Thyroid UK
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Blood results

Hello would anyone mind explaining these results.

TSH. 1.83 mIU/L 0.27-4.20

Free thyroxine 20.1 pmol/L 12.0-22.0

Total thyroxine T4 102.0 nmol/L 59.0-154.0

T3. 3.83 pmol/L 3.10-6.80

Thyroglobulin anti 588.000 iu/ml 0.00-115.00

Thyroid peroxidase anti 570 iu/ml 0.00-34.00

B12. 54.1. Pmol/L 25.10-165.00

Folate. 6.38 ug/l. 2.91-50.0

Vit D. 46.6. Nmol/L 50.00-200.00

Ferritin. 36. Ug/L. 13.00-150.00

I'm on 100mg levothyroxin and I'm not taking any vitiamin supplements

Just want to confirm with you guys as you have a lot of experience and knowledge on these sort of things

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As mentioned on your other post, those high antibodies are indicative of Hashimoto's. You'll have seen SlowDragon's helpful replies about reducing antibodies so they may well be helpful to you, given your high numbers.

TSH 1.83 (0.2 - 4.2)

Free T4 20.1 (12 - 22)

Free T3 3.83 (3.1 - 6.8)

Your TSH is within range but you might prefer it a little lower, depending on your symptoms. An appropriately-medicated hypo patient tends to find that the TSH is <1 as that is typical for FT4 and FT3 to be in the upper part of their respective reference ranges when on Levo.

It's plain however, that altho' your FT4 is nicely high in its range, your FT3 is in the lowest quarter of its range. And, tho' I don't know much about it, your conversion ratio is

FT4:FT3 = 20.1 : 3.83 = 5.25 : 1

Seaside Susie comments that good conversion takes place typically when the ratio is 4:1 or less - yours is higher than that. You can read about conversion in the comments of this discussion where diogenes writes, " If in a patient on T4 only you get a ratio greater than 5 then poor conversion is likely": healthunlocked.com/thyroidu...

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Your vitamin D is not only below the range you give but it is in the "deficiency" category of most reference ranges I've seen so you would need to supplement to correct that, following SeasideSusie's suggestions.

Likewise, your ferritin is lower than is optimal for Hashi patients, and, again, SS has suggestions for addressing that and I think she mentions the range that people find optimal.

I'm not familiar with that narrow a B12 reference range - so, all I can comment is that it is within range but in the lower part of it. I'd be making similar comments about the folate :)

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Thank you so so much this is all so helpful. Are you referring to @seasidesusies comments on previous posts or has she posted a list of recommendations? I do want to start supplementing my vitamins.

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Her previous post replies if she doesn't see your posts. :)

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Thank you so much :) il read through a few. I really appreciate your help

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Hello A_lice I'm here now :) I wont mention the antibodies because I know Slowdragon will have covered that.

Optimal nutrient levels are needed for thyroid hormone to work, so you need to improve these first:

B12. 54.1. Pmol/L 25.10-165.00

This is Active B12 which I don't know much about (I'm better with Serum B12) but it is obviously low in range.

Folate. 6.38 ug/l. 2.91-50.0

Folate is too low, it should be at least half way through it's range.

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."

You can check for signs of B12 deficiency here b12deficiency.info/signs-an... and you could ask on the Pernicious anaemia Society for advice about Active B12 healthunlocked.com/pasoc but if it is a case of self supplementing then sublingual methylcobalamin lozenges are what's needed if you wish to self supplement, along with a good quality B Complex (eg Thorne Basic B) to balance all the B vitamins.

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Vit D. 46.6. Nmol/L 50.00-200.00

The recommended level, according to the Vit D Council, is 100-150nmol/L. Your GP wont prescribe anything for your level so it's best to deal with this yourself. My suggestion would be to buy some D3 softgels like these bodykind.com/product/2463-b... and take 5000iu daily for 3 months then retest.

When you've reached the recommended level then you'll need a maintenance dose, you couldl try 5000iu alternate days, you may need less, 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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Ferritin. 36. Ug/L. 13.00-150.00

For thyroid hormone to work (that's our own as well as replacement hormone) ferritin needs to be at least 70, preferably half way through range. You need to improve this but I am loathe to recommend iron tablets as there is much more involved than just ferritin. You could ask your GP to do an iron panel and full blood count to see if there is any form of anaemia.

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...

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Don't start all supplements together. Start with one, give it a week or two and if no reaction then add in the second one, give it another week or two and if no reaction add in the next one, etc. By doing it this way, if you do have any reaction you will know what caused it.

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Once your nutrients are at optimal levels things should improve and thyroid hormone should work better. However your current results are worth trying for an increase in Levo.

TSH. 1.83 mIU/L 0.27-4.20

Free thyroxine 20.1 pmol/L 12.0-22.0

Total thyroxine T4 102.0 nmol/L 59.0-154.0

T3. 3.83 pmol/L 3.10-6.80

Following on from ITYFIALMCTT's comments, you could do with an increase in dose to get the TSH down t 1 or below. See thyroiduk.org.uk/tuk/about_... > Treatment Options:

According to the BMA's booklet, "Understanding Thyroid Disorders", many people do not feel well unless their levels are at the bottom of the TSH range or below and at the top of the FT4 range or a little above.

The booklet is written by Dr Anthony Toft, past president of the British Thyroid Association and leading endocrinologist. It's published by the British Medical Association for patients. Avalable on Amazon and from pharmacies for £4.95 and might be worth buying to highlight the appropriate part and show your doctor.

Also -

Dr Toft states in Pulse Magazine, "The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance.

But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."

You can obtain a copy of the article by emailing louise.roberts@thyroiduk.org print it and highlight question 6 to show your doctor.

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Once your nutrients are at optimal levels and your TSH down to about 1, we can see how your FT3 is and whether you are converting properly. If not then is the time to consider the addition of T3 or maybe even changing to NDT.

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Thank you seasidesusie that's such an informative and helpful reply, I'm going to have to re-read it a few times as there's a lot to take in. I'm so grateful for your help

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I know, I talk too much :D

Take your time, as you say, there's a lot to learn.

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It's so helpful! I'm so relieved to be making progress

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