Lucy_Ann Yes you are currently undermedicated and need an increase in Levo. 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 haven't said what dose you're taking, but I assume it's been reduced to produce those results. Why was it reduced? How much was your dose changed? What was the reason given?
The most likely cause is
Anti TPO 289.5 (<34)
Anti TG >1300 (<115)
and these 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. Not many doctors know much about Hashi's (they call it autoimmune thyroiditis) and have no real idea what to do when you have these fluctuations.
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.
Gluten/thyroid connection: chriskresser.com/the-gluten...
Hashi's and gut/absorption problems tend to go hand in hand, and low nutrient levels often result. Yours are pretty dire. What has your GP said about them?
Ferritin 15 (15 - 400)
As this is at the bottom of the range, you really need an iron panel and full blood count to see if you have iron deficiency anaemia.
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 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 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...
Folate 2.37 (2.50 - 19.50) Vitamin B12 205 (190 - 900)
You are folate deficient with very low B12. Do you have any signs of B12 deficiency b12deficiency.info/signs-an... You need to post on the Pernicious Anaemia Society forum for further advice healthunlocked.com/pasoc Quote your Folate, B12 and Ferritin result, any iron deficiency anaemia information that you may already have, and any signs of B12 deficiency you may be experiencing. See what they say and discuss with your GP. You will need folic acid for your folate deficiency but don't start taking that until you have had further investigation for Pernicious Anaemia. You may need B12 injections.
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."
Vitamin D total (25 OH) 44.3 (25 - 50 deficient)
Been taking 800iu since 2013.
You need to ask your GP why, considering you've been supplementing with D3 for 4 years, is your level still in the deficient category.
800iu is nowhere near enough to raise your level, you wont get any more from your GP on prescription so I suggest you buy your own softgels like these bodykind.com/product/2463-b... and take 5000iu daily for 8 weeks, then reduce to 5000iu alternate days. Retest 3 months after starting this dose. When you've reached the level recommended by the Vit D Council - which is 100-150nmol/L - and then you'll need a maintenance dose 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
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
Check out the other cofactors too.