problems and that perhaps you need a T3-only therapy. But I'd try the NDT route first.

with best wishes,