Log in
Thyroid UK
91,982 members106,233 posts

Hypo after RAI - Some advice regarding blood test results appreciated

Hi - hoping for a steer in the right direction if possible. I was diagnosed with hyperthyroidism in 2007, RAI in 2010 and hypothyroid ever since. Never any confirmation of Graves disease but I'm presuming that was the cause. Been on 100mcg since I went underactive. Feeling awful recently - very fatigued, sore back and tailbone etc so looking some advice interpreting latest blood results which were as follows (Medichecks). I'm seeing my GP in two weeks so would like to have some info before I go. If anyone can help it would be so much appreciated. Thanks.

TSH 1.29 (0.27-4.20)

Free thyroxine 15.9 (12.00-22.00)

Total thyroxine (T4) 91.4 (59.00-154.00)

Free T3 4.22 (3.1-6.8)

Thyroglobulin antibody 201 (0-115)

Thyroid peroxidase antibodies 43.6 (0-34)

Active B12 165 (25.1-165)

Folate (Serum) 6.73 (2.91-50)

25 OH Vitamin D 48.1 (50-200)

CRP high sensitivity 0.2 (0-5)

Ferritin 12.9 (13-150)

Now taking 25ug D3 daily though unsure if this is enough.

Obviously a problem with antibodies and ferritin which I will need to address with my GP

So sorry for the long post and thanks in advance for any advice

9 Replies

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, lowest FT4 and most consistent results

Was this how test was done?

Your FT4 is low, also FT3.

This suggests you dose increase, perhaps ask GP for 25mcg increase

TSH is a bit high, though GP unlikely to think so

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 articles from Thyroid UK email dionne.fulcher@thyroidUK.org. print it and highlight question 6 to show your doctor.

Ferritin and Vitamin D are too low obviously

Folate might benefit from taking good vitamin B complex

See this reply from SeasideSusie to similar levels


Consider trying strictly gluten free diet because of raised antibodies

1 like

Hi - thanks for the reply and some really useful info! Took the test not that early in the morning but had fasted and no levothyroxine in 24 hours.

I will certainly get in touch with Thyroid UK and ask them to email me the article - will be helpful when I see my GP. And will definitely investigate Gluten Free diet - even if Christmas is on the way!! Thanks Slowdragon!


Other things to avoid

Flouride toothpaste, easy to change to flouride free

Check your water supply does not have flouride added (most don't)

Avoid all soya including soya lecithin if possible. (There is chocolate without soya lecithin )


Cheers Slowdragon. Chocolate is very important! 😊


Thanks - I know, I'm only now realising that so much of this is directly affected by diet and what I eat can impair the absorption of nutrients I'm already deficient in! It's a complete minefield. Thanks for the book suggestion, will certainly look that out and will have a nosey at the paleomum autoimme paleo protocol.

So much to take in but all the suggestions are great - thanks for taking the time to reply!



B12 doesn't look low to me. It's not the serum test, it's the Active B12 test and is at the top of the range

Active B12 165 (25.1-165)



Some information about Hashi's, most doctors dismiss antibodies as being of no importance and know little or nothing about Hashi's and how it affects the patient, test results and symptoms.

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...






Vit D 48.1 (50-200)

The Vit D Council recommends a level of 100-150nmol/L. I'd suggest taking about 5000iu D3 daily for 3 months then retesting.

As you have Hashi's, an oral spray is better absorbed than softgels or tablets. BetterYou do a 3000iu dose, it would be a good idea to double dose and take 6000iu for the 3 months and retest. When you've reached the recommended level 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 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.

BetterYou do a combined D3/K2-MK7 so that would be one less supplement to take if you chose that rather than separate D3 and K2-MK7.


Ferritin 12.9 (13-150)

Your GP should do a full blood count and iron panel to see if there is any iron deficiency anaemia.

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 an iron supplement and as your level is so low you should ask for an iron infusion which will raise your level within 24-48 hours, tablets will take many months.

If you are given iron tablets, then take each one 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...


Iodine apparently is not a good idea when you have Hashi's, apparently it can trigger antibody attacks. No link, just what I've read here.


Thanks so much for all this info.

Not sure how much of a difference it makes but this all started with an overactive thyroid which I 'presume' was Graves and not Hashis. However as far as I've been able to gather today Graves responds really well to a strict gluten free diet too.

Will print out and have a really good look at it all when I get the chance to properly digest it all later. Looks like I have some big changes to make. Thanks!!


Yes I am not sure it is Hashimoto's, as you can have high TPO and high TG due to Graves. The only one that is unique is TSI - you only get that with Graves

But either way, Graves or Hashi, very many find gluten free diet helps enormously

The Thyroid Pharmacist website and her video series the Thyroid Secret (on YouTube) is mainly Hashimoto's, but some reference to Graves

Amy Myers had Graves, she runs good website and also recommends gluten free

Gluten links








Yes, I've read that iodine should only be taken under the supervision of a qualified practioner. Needs a lot of research.


You may also like...