Nurse appointment Monday - need advice please

[Sunny537]

Hi, I am a 29 year old girl and I was diagnosed with Hashimoto's Thyroiditis (primary autoimmune hypothyroidism) this year.

I have been having real trouble gaining weight despite improving my diet and increasing my intake of healthy fats, proteins, carbohydrates etc. and so I registered with a doctor practice that provides dietary advice and support since my previous practice did not follow-up my unexplicable failure to gain weight.

I am currently underweight with a BMI of 17.9, possibly less as we do not have any scales and I use them at my grandparents' or mum's house when I am there which isn't very often.

I have been told I am deficient in iron and that my Vitamin D is low (no number given) and seeing as I have an appointment with my new practice on Monday to see a treatment nurse who will be weighing me, measuring my height and body mass index as well as take a sample of my urine I would like some advice on how best to approach the subject of acquiring dietary advice despite my current efforts. I am very much convinced that I will be, yet again, classed as underweight and seen as someone who is neglecting themselves.

I used an online food adviser which allowed me to input my age, gender and daily food intake and this food adviser told me I am highly likely to be deficient in the following nutrients:

Copper
Iron (already been told my ferritin is low)
Folate
Vitamin E
Vitamin B2 (Riboflavin)
Vitamin B12 (normal level)
Vitamin A
Vitamin C
Magnesium: (but magnesium levels are normal at 0.89)
Vitamin B3 (Niacin)
Vitamin B6
Protein
Selenium
Calcium
Phosphorus (levels are normal as per urea and electrolytes tested)
Zinc
Potassium (levels are normal as per urea and electrolytes tested)
Pantothenic Acid
Omega 3 Fatty Acids
Manganese
Vitamin K
Vitamin D (already been told level is low but no number)
Vitamin B1 (Thiamine)
Dietary Fiber

Please give me any suggestions so I can arrive prepared into my appointment on Monday. I'm aware I'm likely to be under the cosh if any deficiencies are found, especially as many as the food adviser has pointed out already.

Thanks! :)

Blood test results:

Ferritin: 15 (30-400)
Folate: 4.9 (4.6-18.7)
Vitamin D: low (no number given for recent one so here is previous result: 59.6 with 50-75 suboptimal)
Vitamin B12: 362 (180-900)

[Sunny537]

Hi there, thanks for reply. Here are my most recent results:

TSH: 0.30 (0.27-4.27)
Free T3: 4 (3.9-6.7)
Free T4: 15 (12-22)
Anti-TPO antibodies: 144 (>34)

As long as the holistic nutritionist is affordable I'm willing to give it a go.

The new doctor is testing me for coeliac but she said it was hit and miss.

[Paxiled]

Also, did she test for T3?  Tsh isn't really worth much, and T4 is just one of the four main thyroid hormones.  A holistic nutritionist might be an idea for you, as they will often test all four of the hormones.  Good luck.

[Paxiled]

I didn't know they could test for antibodies, as there are so many different ones.  But let's say that's true.  Antibodies are an immune system reaction to something the body thinks is bad for it -- it causes an inflammatory response as part of this defense.  So it sounds like gluten may in fact be a problem for you.  It could also just be wheat, which is a more common problem.  But I'm not sure I really understand the antibody test, so this is just a guess.

[Sunny537]

Thanks for reply.

Yes, I'm on synthetic thyroid medication.

The endocrinologist seemed fairly happy with my thyroid function test results when she accessed my records at the time. This was back at the end of May. My TSH was 4.5 (0.2-4.2) and my Free T4 was 19.3 (12-22). She said for me to eliminate gluten as she did not feel an endoscopy was worth putting me through (she told me it was an unpleasant procedure). But when I re-introduced gluten back into my diet my antibodies almost quadrupled which I don't really understand.

Even though I have emailed my endocrinologist on more than one occasion she hasn't gotten back to me. I once emailed her about 10 questions I had - this is going back to August - and I've had no answer from her. I have been leaving messages with her secretary but somehow these messages get lost in transit because I don't get her returning my messages I left. I know she works part-time, goes between two hospitals and uses a lot of her annual leave in one go and so I don't know when she is and when she is not.

I am tempted to change endocrinologists due to this but I really don't know where to go or what to do.

[Paxiled]

I don't know how anyone who didn't know what you ate and how well you metabolized it and gave you a series of blood tests to account for differences that naturally occur could possibly tell you what you are deficient in -- in other words, I don't see how this on-line food adviser could possibly be accurate.  If you have Hashimoto's I'm assuming you're now on synthetic thyroid medication, and it's very possible it's not adjusted correctly, as this is very common.  Have you mentioned this to your endocrinologist?