Thyroid UK
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New member results from GP what do they mean please

Taking 25mcg levothyroxine diagnosed 2013

TPO antibodies 108.5 (<34 IU/mL)

Serum TSH level 5.2 (0.2 - 4.2 mIU/L)

Serum Free T4 19.3 (12.0 - 22.0 pmol/L)

Serum Free T3 3.3 (3.1 - 6.8 pmol/L)

Ferritin 21 (30 - 400 ug/L)

Folate 2.2 (2.5 - 19.5 ug/L)

Vitamin B12 196 (190 - 900 pg/L)

Total 25 OH vitamin D 27.2 (25 - 50 nmol/L vitamin D deficiency. Supplementation is indicated)

No supplements thanks for reading

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Can you edit your post to include the dose of levo. that you are taking, please? It will help people to comment. Can you also mention if you are taking any supplements?

Your TSH is above the range and all the more so for someone who is medicated and more knowledgeable people than I am will comment on that.

Your ferritin and folate levels are below range and someone will be along with advice on those. In addition, your B12 is very low in the bottom of the range and you might want to think about addressing that, particularly in the light of your folate result. Do you have the results of any recent CBC tests so that people can look at those as they might give more insight into your iron and B12 status.

Your vitamin D is in the insufficient category and if you look at SeasideSusie replies, she provides a lot of information on appropriate products and dosages to remedy that.

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Taking 25mcg levothyroxine and no supplements thanks

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That's a very low dose - your GP has never suggested that you increase it or is this high TSH reading very recent for you and it's previously been OK?

As an example, you can see one of SeasideSusie's very helpful responses here which covers some of the items in which you might be interested: healthunlocked.com/thyroidu...

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Hi thanks no my doctor has never suggested I increase it. I don't know why.

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Clutter usually sums it up that when you're medicated appropriately: "the goal of Levothyroxine is to restore the patient to euthyroid status. For most patients that will be when TSH is 0.4 - 1.0 with FT4 in the upper range. FT4 needs to be in the upper range in order that sufficient T3 is converted".

Another SeasideSusie response that might be relevant to you if you scroll down: healthunlocked.com/thyroidu...

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Ro_sie It's very negligent of your GP to have kept you on a very low starter dose for 4 years, what on earth was he thinking? I doubt he really knows anything about treating hypothyroidism.

Once diagnosed and started on Levo, retesting and increases in dose of 25mcg should be carried out every 6-8 weeks until the patient feels well and symptoms abate. The aim of a treated hypo patient generally is for TSH to be 1 or below or wherever it needs to be for FT4 and FT3 to be in the upper part of their respective reference ranges when on Levo.

You need an immediate increase in your Levo so ask for one, then ensure that you are tested every 6-8 weeks with an increase in dose until you feel well and your results are nearer the norm for a hypo patient.

When having thyroid tests, always book the very first appointment of the morning, fast overnight (water allowed) and leavo off Levo for 24 hours. This gives the highest possible TSH which is needed when looking for an increase in dose or two avoid a reduction. This is a patient to patient tip so we don't discuss it with doctors and phlebotomists as they probably wouldn't agree.

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TPO antibodies 108.5 (<34 IU/mL)

Your high antibodies mean that you are positive for autoimmune thyroid disease aka Hashimoto's which is where antibodies attack the thyroid and gradually destroy it. The antibody attacks cause fluctuations in symptoms and test results.

You can swing from hypo to hyper and back to hypo again during these 'Hashi's flares'.

You can help reduce the antibodies by adopting a strict gluten free diet which has helped many members here. Gluten contains gliadin (a protein) which is thought to trigger autoimmune attacks so eliminating gluten can help reduce these attacks. You don't need to be gluten sensitive or have Coeliac disease for a gluten free diet to help.

Supplementing with selenium l-selenomethionine 200mcg daily can also help reduce the antibodies, as can keeping TSH suppressed.

Some information about Hashi's so that you can help yourself, your GP doesn't appear to be much help, and most of them dismiss antibodies as being of no importance anyway.

Gluten/thyroid connection: chriskresser.com/the-gluten...

stopthethyroidmadness.com/h...

stopthethyroidmadness.com/h...

hypothyroidmom.com/hashimot...

thyroiduk.org.uk/tuk/about_...

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Hashi's often causes gut/absorption problems and as a consequence nutrient levels can often be low or deficient, as we can see from your results. Your GP should have picked up on these but again he appears to have been extremely negligent. You will need to discuss these with him and ask why he has seen fit to ignore them rather than treat these deficiencies.

Ferritin 21 (30 - 400 ug/L)

Your ferritin is below range and this can often suggest iron deficiency anaemia so you need a full blood count and iron panel carried out.

For thyroid hormone to work ferritin needs to be at least 70, preferably half way through range. You need an iron supplement, ideally you need an iron infusion as your level is below range so ask for one, but you may only be prescribed tablets which will take months to raise your level whereas an infusion will raise your level within 24-48 hours.

Take each iron tablet with 1000mg Vitamin C to aid absorption and help prevent constipaton. Always take iron 4 hours away from thyroid meds and two hours away from other medication and supplements as it will affect absorption.

You can also help raise your level by eating liver regularly, maximum 200g per week due to it's high Vit A content, and including lots of iron rich foods in your diet apjcn.nhri.org.tw/server/in...

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Folate 2.2 (2.5 - 19.5 ug/L) Vitamin B12 196 (190 - 900 pg/L)

You are folate deficient with extremely low B12. Do you have any signs of B12 deficiency b12deficiency.info/signs-an... Pleas post on the Pernicious Anaemia Society forum for further advice. Quote your folate, B12 and ferritin results, any iron information you may have, plus any signs of B12 deficiency you may be experiencing. You may need testing for Pernicious Anaemia and you may need B12 injections. Discuss what they say with your GP. If your GP prescribes folic acid, do not start taking it until further investigations have been carried out with regard to your B12 level and Pernicious Anaemia.

healthunlocked.com/pasoc

I have read (but not researched so don't have links) that BCSH, UKNEQAS and NICE guidelines recommend:

"In the presence of discordance between test results and strong clinical features of deficiency, treatment should not be delayed to avoid neurological impairment."

And an extract from the book, "Could it be B12?" by Sally M. Pacholok:

"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".

"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."

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Total 25 OH vitamin D 27.2 (25 - 50 nmol/L vitamin D deficiency. Supplementation is indicated)

You are just 2.2 away from severe Vit D deficiency, you need supplementing with loading doses to start with followed by a decent maintenance dose. See NICE treatment summary for Vit D deficiency:

cks.nice.org.uk/vitamin-d-d...

Treat for vitamin D deficiency if serum 25-hydroxyvitamin D (25[OH]D) levels are less than 30 nmol/L.

For the treatment of vitamin D deficiency, the recommended treatment is based on fixed loading doses of vitamin D (up to a total of about 300,000 international units [IU]) given either as weekly or daily split doses, followed by lifelong maintenance treatment of about 800 IU a day. Higher doses of up to 2000 IU a day, occasionally up to 4000 IU a day, may be used for certain groups of people, for example those with malabsorption disorders. Several treatment regimens are available, including 50,000 IU once a week for 6 weeks (300,000 IU in total), 20,000 IU twice a week for 7 weeks (280,000 IU in total), or 4000 IU daily for 10 weeks (280,000 IU in total)."

Each Health Authority has their own guidelines but they will be very similar. Go and see your GP and ask that he treats you according to the guidelines and prescribes the loading doses. Once these have been completed you will need a reduced amount (not the paltry 800iu you will be prescribed) to bring your level up to what's recommended by the Vit D Council - which is 100-150nmol/L - and then you'll need a maintenance dose (not 800iu) which may be 2000iu daily, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. You can do this with a private fingerprick blood spot test with City Assays vitamindtest.org.uk/

There are important cofactors needed when taking D3

vitamindcouncil.org/about-v...

D3 aids absorption of calcium from food and K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems.

D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds.

Magnesium comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds

naturalnews.com/046401_magn...

Check out the other cofactors too.

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