Further blood results - advice please

[loobyp]

Hello

Further to some really helpful advice on here recently I have asked my GP for some more blood tests. To give some background I was diagnosed with hypo and hashimotos in July and am now taking 75mcg of Thyroxine. I do feel much better than I was but I still don't feel normal. GP just advised iron tablets after latest results.

These are my latest results (just a few days after the increase from 50mcg to 75mcg) so I'd be interested to hear your views, as my T4 suddenly seems to have increased and I'm wondering if I may become overmedicated now I have increased levo.

Date: 28/09/18

TSH 2.6 mIU/L (0.27-4.20)

T4 21.8 pmol/L (12-22)

T3 4.36 pmol/L (3.10-6.8)

Folate 15.5 ug/L (>3.90ug/L)

B12 372 ng/L (197-771 ng/L)

Ferritin 20 ug/L (30-150)

My Vit D 25-OH level in May was 36 nmol/L (30-50 insufficient) GP wouldn't test again.

TPO antibodies in August were 54 IU/no (0-34)

I'd appreciate any advice. Thank you.

[SlowDragon Administrator]

Your vitamin D is far too low.

Did GP prescribe vitamin D, if so how much?

You need a minimum of 1600iu per day for 6 months, as per guidelines

clinox.info/clinical-suppor...

Ferritin, you can help improve levels by eating liver or liver pate once a week

B12 is borderline

TSH likely too high

Official NHS guidelines saying TSH should be between 0.2 and 2.0 when on Levothyroxine

(Many of us need TSH nearer 0.2 than 2.0 to feel well)

See box

Thyroxine replacement in primary hypothyroidism

pathology.leedsth.nhs.uk/pa...

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

Ideally ask GP for coeliac blood test first

amymyersmd.com/2017/02/3-im...

chriskresser.com/the-gluten...

thyroidpharmacist.com/artic...

scdlifestyle.com/2014/08/th...

drknews.com/changing-your-d...

thyroidpharmacist.com/artic...

[greygoose]

Over-medicated on levo, possibly. But, how long did you leave between your last dose of levo and the blood draw? I'm not sure the FT4 can suddenly go up like that.

[SlowDragon Administrator in reply to greygoose]

Here's results after being on 50mcg eight weeks

[greygoose in reply to SlowDragon]

Where?

[SlowDragon Administrator in reply to greygoose]

healthunlocked.com/thyroidu...

[greygoose in reply to SlowDragon]

Right. So, that's why I asked how long between the last dose of levo and the blood draw. it's inconceivable that the FT4 would go up like that just a few says after the increase.

[SlowDragon Administrator]

So has your GP prescribed ferrous fumerate or similar iron supplements and how much per day

Taking each iron supplement alongside vitamin C can improve absorption of iron too

[loobyp]

Thanks for the advice. My GP just advised over the counter vitamin d and iron tablets.

If I keep taking 75mcg of levo to reduce the TSH won't my T4 become too high?

My GP says she will test only my TSH in 6 weeks. I have had to pay for all other thyroid tests.

[SeasideSusie Remembering in reply to loobyp]

Loobyp

Ferritin 20 ug/L (30-150)

"My GP just advised over the counter vitamin d and iron tablets."

Please make an appointment to see a doctor, a different one might be a good idea.

Point out that your Ferritin is below range and that low Ferritin can suggest iron deficiency anaemia , therefore you require a full blood count and iron panel to determine whether or not this is the case.

Below range Ferritin is not something that should be left for the patient to deal with by purchasing over the counter iron tablets. My opinion is that your doctor is being negligent here.

I would go as far as to suggest that an iron infusion should be given, that will raise your Ferritin in 24-48 hours, iron tablets will take months.

[loobyp in reply to SeasideSusie]

Thank you. I will speak to another GP as soon as possible.

[loobyp]

I left 24 hours after my last dose before drawing blood, early in the morning and fasting.

[SlowDragon Administrator in reply to loobyp]

Only ever do blood tests 6-8 weeks after any dose increase

So test results above were done too soon after last increase

SeasideSusie can advise on iron supplements. She may be along with suggestions

[loobyp]

Ah ok. So I need to repeat everything in 6-8 weeks.

[loobyp]

I'm a little confused. Does my T4 seem ok at this stage? Should I just wait for 6 weeks and test TSH and T4 again then? I'm wondering if an increase of 25mcg of levo was the wrong thing to do?

[SlowDragon Administrator in reply to loobyp]

Stick on the current dose and retest in 6-8 weeks

Improving vitamins will help as well