After reading lots of advice on here I asked my GP for extra blood tests which came back ‘within range’.
My symptoms are: feeling freezing, lack of concentration, fuzzy head, terrible memory, dry itchy skin, brittle nails, constipation, cramps & tingling in feet, an occasional numb left hand & weight issues. My eyesight has changed lately too but I don’t know if this is just the normal aging process (I’m 46). I also have palpitations & ectopic heartbeats, 2 ECG’s have come back normal am now waiting for a 48 hour monitor.
Do you think supplements will help? & if so what exactly should I be taking?
The only thing I currently take is 75mcg Levothyroxine (since March 2018)
July 2017 – original diagnosis (started on 25mcg Levo)
Welcome to the forum, sorry it's taken so long for a reply
As you can see this is an extremely busy forum with 50-100 posts a day. It's easy for some to get missed
Your results suggest you are under medicated
The aim of Levothyroxine is to increase dose in 25mcg steps until TSH is around one and FT4 towards top of range and FT3 at least half way in range
Your TPO antibodies are extremely high, this confirms cause as autoimmune thyroid disease also called Hashimoto's
Hashimoto's very often 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
Vitamin D is too low, but not low enough for GP to prescribe. Aiming to improve to around 100nmol. Vitamin D mouth spray by Better You is good as avoids poor gut function. Suggest you supplement at 2000-3000iu daily for 2-3 months and retest. 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. Very important to retest twice yearly when supplementing. NHS test via vitamindtest.org.uk
Also read up on importance of magnesium and vitamin K2 Mk7 supplements when taking vitamin D
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
Ferritin is too low. Has GP done full iron panel to test for Anaemia?
Eating liver or liver pate once a week should help improve levels
Low vitamins are direct result of being under medicated and having Hashimoto's
Only start one supplement at a time or make one change at a time or you can not assess what is helpful
So see GP and ask for dose increase in Levothyroxine. Ask for full iron panel testing and coeliac blood test too
Blood should be retested 6-8 weeks after each dose increase in Levothyroxine
All thyroid tests should ideally be done as early as possible in morning and fasting. When on Levothyroxine, take last dose 24 hours prior to test, and take next dose straight after test. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, GP will be unaware)
Most patients eventually need somewhere between 100mcg and 200mcg Levothyroxine As stated in these NHS guidelines
Always take Levo on empty stomach and then nothing apart from water for at least an hour after. Many take Levothyroxine early morning, on waking, but it may be more convenient and possibly more effective taken at bedtime.
Other medication at least 2 hours away, some like HRT, iron, calcium, vitamin D or magnesium at least four hours away from Levothyroxine
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 or at repeat prescription. Many patients do NOT get on well with Teva brand of Levothyroxine. Though it is the only one for lactose intolerant patients
You are undermedicated. Some of your symptoms will be due to this. 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.
You need an increase of 25mcg immediately, retesting in 6 weeks, a further increase of 25mcg if necessary followed by testing 6 weeks later, and repeat until levels are where they need to be for you to feel well.
Your raised antibodies mean that you are positive for 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.
I have read (but not researched so don't have links) that BCSH, UKNEQAS and NICE guidelines recommend:
"In the presence of discordance between test results and strong clinical features of deficiency, treatment should not be delayed to avoid neurological impairment."
And 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."
If you do have signs of B12 deficiency, list them to discuss with your GP and ask for testing for B12 deficiency/Pernicious Anaemia.
If you don't have signs of B12 deficiency you could supplement with sublingual methylcobalamin lozenges to raise your level, along with a good B Complex to balance all the B vitamins.
Serum folate level 4.3 ng/mL [2.4 - 26.8]
Folate and B12 work together, your folate level is very low. Folate is recommended to be at least half way through it's range, so 15+ with your range.
If you have no signs of B12 deficiency then you can go ahead with a B Complex after you start the methylcobalamin lozenges. Look at Thorne Basic B or Igennus Super B, both contain 400mcg methylfolate at the recommended dose which will help raise your level.
If you do have signs of B12 deficiency don't start the B Complex until after further testing of B12 as supplementing with folic acid/methylfolate masks signs of B12 deficiency.
Serum ferritin level 34 ug/L [12.0 - 233.0]
This is low and it's recommended to be half way through it's range. Ferritin needs to be at least 70 for thyroid hormone to work. Low ferritin can suggest iron deficiency anaemia so you could ask your GP for an iron panel and full blood count.
If no iron deficiency anaemia, which would require treatment with iron supplements from your GP, then 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 51.8 nmol/L
This is low. The Vit D Council, the Vit D Society and Grassroots Health all recommend a level of 100-150nmol/L. It's not low enough for your GP to prescribe anything so you will have to buy your own supplement.
For your level, the Vit D Council suggests the following
To achieve 100nmol/L take 2000 IU D3 daily
To achieve 125nmol/L take 3700 IU
To achieve 150nmol/L take 5800 IU
As we can't make Vit D naturally from the sun during the winter, I'd aim for the higher end of the suggested range.
As you have Hashi's then an oral spray gives best absorption, eg BetterYou, which comes in 3000iu dose. I would take 6000iu daily for 6 weeks, then 3000iu daily for 6 weeks, then retest to see where your level lies.
Once you've reached the recommended level (100-150nmol) 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
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First Post- Advice re Blood Results Please
Any advice on results please?
Advice please re B12 to supplement or not
Help with test results please
Any advice going forward would be really appreciated 
