Latest Medichecks blood test results. Do I increase levothyroxine slightly or not? Current dose alternating 50/75 mcg

[Caroline888]

Hi everyone,

Have already received Medichecks blood test results - only sent blood sample yesterday! Very impressive.

My results are as follows:

TSH 1.2 (0.27 - 4.20), previously in June 1.7

FT4 19.4 (12 - 22), previously in June 16.700

FT3 4.2 (3.10 - 6.80), previously in June 4.05

Both sets of results are Medichecks.

Am unsure where to go from here. Would be grateful for any advice.

Best wishes

Caroline

[SeasideSusie Remembering]

Caroline

How do you feel?

Your conversion is a little off. Good conversion takes place when the ratio of FT4 : FT3 is between 3 :1 and 4:1 and yours is 4.6 : 1

How are your nutrient levels? All vitamins and minerals optimal?

Vit D - 100-150nmol

B12 - top of range

Folate - at least half way through range

Ferritin - half way through range

[Caroline888 in reply to SeasideSusie]

Thanks Susie for your quick reply.

In answer to your questions:

Vitamin D is 108;

B12 and folate are slightly above range; all due to supplementation.

Ferritin is at the lower end of the range at 34.

I know ferritin should be half way through range from what I have read here, but the gp said I was not anaemic. She said, though, that I could take one 210 mcg ferrous fumurate per day without specifying for how long, and I neglected to ask as it was on the phone and at the time I had more urgent concerns and failed to ask. I took it for just over a month. I am concerned that you can overdose on iron. Perhaps I need to get a full blood panel. Is that what you would recommend? Difficult to get an appointment at our surgery but I will try.

As to how I feel, well I didn't really know I had symptoms of hypothyroidism as I put everything down to everlasting menopausal symptoms (long after they should have ceased!) or ageing.

I actually went to the gp only with discomfort at front of neck and a strange ledge below bottom lip (mucin?). Asked for thyroid blood test because of thyroid discomfort. And so was diagnosed!!

Since diagnosis, I have noted fourteen things that have improved noticeably healthwise and some of these aren't even on the hypo symptoms list!! I certainly feel better these days but still mostly fall asleep mid afternoon.

My conversion rate was certainly better earlier in the year - perhaps whilst taking the ferrous fumurate?

Sorry for long post.

Hope your results have come back already too and that they are just as you would wish.

Any advice would be appreciated.

Best wishes

Caroline

[SeasideSusie Remembering in reply to Caroline888]

Caroline

I know ferritin should be half way through range from what I have read here, but the gp said I was not anaemic

Did she confirm that with a full blood count?

If you're definitely not anaemic and if you are not vegetarian, an easy way to increase ferritin is to eat liver once a week (no more than 200g), or liver pate and black pudding. Also include other iron rich foods in your diet apjcn.nhri.org.tw/server/in...

Your ferritin level may have been higher when taking the ferrous fumarate and that may have helped with conversion. Are you taking selenium? That helps with conversion.

Are you supplementing Vit D? If not it's best to take some during the winter when we can't make any naturally from the sun, we draw on what was stored during the summer so it will lower over the next few months. My level is best at the top end of the recommended range so I try to keep mine around 150.

My results were emailed to by just before 2pm. More or less what I was expecting

[Caroline888 in reply to SeasideSusie]

Thanks Susie for replying. I think my gp referred to some other results, after I asked about the low ferritin, and did some sort of calculation. Does that make sense? Anyway will look out my more comprehensive results tomorrow and post again. She definitely said not anaemic.

Unfortunately I am vegetarian so liver is out for me. I’m trying to eat more iron-rich foods but, as you will know I’m sure, non-haem iron is not so well absorbed so it might be an uphill battle without supplementation. I guess I’m going to have to make another appointment.

I do supplement 2000 I.U vitamin d and vitamin b complex. Also selenium as recommended here. So it’s just ferritin that’s the problem from a nutrient point of view.

Glad to hear you received your results from Medichecks today too and that they were as expected.

Best wishes

Caroline

[SeasideSusie Remembering in reply to Caroline888]

Caroline

I think my gp referred to some other results, after I asked about the low ferritin, and did some sort of calculation. Does that make sense?

Within the full blood count there will be MCV, MCH and/or MCHC, these are the results that suggest anaemia when ferritin is low.

Now that I've got my ferritin up to a decent level (with liver), when I'm too lazy to cook liver (which I often am) then I supplement with this

amazon.co.uk/MegaFood-Daily...

I find that one tablet a week seems to keep my level stable, if I want to nudge it up I'll take 2 a week, but it's not as low as yours currently is.

If you go back on ferrous fumarate, make sure you take each one with 1000mg Vit C to aid absorption, and take it 4 hours away from thyroid meds.

[Caroline888 in reply to SeasideSusie]

I did remember your advice to take 1000 mg vitamin c with the ferrous fumurate and took it diligently for that month.

Have looked out my blood test results now. All of these are dated November 2017. Apart from the regular thyroid tests, I have not had any done since then so my iron might have improved. These though are the results on the basis of which my gp said I was not anaemic.

The results are :

Full blood count (424..)

Haemoglobin concentration (Xa96v) 133 g/L [115.0 - 165.0]

Total white blood count (XaldY) 6.6 10*9/L [4.0 - 11.0]

Platelet count - observation (42P..) 310 10*9/L [150.0 - 450.0]

Red blood cell count (426..) 4.21 10*12/L [3.8 - 5.8]

Haematocrit (X76tb) 0.404 1/1 [0.37 - 0.47]

Mean cell volume (42A..) 96 fL [84.0 - 102.0]

Mean cell haemoglobin level (XE2pb) 31.6 pg [28.0 - 33.0]

Mean cell haemoglobin concentration (429..) 329 g/L [300.0 - 350.0]

These results mean little to me other than that they are all in range. Hope you can shed some light on them for me.

Thanks Susie for all your help and support so far.

Best wishes

Caroline

[SeasideSusie Remembering in reply to Caroline888]

MCV/MCH are nicely in range so no sign of anaemia with those results

[Caroline888 in reply to SeasideSusie]

Goodness Susie, are you always up this late? - I didn't expect an answer until tomorrow. I'm up because it took me ages to type in all those numbers!!

So.. if I'm not anaemic should I still be working on getting my ferritin up? If so, should I carry on taking the 210 mcg ferrous fumurate? (with vitamin c of course😊). Also would you advise me to stay on my current dose of 50/75 mcg levo?

Thanks so much for all your help.

Goodnight!

[SeasideSusie Remembering in reply to Caroline888]

Caroline

No, I'm not always up that late, I just wasn't tired last night so no point in going to bed, it always takes me at least 2 hours to get to sleep even when I am tired. And, of course, I'm paying for it this morning!

Yes, your ferritin would be better higher in range, it's said it needs to be 70 for thyroid hormone to work, recommended is half way through range.

As iron is complicated I can't say if you need ferrous fumarate. You'd need an iron panel, because if your serum iron is high then taking an iron supplement would raise it even more which is not recommended. This is why you'll only see me suggest raising ferritin with liver, etc. As you've been on FF before, you could see if your GP will do an iron panel, pointing out that your ferritin is low in range.

If those were my thyroid test results, I wouldn't be raising my dose of Levo. That will raise your FT4 and most likely take it over range and you could then end up with reverse T3. Your conversion is poor so you need your FT3 higher but not your FT4.

[Caroline888 in reply to SeasideSusie]

Thank you Susie for all your advice, which I will follow to the letter.😊

Hope you manage to get a good afternoon nap to make up for your late night!

Thanks again

Best wishes

Caroline

[Caroline888 in reply to SeasideSusie]

Just got round to looking at the link you gave me re. iron-rich food and drinks. Thank you so much. This is really useful. I was surprised by some of the things contributing to iron intake, and was particularly glad to see my occasional glass of red wine contributes 2 mg iron😊 - almost an excuse to drink it with every meal!!!

[Hidden in reply to SeasideSusie]

Can I ask a truly dumb question? To get that ratio, are you doing this? FT4/FT3 = ratio?

Cheers.

[SeasideSusie Remembering in reply to Hidden]

Yes, that's right

[Hidden in reply to SeasideSusie]

I said it was a dumb question Thanks. What does it mean if it is 2.something? (Or maybe this should be another question.)

[SeasideSusie Remembering in reply to Hidden]

SewinMin

To have a ratio of 2.something you would have a FT3 result higher through it's range (percentage wise) than FT4 is through it's range, for example

FT4: 19 (12-22) [70% through range]

FT3: 6.5 (3.1-6.8) [91% through range]

Ratio 19/6.5 = 2.92

That would be very unusual and you wouldn't expect to see that with someone on Levo only.

You can only work out conversion when on Levo, if you're on NDT or add T3 to Levo then conversion is irrelevant because you're adding T3 so can't work out your natural conversion.

So if you're on NDT or add T3 to Levo, then forget conversion, it doesn't apply to you.

[HughH]

The key thing with these results is how you feel. If you still have hypo symptoms then you could increase your levo.

[Caroline888 in reply to HughH]

Thanks Hugh,

Actually I find it difficult to say how I feel. I never really felt ill, just lacked energy, had achey bones, dry nails and skin, etc. But didn’t think any of this was unusual at my age (69). Do feel lots better in myself and less anxious since starting Levo but difficult to know if I could feel better with an increase in dose. I’m really lucky I guess in that I’ve never suffered the really debilitating symptoms some others have.

I have gone gluten free in an attempt to reduce my high antibodies (>1300) so am hopeful that will have a good effect.

Thank you so much for taking the time to reply.

Best wishes

Caroline

[HughH in reply to Caroline888]

As you get older thyroid function declines and fifty year-olds only produce about half the thyroid hormones that they made during their twenties. A lot of the changes which we associate with getting older are actually caused by the decline in thyroid hormones. It is therefore possible to delay or reduce many of the symptoms of getting older by keeping up the thyroid hormone levels.

In order to tell if you need to increase your thyroid hormones you could use temperature as a guide - if it is low you need more. Alternatively you could try increasing and look for symptoms of over-medication - if your heart rate is too fast, temperature high etc then go back to your previous dose.

[Caroline888 in reply to HughH]

Hugh

Thank you for that. I will certainly remember about using my temperature as a guide if I decide to increase my dose of levo. At the moment I am planning to work on improving conversion of FT4 to FT3 by raising my ferritin level. As I said before, I am lucky in that my symptoms are not too bad. Bone and muscle pain virtually gone and many other symptoms have improved or gone away completely, even some I didn't even associate with being hypo! I will take another blood test in 8 weeks and see if raising ferritin helps at all.

Thanks again for taking the trouble to help and advise me.

Best wishes

Caroline