Given how all of your levels have tanked, that’s looking like an absorption problem. If it’s not too indelicate a question, how are your guts behaving?
T3 is the active thyroid hormone which controls the metabolism and therefore the symptoms. Your Free T3 is below the mid point of the normal range. If you still have hypothyroid symptoms then you could increase your thyroid meds.
Vitamin D is just in range. The “normal” ranges are found by testing a sample of the population, but the issue is that these people may all be deficient. Optimal levels rather than levels in the “normal” range should be the aim.
Although vitamin D is found in some foods, food only provides about 250 IU daily, which is about five percent of the amount needed. So unless someone is getting a lot of exposure to sunshine they need to supplement. A daily supplement of around 5,000 IU (125 mcg) of vitamin D3 is needed for most people. There is no danger in taking this amount. The 2010 US Institute of Medicine (IOM) report indicates 10,000 IU/day is considered the NOAEL (no observed adverse effect level).
Thinking I need to increase thyroid meds, last time I increased NDT I couldn’t tolerate it so stayed at 1.5 grains and included T3, have been stable since but all numbers have taken a nose dive
The only result we have from last year is your B12 result so apart from that we don't know how much lower your results are.
B12: >1000 (range -700)
That was a Serum B12 test.
Active B12 58.200 (37.50 -188.00)
This is an Active B12 test so they're different.
Considering you said that you weren't supplementing when you had the Serum B12 test done last year, then the Active B12 result is a surprise. Your level is quite low and according to this article anything below 70 should be tested for B12 deficiency
This is deficient and you should discuss this with your GP. You may be prescribed folic acid, but don't start taking it until after further testing for B12 deficiency has been carried out and supplementation/B12 injections started as folic acid masks signs of B12 deficiency.
Iron - 29.41 (5.80-34.50) umol/L
T.I.B.C - 67.21 (45.00-72.00) umol/L
Transferrin Sat - 43.76 % (20.00-50.00
Ferritin - 46.2 (13.00-150.00) ug/L
Your ferritin is on the low side. For thyroid hormone to work (that's our own as well as replacement hormone) ferritin needs to be at least 70, preferably half way through range. Your other iron results don't show the need for iron supplementation so I would just eat liver, liver pate or black pudding to try and raise your ferritin level.
humanbean knows more about interpreting the iron panel than I do so she may have other suggestions.
so you might want to supplement with D3 to raise this. To raise your level to the recommended level, they suggest 3700iu D3 daily, along with D3's important cofactors.
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
Considering that you take 1.5 grains NDT & 20mcg of T3, then your TSH and FT4 are not unexpected. NDT and T3 tends to lower, even suppress TSH, and also lowers FT4. However, yours is a long way below range which wouldn't suit everyone but that might be right for you.
Your FT3 is quite low in range considering your total T3 from the NDT (13.5mcg) and T3 (20mcg) is 33.5mcg. If you are symptomatic then there is plenty of room to increase your FT3.
Based on the optimal results your results are giving very mixed messages.
Your iron is substantially higher than optimal, suggesting that iron supplementation would be a bad idea.
Your TIBC (Total Iron Binding Capacity) is high suggesting that your body is short of iron and iron supplementation would be a good idea.
Your Transferrin Saturation is higher than optimal, suggesting that iron supplementation would be a bad idea.
Your ferritin is lower than optimal, suggesting that iron supplementation would be a good idea. [Optimal for ferritin for many people is around middle of the range or a little bit higher, although there are varying opinions on this.]
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What would happen if you supplemented iron? Well, one of two things are likely to happen...
1) The best scenario is that your ferritin would rise, and your serum iron would be largely unchanged, and you would feel less fatigued.
2) The worst scenario - and in my untrained opinion the most likely outcome - is that your ferritin would stay largely unchanged and your serum iron would rise, possibly a lot. In this scenario you would have too much iron being carried around your body via your blood stream, which would be wonderful for any infectious bacteria, virus, yeasts etc that may be in your body because they need iron to reproduce. But it wouldn't be good for you at all for those bad bugs to start reproducing a lot. And another possibility is that your blood stream might dump excess iron in your soft tissues, like your brain, your liver, your heart, your muscles. And once that happens the body is not good at getting rid of it.
The good news :
With such low in range ferritin there is nothing (at the moment) to suggest you have haemochromatosis.
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I think the most likely scenario is that you have a problem with methylation (an MTHFR mutation). This is very common - about 50% of the population have less than ideal genes controlling methylation, and whether or not the problem affects them depends on whether or not the dodgy genes they have controlling this are active or not.
The Methylation Cycle is hugely important for all sorts of processes in the body. Nutrients are taken in in one form and in order to make use of them the body has to convert them into another form. The Methylation Cycle can grind to a halt, but it can be started again with supplements.
In a healthy body folic acid will be converted into folate, but someone with an MTHFR problem can't do it, or it is done very inefficiently. Your blood results for folate might end up looking fab, but you won't be getting any benefit from it. What you need instead is methylfolate or 5-methyltetrahydrofolate which is easily obtained from supplement sites on the web and shopping sites like Amazon. Since you are deficient you will need quite a high dose for a while. Try 800mcg - 1000mcg per day and see if you start to feel better.
Vitamin B12 supplements are often sold in the form cyanocobalamin. In order to make use of it you need the type which is already converted into the active form - methylcobalamin. There is another active form available called adenosylcobalamin, but stick with the methylcobalamin to begin with, and take a dose of 1000mcg per day. You can try adenosylcobalamin later if need be - it's expensive and quite possibly not necessary.
Please start the B12 (methylcobalamin) a couple of days before you start the methylfolate.
You should test your folate and active and/or serum B12 in a couple of months. You should be aiming to get your folate into the upper half of the reference range and your serum B12 close to the top of the range or even a little bit over.
For more info on methylation, and a different protocol on how to fix the issue (which is far more complicated and expensive than the B12 and folate I've suggested), read this - it is well worth the effort :
Please note that I am not medically trained, and everything I've written is based on my reading and research on the web. You pay attention to it and/or follow my suggestions at your own risk.
Presumably you know not to take NDT less than an hour before or 2 hours after food or caffeine, and you don’t take your meds within 3 hours of calcium, iron, etc?
Hmmm. Well, this happened to me once after my daughter got married, although I didn’t have everything checked, just tsh and it has gone much higher. I put it down to stress, but as many of your results are down, I doubt that’s the cause.
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