Baileysmurph You have another doctor who seems to think that just because your TSH is in range then everything is fine; however, in range doesn't mean that it's the best place for you. Your TSH has been rising and FT4 lowering and that means that your thyroid is struggling and becoming worse.
March 2017 TSH 2.75 (0.4-5.0) FT4 16 (9-25) - FT4 is 43% through range
Sept 2017 TSH 3.54 (0.4-5.0) FT4 14.9 (9-25) - FT4 is 38% through range
and your BH results
TSH 1.97 (0.27-4.2) mIU/L FT4 15.8 (12-22) pmol/L - FT4 is 36% through range
I was surprised that the TSH result was lower than previously. Maybe this is because the GP ones were done at 8.30am.
That's exactly right. Check the first graph in this post and you will see how much higher TSH is at 9am than at 11am. healthunlocked.com/thyroidu...
Vitamin B12 383 (197-771) pg/ml
Folate not available - sample haemolysed
Do you have any signs of B12 deficiency b12deficiency.info/signs-an... If so then please post on the Pernicious Anaemia Society forum for further advice. If not then you could self supplement.
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."
I keep my level at around 1000. Sublingual methylcobalamin lozenges are what's needed if you wish to self supplement, along with a good quality B Complex to balance all the B vitamins. I would suggest you start with sublingual methylcobalamin 5000mcg and when the bottle is finished change to 1000mcg as a maintenance dose, along with Thorne Basic B as a B Complex.
25 OH Vitamin D 50 (50-200) nmol/L
The Vit D Council recommends a level of 100-150nmol/L. I would suggest you supplement with 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 you will 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 helps D3 to work and 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.
Ferritin 63 (13-150) ug/L
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're not really low enough to need an iron supplement so I would 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...
Also, selenium is a good supplement as it aids conversion of T4 to T3 so you could take 200mcg selenium l-selenomethionine daily if you wish.