On 17th April I had numerous blood tests following a visit to the doctors to discuss my extreme tiredness and hair loss. I was subsequently diagnosed with an under active thyroid but I wonder if any one can look at the other test results and suggest some supplements. I've entered my subsequent thyroid test results also.
ng/L is the same as pg/ml and yours is on the low side according to an extract from the book, "Could it be B12?" by Sally M. Pacholok:
"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."
You may wish to supplement to increase this.
Serum folate level 5.2 ug/L [2.0 - 18.7]
Folate should be at least half way through it's range. Eating leafy greens and other folate rich foods can help, but I would suggest you buy a decent B Complex containing 400mcg methylfolate, eg Thorne Basic B or Igennus Super B. This would also help raise your B12 level. Igennus Super B x 2 tablets daily gives more B12 than the Thorne Basic B so that might be your best choice.
Serum ferritin level 36.7 ug/L [20.0 - 130.0]
Ferritin is low, it should be half way through it's range. Your full blood count doesn't suggest iron deficiency anaemia but you could ask your GP to do an iron panel.
Ferritin needs to be 70 for thyroid hormone to work properly and convert T4 to T3 efficiently.
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...
Serum total 25-hydroxy vitamin D level 73 nmol/L
The Vit D Council, the Vit D Society and Grassroots Health all recommend a level of 100-150nmol/L so you might want to supplement to reach that level. I would take 3000-4000iu D3 daily for 3 months then retest. When you've reached the recommended level then you'll need a maintenance dose which may be 2000iu daily, maybe more or less, maybe less in summer than winter, 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 as recommended by the Vit D Council -
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 such as hardening of the arteries, kidney stones, etc.
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. We need Magnesium so that the body utilises D3, it's required to convert Vit D into it's active form. So it's important we ensure we take magnesium when supplementing with D3.
Magnesium 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
ESR checks for inflammation, yours looks good as normally a low result is nothing to worry about.
There doesn't appear to be any problems with your other results, they are all within range and nothing borderline.
**
24th July
Serum free T4 level 16.2 pmol/L [11.0 - 23.0]
Serum TSH level 8.2 mU/L [0.27 - 4.5]
Stay on 50 mcg levothyroxine
Your doctor doesn't understand how to treat hypothyroidism if he has told you to stay on 50mcg Levo.
The aim of a treated hypo patient generally is for TSH to be 1 or below or wherever it needs to be for FT4 and FT3 to be in the upper part of their respective reference ranges when on Levo if that is where you feel well.
NICE Clinical Knowledge Summary of Initiation and Titration of Levo
◦For most people: 50–100 micrograms once daily, preferably taken at least 30 minutes before breakfast, caffeine-containing liquids (such as coffee or tea), or other drugs.
◾This should be adjusted in increments of 25–50 micrograms every 3–4 weeks according to response. The usual maintenance dose is 100–200 micrograms once daily.
◦For people aged over 50 years and people with cardiac disease or severe hypothyroidism: 25 micrograms once daily, adjusted in increments of 25 micrograms every 4 weeks according to response.
•Once a stable thyroid-stimulating hormone (TSH) level is achieved and an adequate dose determined, arrange follow up to check thyroid function tests (TFTs) at 4–6 months and then annually.
Patient experience tells us retesting 6-8 weeks after dose change is best as it takes 6 weeks for the full effects.
From pathology.leedsth.nhs.uk/pa... you will see the recommended levels for Thyroxine Replacement Therapy in Primary Hypothyroidism (scroll down)
0.2 - 2.0 miu/L Sufficient Replacement
> 2.0 miu/L Likely under Replacement
Also Dr Toft, past president of the British Thyroid Association and leading endocrinologist says in his article in Pulse magazine (the magazine for doctors):
"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 Dionne at
tukadmin@thyroiduk.org
print it and highlight question 6 to show your doctor.
So you need an increase in your Levo and you have information to show your GP that he should now be prescribed 75mcg, retest in 6-8 weeks, another increase of 25mcg if necessary, and repeat until your levels are where they need to be for you to feel well.
Your GP should be following NHS guidelines and increase Levothyroxine dose by 25mcg steps retesting 6-8 weeks after each dose increase
See GP and ask for 25mcg dose increase asap and blood test form for 6-8 weeks time
This should repeat until TSH is around one and FT4 towards top of range and FT3 at least half way in range
NHS guidelines saying standard starter dose is 50mcg and that dose should be increased slowly. Eventually most patients need somewhere between 100mcg and 200mcg
Your high TPO antibodies confirm the cause of hypothyroidism is due to autoimmune thyroid disease, also called 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
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)
Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies
Thank you both so much for your replies. So much appreciated and apologies for taking so long to thank you!
I have started taking Igennus super b complex twice a day and am also taking desiccated liver capsules.
I had another blood test last week on Thursday and my results are below. (I did not stop taking my supplements beforehand, although I didn't take my levothyroxine on the morning of the blood test).
Serum free T4 level 15.9 pmol/L [11 - 23]
Serum TSH level 6.5 miu/L [0.27 - 4.5]
My doctor hasn't called to advise me of these results yet but I've logged on to my online records and can see them. Above the results it says "results satisfactory" remain on 50mcg.
However, I feel terrible, I'm pretty sure I need a dose increase, my severe constipation has returned and I'm feeling exhausted again. I could really cry! I was so hoping for an increase as the last few weeks have really been getting me down.
So the doctors receptionist called last night to tell me my results are now normal and I’m to remain on 50mcg. I’m shocked, those results aren’t normal...my TSH is no where near in range.
If you have been sceptical of some of the stories here about mishandling of hypothyroidism, I am sure you aren't now!
Totally agree. Those results are not satisfactory, they are not "normal". You should have your dose incremented followed by a further test about six weeks later.
You will, I'm afraid, have to put forward your view that they are not acceptable and request an increase.
Just called the doctor and spoke to the receptionist. I queried why my results were showing as satisfactory when they're outside the range, she replied that they're only just outside the range and that's why they've said for me to continue on 50mcg levo.
I replied and said I think they're quite far out of range and either way I feel like I need a dose increase. She then asked me why I felt that way...?!
I told her I'm feeling dreadful, my tiredness and constipation has returned. Apparently she's going to send a message to the nurse who analyses the results and get back to me this afternoon.
I know they're busy, but she couldn't get me off of the phone quick enough. Really didn't seem interested at all. So tempted to increase my dose myself!
I think she has no clue as I've just been called back and given the following info:
* Stay on 50mcg as my levels are "fine".
* Next blood test in 3 months
* Biotin would make my results look worse than they are so maybe they're actually much better.
I replied that my levels are most certainly not fine, 3 months to wait for a possible dose increase is far too long and the biotin would make my results look better than they are not worse which is why some people taking high doses of biotin are mis-diagnosed with Graves disease. To which she replied, "we're going backwards and forwards", I suggest you book an appointment with a dr!
NHS guidelines saying standard starter dose is 50mcgs and that most patients eventually need somewhere between 100mcg and 200mcg Levothyroxine. Increased in 25mcg steps until TSH is around one and FT4 towards top of range and FT3 at least half way in range
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