Thyroid UK

Blood Test Results

I've been taking 125mcg of Levothyroxine, but I'm still feeling unwell. Suffering from all the usual symptoms and still gaining weight. I also have Hashimoto, although it hasn't been explained to me what this actually is !

My latest blood results are as follows and I have a doctors appointment in the morning to discuss them. Any advice in advance would be greatly appreciated.

Serum B12 251ng/l (187.00 - 883.00ng/l)

Serum Folate 4.5ug/l (3.00 - 20.00ug/l)

Serum Ferritin 44ng/ml (6.00 - 204.00ng/ml)

Free T3 3.7 pmol/l (2.90 - 6.10pmol/l)

Free T4 11.5pmol/l (9.00 - 19.00pmol/l)

TSH 1.3miu/l (0.35 - 5.00miu/l)

Total 25hydroxyvitamin D 64nmol/l (75.00 - 200.00nmol/l)

Liver function test

protein 71g/l (60.00 - 80.00g/l)

Albumin 37g/l (35.00 - 50.00g/l)

Globulin 34g/l (25.00 - 35.00g/l)

Bilirubin 6umol/l (2.00 - 21.00umol/l)

Alkaline Phosphatatase 80iu/l (30.00 - 130.00iu/l)

AST serum 16iu/l (5.00 - 40.00iu/l)

Sodium 140nmol/l (133.00 - 146.00nmol/l)

Potassium 4.3 nmol/l (3.50 - 5.30nmol/l)

Creatinine 67umol/l (50.00 - 98.00umol/l)

Urea 5.4mmol/l (2.50 - 7.80mmol/l)

GFR abbreviated MDRD 81ml/min/1.73m2 (>90.00ml/min/1.73m2)

Chloride 104nmol/l (95.00 - 108.00mmol/l)

Thanking you in advance

4 Replies

Your results show you probably need a dose increase

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

(Patient to patient tip)

Is this how you did the test?

Your FT4 is too low - should be higher - 15-17 minimum

FT3 too low - should be above 5

Ask GP for 25mcg dose increase

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 print it and highlight question 6 to show your doctor

please email Dionne:

Your antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).

About 90% of all hypothyroidism in Uk is due to Hashimoto's

Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels

Low vitamin levels affect Thyroid hormone working

Your vitamins are too low and need supplementing

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

But don't be surprised that GP or endo never mention gut, gluten or low vitamins. Hashimoto's is very poorly understood

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

Ask GP for coeliac blood test first


Ferritin - needs to be at least 70

Ask GP for full iron panel to check for Anaemia

Vitamin D at 64 GP can only prescribe 800iu. Self supplement is probably necessary-.Better You vitamin D mouth spray is good as avoids poor gut function

Aim to increase to around 100nmol. Try 2000iu daily and retest in 2-3.months via £28. Likely to need ongoing maintenance dose - test twice yearly

B12 and folate both on low side. They might/should improve with increased dose of Levo

But you may need to consider supplementing with a good vitamin B complex that has folate in and possibly also a sublingual B12 daily

Oral B12 is apparently as good as injections

B12 generally with thyroid issues

If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 3-5 days before any blood tests, as biotin can falsely affect test results

Always take Levo on empty stomach and then nothing apart from water for at least an hour after. Many take on waking, but it may be more convenient and possibly more effective taken at bedtime

Many people find Levothyroxine brands are not interchangeable. Once you find a brand that suits you, best to make sure to only get that one at each prescription. Watch out for brand change when dose is increased



Thank you for your comprehensive reply.

I do have my tests early in the morning, with fasting and no Levo for 2 days.

I don't take any other supplements, so that isn't affecting any results.

I wonder if you could help me with just a couple of other questions, to help me fully understand the whole picture?

What actually is Serum TSH?

Is Levothyroxine T4 only?

What is the test that shows Hashimotos results?

Should I be taking additional meds for Hashimotos or is this all within the Levo?

If my T3 is too low, is this because I'm not converting from T4 or do I just need more T4 to convert to T3?

Sorry for the bombardment of questions, but I want to be prepared for my appointment in the morning.

Many Thanks


I do have my tests early in the morning, with fasting and no Levo for 2 days.

Just delay the dose directly before test. If you take at bedtime night before, or in morning of test, delay until immediately after blood test

You don't need to stop for two days

I don't take any other supplements, so that isn't affecting any results.

Yes, can see that. Vitamin D, folate, ferritin and B12 are all on low side. You may need to supplement. Vitamin D and ferritin especially

What actually is Serum TSH?

This is the Thyroid Stimulating Hormone. Sent by pituitary to tell Thyroid to work.

Link about thyroid blood tests

Is Levothyroxine T4 only?


What is the test that shows Hashimotos results?

High TPO antibodies and confirm its autoimmune thyroid disease (rest of world calls it Hashimoto's)

Not on this test. NHS rarely repeat antibodies tests. If it's high once it confirms its autoimmune.

Should I be taking additional meds for Hashimotos or is this all within the Levo?

Conventional medicine at the moment doesn't have any official way of treating the autoimmune aspect. Levothyroxine replaces the missing thyroid hormones caused by the thyroid being attacked and destroyed

But vast numbers find that strictly gluten free diet helps. Can lower TPO antibodies. Which is why patients often test these privately along with FT3.

As there's no definitive test for gluten intolerance, only tests for coeliac NHS don't currently mention gluten intolerance as possible importance.

Very unlikely your GP will have heard of gluten connection or approve. Unless they take particular interest in leaky gut issues

Masses of info all over the Internet on gluten, leaky gut and Hashimoto's

If T3 is too low, is this because I'm not converting from T4 or do I just need more T4 to convert to T3?

increasing you dose, should improve FT3. As will improving vitamins

strictly gluten free diet can help gut heal and then vitamin levels improve too.

Only add one supplement or make one change at a time

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That is a great help. Thank you. I now feel prepared for a discussion with my doctor tomorrow ;-)


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