My son has Hashimotos for which he is taking 100 Levothyroxine - had recent dose increase, next bloods due in a couple of weeks.
As he's still feeling exhausted a lot of the time he's compared his vitamin results from Medichecks and can see that his folate has remained the same over the last 6 months 20 (3-50) and his ferritin has dropped from 140 (30-400) in May to 96 (30-400) in September.
In September he started taking 5 (not sure of measurement) folic acid but didn't address the ferritin. Is anyone able to give us some guidance as to what he could take to increase his ferritin levels and should he be taking more folic acid?
On another note his Endo has referred him for a short synacthen test which he has on 15th December. I've googled this and can see its to do with cortisol levels and wondered if they might be testing him for Addisons??
Many thanks for your help
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Rhinogirl1959
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If he wants supplements then he should talk to his GP, there's more to iron results than just ferritin. He could do an iron status test with Medichecks to get the other iron results for a full picture, which might be best before discussing it with his GP.
What about his B12 and Vit D, presumably they were part of the test?
As for the Hashi's, is he strictly gluten free and supplementing with selenium L-selenomethionine 200mcg daily to help reduce the antibodies?
Many thanks for your reply Seaside Susie. He's supplementing D which we can see is getting better.
Not sure if he did the right thing with B12 as it was originally half way through the range so he started supplementing in May, in September he was well over range so stopped and just started taking a B complex.
Will ask GP to re-test vitamins and full iron at his next bloods at beginning of December, if won't he'll do Medichecks again. He's never had full iron before so that's a good idea.
He's not strictly gluten free (trying but doesn't find it easy) he is taking Selenium and Zinc.
His Levo was increased in October from 75 to 100 as his TSH was somewhere around 3, he was hoping to feel better by now but isn't. He's finding it a long road to getting all his levels sorted out.
TSH of 3 is too high. Should be around one and FT4 towards top of range
So he will need bloods rechecked in 6-8 weeks
All thyroid tests should be done as early as possible in morning and fasting and don't take Levo in the 24 hours prior to test, delay and take straight after. This gives highest TSH and most consistent results
Dr Toft, past president of the British Thyroid Association and leading endocrinologist, 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.
Does he take Vit D's important cofactors vitamindcouncil.org/about-v... in particular magnesium which helps D3 to work and K2-MK7 which directs the increased uptake of calcium to bones and teeth where it's needed and away from arteries and soft tissues where it can cause calcification.
The recommended level, according to the Vit D Council, is 100-150nmol/L.
Keeping B12 at around 900-1000 is a good idea, so if the amount in his B Complex doesn't do that then adding a sublingual methylcobalamin 1000mcg lozenge a couple of times a week or so might.
I'm not Hashi's and not gluten free, but I can only repeat what Hashi's members have said and that is 100% gluten free has helped many where reducing antibodies is concerned.
Yes, he's taking both Magnesium and K2-MK7. Got his D up to 135 so he's taking a maintenance dose now. Just get confused with Iron and the B vitamins, especially with B12 being skewed when supplementing with it.
Will post his new results when we get them and take it from there.
Thanks everyone, hoping TSH will be somewhere around 1 or lower when he's retested in early December and that he starts to feel better soon. His last test was done around 8am before levo, breakfast etc so will be aiming to do the same again.
Will get T4 and T3 done by medichecks at same time as GP won't do those.
On another note his Endo has referred him for a short synacthen test which he has on 15th December. I've googled this and can see its to do with cortisol levels and wondered if they might be testing him for Addisons??
For info on how to prepare, timing, how the test is performed, and how to interpret the results see page 68 - 70 in this document :
It would be worth printing out just those pages to take to the hospital. It would also be a good idea to print out the title page of the document too, so your son can show where the pages came from, if he decides to show the pages to anyone.
A lot of hospitals don't automatically do the ACTH test which is required to get full info from the SST test, or they have to be prompted to do it. Many of them just test cortisol, which doesn't tell you a huge amount by itself. Tell your son to ask about including the ACTH test as soon as the opportunity arises. Samples for ACTH testing have to be put on ice and sent to the lab immediately. It might even be best to phone up the department the day before and ask for the ACTH test to be included and then mention it again to a nurse when he arrives. I'm not sure how they will react though!
If your son requires any other testing done by an endocrinology department in the future the document I linked should include the details and explain how it is done.
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Endo Prescription - advice please
