Both times blood test done around 9 am on fasting and levo taken only after blood test that day.
Above are the results taken while on 50 mcg & after Levo dose increased from 50mcg to 100mcg. I'm also on ferrous fumarate 210mg, one twice a day started on end of May 2018 as my ferritin was 4.9 (13-150).
I'm due to see GP next week to discuss about the results. My b12, folate, vit d are in normal range. I still experience tiredness, hair thining and sometimes lightheaded. After dose increment I've also joint pain sometimes (in knees & elbows). Are my symptoms low ferritin & suppressed tsh related?
Will I benefit from the levo dose decrease? To 75mcg or 88mcg? Pls suggest🙏🏼
Thanks
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Ujna
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It's advisable to adjust levo dose by 25 mcg increments so the 50mcg increase was a bit of a leap and an adjustment for your body. Now you're on that dose, your FT3 is in range so perhaps retest in 6 week's to make sure it's not still rising and adjust according to results if needed. Joint pain may be due to the adjustment or other factors like low ferritin.
A suppressed TSH is not a problem for your health. It doesn't make you feel anything, and it has been proved that it does not affect hearts or bones. The only thing is that conversion can drop when TSH is very low, but your conversion looks just fine. My TSH has been zero for a long, long time.
Yes, a high FT4 will convert to more rT3 than T3, and your rT3 will be high. But nobody really knows what that means. What rT3 does, nobody really knows.
So, seems to me that Nanaedake has given very good advice. Leave it for another six weeks and retest to see how things progress - if at all. And also see how you feel - which is far more important than blood test results.
I would switch to 75 mcg if you still feel OK on it as the highish fT4 can lead to reverse T3 which is counterproductive. It's better not to have a very low TSH if you can although some patients have no choice. There is no need to fast before a thyroid blood test it makes absolutely no difference.
Can I just point out that jimh111's comment about fasting is one that many people would disagree with, including diogenes who is one of Thyroid UK's scientific advisors.
See the link I give below and search for thequestion I asked diogenes :
I will contact diogenes via a pm about this. I suspect he based his comments on a hopeless Indian study that appeared to show TSH fell after breakfast. They measured TSH early morning and later in the day, they assumed the fall in TSH was due to breakfast!!! (TSH falls during the day). They did a follow-up study which showed no effect from eating.
If you look at Fig 1 in this study academic.oup.com/jcem/artic... you can see there is no change in TSH at meal times. 'Three standard hospital meals were provided at 0830, 1230, and 1800 h'. Perhaps allow 30 minutes for delivery and eating and you can see that in particular at 1300 and 1830 the TSH graph is flat as a pancake (no pun intended). Fasting makes no difference.
(By fasting I mean skipping a meal such as breakfast until after the blood draw. Long fasting of more than 24 hours, or low calorie diets do affect TSH, they produce a lower TSH).
Fasting absolutely does make a difference. Withhold meds for 24 hours and levels will be different than if meds are taken the morning of testing. I've had my bloods tested both ways. There is a difference.
your results look pretty much what people are aiming for when taking t4 🙂 I would dose according to how u feel though x
Your ferritin was extremely low. This will be not be helping your use of thyroid hormones. Just read you had iron infusion- good
I would insist that ferritin and full iron panel is done to recheck levels before considering changing dose of Levo
Ferritin needs to be above 70 for good thyroid function
What are the actual results and ranges for vitamin D, folate and B12
Just because they are within range does not mean they are optimal.
Vitamin D needs to be at least above 80nmol, around 100nmol likely better
B12 at least above 500 and near top of range is likely better. Folate near top of range too
Essential to test both TPO and TG thyroid antibodies. If you don't want to ask GP, or GP unhelpful then test privately
For full Thyroid evaluation you need TSH, FT4, TT4, FT3 plus TPO and TG thyroid antibodies, important to also test vitamin D, folate, ferritin and B12. You always need actual results and ranges
Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies
Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have money off offers.
All thyroid tests should ideally be done as early as possible in morning and fasting. When on Levothyroxine, don't take 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, GP will be unaware)
Is this how you did the test above?
If 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. Low vitamins are especially common with Hashimoto's. Food intolerances are very common too, especially gluten. So it's important to get TPO and TG thyroid antibodies tested at least once .
GP receptionist only printed the thyroid funtion test results as she said it only needs action and rest are normal (including ferritin, folate, b12, vit d, iron saturation, bone profile, crp, fbc, esr, kidney, liver etc) and said to come back next week to collect the rest.
Blood test results, on end of May 2018
ferritin 4.9 (13-150)
Hemoglobin 95 (120-150)
folate 5.8 (3.9-26.8)
b12 427 (197-771)
Vit d 88.8
Prescribed only iron tablets after this results on May.
GP will think B12 and folate are fine, but on Levothyroxine we need very god levels of both
Many people on here find it beneficial to supplement a good quality vitamin B complex daily. One with folate in, not folic acid. Eg Igennus Super B complex or Jarrow B-right .
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
Are you supplementing vitamin D still? It's likely you will need ongoing maintenance dose. Aiming to keep level up around 100nmol. Vitamin D mouth spray by Better You is good as avoids poor gut function. It's trial and error what dose each person needs. Once you Improve level, very likely you will need on going maintenance dose to keep it there. Retesting twice yearly via vitamindtest.org.uk
Also read up on importance of magnesium and vitamin K2 Mk7 supplements when taking vitamin D
I started taking multivitamins (containing vit d 400 units, B vitamins and many other vitamins) in June but it made my knee pain more worse so I stopped taking it. Now that the days are sunny here in London, I stay in the sun for a while everyday. Just curious, is there any risk of overdosing in B complex vitamins as the Igennus super B complex has very high dose of B vitamins like 2 tablets has b12 36000% of Reference intake.
About thyroid antibodies, TPO was tested last year which came back negative.
It's not that uncommon for improving vitamin D when supplementing to cause temporary pain as bones remineralise if you have been vitamin D deficient some time
It can be excruciating. I found it lasts about 4-6 months, then slowly fades
Hi Ujna. There are two thyroid antibodies, not just TPO/ab. The other is called TG/ab. Both need to be tested to rule out Hashimoto's as the cause to your hypothyroidism. With your symptoms, was suspicious of Hashimoto's. Knowing only one antibody was tested makes me think Hashimoto's even more.
Your symptoms might also be caused by your too high FT3 and FT4. Your FT3 is well over 3/4 range, which is too high for many people because it causes symptomos. FT4 at the very top number of range is much too high and causes symptoms.
Do you have a goiter, swelling in your neck or any strange sensations around your thyroid? If you do, this must always receive an ultrasound to make sure you do not have thyroid cancer. It is not common and has a high curability rate. Most goiters are caused by benign nodules and an inflamed thyroid.
Thanks shootingStars...do I need a dose decrease..what you think? It's nearly 1 year on levo, still unwell. I neither have swelling nor pain in my neck. My doctors never ever examined or touched my neck area. Does thyroid cancer get detected in Full blood count (white blood cell)..any idea..my wbc is normal.
Hi Ujna. Both of your levels are very high. When they are that high, most people have symptoms. I would feel completely horrible if my levels were that high or anywhere near that level. I'd probably feel like I was dying, but that's just me. The highest part of the range (over 3/4) and the lower part of the range (under 1/2) is where most people tend to have the most symptoms. Each extreme of the range comes with it's own problems.
Thyroid examination and palpation should be done on every patient 1-2 times per year as a routine preventative with a general doctor or nurse. Palpation is a standard part of examining a thyroid disease patient. If your doctors have never even touched your neck, they should be very ashamed! Pain is not a common sign of a goiter, but some people have strange sensations in their neck, in their throat, or their breathing feels restricted, but not all do. I did not know that I had swelling until an acupuncturist felt my thyroid and commented that it was enlarged. From the outside this was not obvious. Then I told a doctor that I wanted to get an ultrasound. He palpated my thyroid and he agreed. It was that ultrasound combined with my positive thyroid antibodies that lead to Hashimoto's diagnosis.
Blood tests cannot detect thyroid cancer or cancerous thyroid nodules. It is common for someone with thyroid disease to have an enlarged thyroid, thyroid nodules, or both. Any of these types of thyroid enlargements are called goiter. There are many types of nodules, as well as cysts. The only way to determine if you have a goiter, a specific type of nodule, cysts or thyroid cancer is to first start with a thyroid exam. If your thyroid feels abnormal in size or shape, then a thyroid ultrasound will be ordered to determine the cause of the abnormality. I have small nodules in my thyroid, so I received an ultrasound. The ultrasound showed suspicious nodules which had to be biopsied to rule out cancer. They are benign. The nodules and the size of my thyroid reduced in size once my thyroid hormones were in the right part of the range. However, when I've had increased autoimmune reactions and my antibodies have increased, my nodules also increase in size. Antibodies go down and nodule size also decreases.
I missed the low ferritin '4.9 (13-150)'. This should be treated.
Note that it is a myth that ferritin needs to be above 70 for good thyroid function, some quack published vague references to this some time ago and this has been passed on as fact. Most women in the UK have a ferritin below 70, their average level is in the low 40s. There is no indication that these women have any thyroid problem. Men have a higher average ferritin level. Low ferritin should be addressed to avoid consequences of anaemia. Hypothyroidism does lead to low ferritin levels.
This is a good example of the sort of exploitative articles I had in mind. It is intentionally misleading, designed to sell products directly restartmed.com/shop/ or via Amazon commission links. Particularly obnoxious is the marketing of ‘T3 Conversion Booster’ restartmed.com/product/t3-c... which is simply a supplement. The ’10 unique … ingredients’ are nothing more than a few common vitamins, minerals and herbs for $43.49. It claims to ‘help naturally increase T4 to T3 conversion while naturally decreasing T4 to Reverse T3 conversion’. The three deiodinases are very similar selenoproteins, they have the same nutritional requirements. D1 and D2 convert T4 to T3, D1 and D3 convert T4 to rT3. If a nutritional deficiency prevents T4 to T3 conversion it will prevent T4 to rT3 conversion also. (Selenium deficiency can lead to impaired T4 to T3 conversion it is very rare and presents with a very high TSH.)
It’s important to treat anaemia and Ujna’s ferritin level of 4.9 is too low. Anaemia can impair thyroid hormone secretion (just a little) as well as impair thyroid response to cold exposure. However, a little levothyroxine would compensate for this tiny reduction in hormone levels, and of course most of us do not get better with a little levothyroxine.
It correctly states, ‘low iron levels are also associated with low levels of free T3’ followed by the dishonest claim ‘This means that in hypothyroid patients low iron levels = low T3 = tissue level hypothyroidism.’ Whilst mathematically correct this is blatantly misleading. It suggests low iron causes low T3, the truth is low T3 (hypothyroidism) tends to lead to low iron levels. The Iranian study Childs referenced (and another study by the same team) reveals a CORRELATION between iron deficiency and thyroid hormone levels. The second Iranian study found that iron supplementation had no effect on TSH, fT3 and fT4 – it did find lower rT3 levels (I believe other studies found no effect on rT3 but I need to check).
Childs also claims that ‘One of the big reasons that Iron deficiency causes worsening hypothyroid symptoms is because it leads to decreased T4 to T3 conversion.’ A study in rats found reduced deiodinase but it’s difficult to compare severe iron deficiency in rodents with typical iron levels found in humans. As I noted earlier when the Iranian girls were given iron supplements that normalised their ferritin levels but TSH, fT3, fT4 remained unchanged. When deiodinase is affected by deficiencies TSH shoots up since the pituitary is reliant on deiodinase.
Ujna, sorry for drifting away from your post but it is so important that we stick to accredited articles or original research. There are so many quacks on the internet, saying things we like to hear to make money or achieve fame. Most are simply a bit dim and lazy, quoting research that they haven’t bothered to study or don’t understand. We get enough problems from endocrinologists without this gang adding to our burden. When confronted with ‘advice’ from internet ‘experts’ it’s a good idea to ask common sense questions such as ‘if most of the UK female population have a ferritin below 70 why aren’t they hypothyroid?’ or ‘if low iron stops T4 to T3 conversion then how does the pituitary convert T4 to T3 so that it can stop TSH going over 200?’.
I'd say looking at and talking to females in the supermarket that a very high proportion probably are at least borderline hypo (fat, constipated, puffy, missing eyebrows, forgetful etc). And who's to say the everyone has a "correctly" functioning pituitary and hypothalamus - my TSH never went above 0.7 even with under range free t4 and free t3. And most women probably don't get TSH tested so it could be way over range - they just get told to eat less, exercise more and get more sleep. So we don't know what low iron is doing.
I see lots of difficult to treat cases on these forums with low normal fT3, fT4 and a non-elevated TSH. I'm sure this abnormally low TSH causes impaired D2 (T4 to T3 conversion) leading to a difficult to treat hypothyrodism which needs T3 treatment. Unfortunately the research hasn't been done to prove this. I think many of the cases you mention fall into this category. Also, I'm sure a significant number of hypothyroid cases are due to endocrine disruption by endocrine disrupting chemicals (EDCs). We know this is so from epidemiological studies, the difficult bit is identifying which patients suffer from this form of hypothyroidism. This form of hypothyroidism can present with perfectly normal TSH, fT3 and fT4.
We do know what low iron is doing, to some extent. Hyppothyroid patients with low iron are given iron and compared to similar controls. Very low iron can reduce T4 production by a small amount.
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