Latest blood results

[Rainbow47]

I’ve just got my latest test results from medichecks and am off to see my GP tomorrow. I’m in the throes of educating him. He did a rotation when at Med school with Dr Toft which is helping! I want to get my facts straight before I go

and any comments on the results, which are a definite improvement for me, would be much appreciated. My antibodies are starting to go down too, which is very exciting.

I’ve been going along the adrenal road for the past two years and am finally beginning to feel better, and planning to go back on NDT when all my results are satisfactory. I still have some way to go though and I would like confirmation that my Folate, Vit D and Ferritin all need to be in the top quarter of the range. T4 and T3 are looking a little low too, but TSH is below range.

I don’t want to give my GP false information so any obs would be much appreciated

[SeasideSusie Remembering]

Rainbow47

I would like confirmation that my Folate, Vit D and Ferritin all need to be in the top quarter of the range.

That's not quite correct.

Vit D comes in categories as you can see - Deficient, Insufficient, etc. The "normal" range is 50-200 but the recommended level, according to the Vit D Council, the Vit D Society and Grassroots Health is 100-150nmol/L. So with your level of 65.1 you are looking to increase and need to supplement and when your level is within the range recommended (100-150nmol/L) you would need to find your maintenance dose to keep it there.

Ferritin is recommended to be half way through it's range.

Folate is recommended to be at least half way through it's range.

SerumB12 (and you have Active B12 there so your result is different) according to an extract from the book, "Could it be B12?" by Sally M. Pacholok, should be along these lines:

"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."

The "top quarter of range" applies to where FT4 and FT3 should be, along with a TSH of 1 or below, if that is where you feel well, and when taking Levo only.

Dr Toft's article in Pulse magazine states

"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)."

And that applies only when taking Levo, as taking NDT tends to lower TSH and FT4 and FT3 should be where you need it to feel well, which for most people would be in the upper part of the range but it is, of course, individual.

Dr Toft has published a new article recently "A counterblast to guidelines" where he states that some people need the addition of T3 to Levo.

rcpe.ac.uk/sites/default/fi...

[Rainbow47]

Thanks SeasideSusie - there’s a lot to take in and I am aware of what you are saying, and I’ve seen Dr Toft’s articles - in fact have already passed them on to my GP. I don’t want to get it wrong when I see the GP as he’s starting to realise that all is not well in the thyroid world and will hopefully appreciate what I have to say.