Help with results : This is my first post but... - Thyroid UK

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Help with results


This is my first post but have received so much information from this site. I was diagnosed with hypothyroid a couple of years ago (although I think I have had it a lot longer than that) and have been taking 75 mg Levothyroxine since then. At the same time I was diagnosed with Hiatus Hernia and Barratts Esophagus which means I also need to take lansoprasol and Ranitidine. I decided to have a private test including the vitamins as I am concerned that I may not be able to absorb enough to keep my levels at optimum. Would someone be kind enough to take a look at my results? which I attach as a photo. Thank you so much.

4 Replies


You are a little undermedicated and need an increase in your 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. See article by Dr Toft, leading endocrinologist and past president of the British Thyroid Association, which says

"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

print it and highlight question 6 to show your doctor in support of your request for an increase in dose.

Once your TSH is down to around 1, then see where your FT4 and FT3 lie. If your FT3 remains low in range compared to your FT4 then you may benefit from the addition of T3. Your conversion doesn't look particularly good at the moment, but you wont know for definite until you have enough Levo to reduce your TSH. Your FT4 will rise and your FT3 should also rise, but it may not rise enough if your conversion is poor.

Your Thyroid Peroxidase antibodies are raised and this confirms autoimmune thyroid disease aka Hashimoto's which is where antibodies attack the thyroid and gradually destroy it. The antibody attacks cause fluctuations in symptoms and test results.

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 need to read, learn, understand and help yourself where Hashi's is concerned.

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:

Hashi's and gut absorption problems tend to go hand in hand and can very often result in low nutrient levels or deficiencies.

Ferritin is actually good, so no problems there.

Vit D is a little low lat 79. The Vit D Council, the Vit D Society and Grassroots Health all recommend a level of 100-150nmol/L. In your position I would be supplementing with D3. As you have Hashi's then an oral spray is best for absorption. BetterYou do a 3000iu spray and you would benefit from taking 6000iu daily for 4 weeks, then reduce to 3000iu daily and retest 3 months after starting.

Once 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

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

Check out the other cofactors too.

BetterYou do a combined D3/K2 spray which you might want to consider.

B12 at 331pmol/L converts to 448pg/ml and an extract from the book, "Could it be B12?" by Sally M. Pacholok states:

"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."

If that was my level I would be wanting to raise it and taking sublingual methylcobalamin lozenges 1000mcg daily will help.

When taking B12 we also need a B Complex to help balance all the B vitamins.

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."

Folate is at the very bottom of the range. Eating leafy greens and other folate rich foods can help, and I would suggest taking a good B Complex containing 400mcg methylfolate (which is needed when taking B12) and that will help raise your folate level. Good brands are Thorne Basic B (one capsule) and Igennus Super B (2 tablets) as they both contain the bioavailable forms of the vitamins.

Thank you SeasideSusie - I will look into vitamin supplements and go through my diet as although I have greatly reduced gluten I am not strict. I have NHS bloods soon and will speak to my GP.


First thing is your high TPO antibodies confirm you have Hashimoto's. Did you know?

So it's likely that your gut issues may actually be gluten intolerance. Going strictly gluten free is definitely worth trying for 3-6 months, if it helps stick on it

Ideally ask GP for coeliac blood test first

Yes you were correct that vitamin levels are low. That may be the PPI or ir may be the Hashimoto's. Either way they need improving

Vitamin D, most Hashimoto's patients find level around 100nmol is likely better

Also read up on magnesium and vitamin K2 Mk7 when supplementing vitamin D

Especially as PPI's low magnesium

B12 and folate are both too low. You will likely benefit from daily good quality vitamin B complex. One with folate in not folic acid

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

PPI's affect B12

Selenium supplements can help improve conversion of FT4 to FT3 as well

Your TSH is a bit high, but FT4 is also quite high. Your conversion is poor.

Your FT3 is very low. Improving vitamins and going strictly gluten free should help improve this, but may not be by enough

Many of us with Hashimoto's still eventually need addition of small dose of T3. But vitamin levels need to optimal first

Only add on supplement at a time, waiting at least 10-14 days to asses changes before adding another. Or when changing to gluten free diet

Once your vitamins are optimal and if gluten free diet helps you may find you can slowly drop ppi and rantitidine

in reply to SlowDragon

Thank you SlowDragon - I didn’t know for certain that I had Hashimotos as the NHS only do the basic tests but from reading the information on this site, I suspected that was what I have. You have given me lots of good advice - Thank you.

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