Hi, I am looking for any advice please. I have been feeling extremely fatigued and achy recently so went for blood tests to check my thyroid function. I currently take 75 mcg of levothyroxine and 10 mg of Liothyronine. Unfortunately, I do have Lupus too but just wondered if the blood test result below could be causing this awful fatigue? Thank you.
TSH - 0.88 Range 0.25 - 5.00
Free T4 - 8.6 Range 9.00 - 23.00
Free T3 - 3.8 Range 3.50 - 6.50
Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and fasting. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)
Last Levothyroxine dose should be 24 hours prior to test, (taking delayed dose immediately after blood draw).
If/when also on T3, make sure to take last dose 8-12 hours prior to test, even if this means adjusting time or splitting of dose day before test
Is this how you do your tests?
Do you take your T3 as 2 x 5mcg doses?
If you did tests as recommended, these results suggest you are under medicated.
FT4 is BELOW range and FT3 too low
Suggest you get 25mcg dose increase in Levothyroxine
Retesting bloods in 6-8 weeks
You may need further increase in Levothyroxine or perhaps a third 5mcg dose of T3
For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also extremely important to test vitamin D, folate, ferritin and B12
Low vitamin levels are extremely common, especially if Thyroid antibodies are raised
Have you had antibodies tested?
what vitamin supplements do you currently take?
Hashimoto's 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. Dairy is second most common.
According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps, sometimes 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
While still eating high gluten diet ask GP for coeliac blood test first or buy test online for under £20, just to rule it out first
Assuming test is negative you can immediately go on strictly gluten free diet
(If test is positive you will need to remain on high gluten diet until endoscopy, maximum 6 weeks wait officially)
Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse
chriskresser.com/the-gluten...
amymyersmd.com/2018/04/3-re...
thyroidpharmacist.com/artic...
scdlifestyle.com/2014/08/th...
drknews.com/changing-your-d...
restartmed.com/hashimotos-g...
Research suggests Lupus linked to gluten intolerance too
glutenfreesociety.org/glute...
ard.bmj.com/content/63/11/1501
drhyman.com/blog/2011/03/17...
Thank you for your reply. I do regularly have my vitamin levels checked as they have been very low before. I take Iron, B12, Vitamin D and Selenium. I am a vegan but have always been sceptical to try gluten free as my Consultant told me this would not help with hypothyroidism!! I think I have had my antibodies checked as I was told it was Hashimotos?! I will definitely look at the above links as it would be amazing if also going gluten free could help with my awful symptoms I still unfortunately have
Please add actual results and ranges on vitamin levels
It's extremely common to have low ferritin if vegetarian or vegan and with Hashimoto's too
Many of us with Hashimoto's find strictly gluten free diet is astounding Improvement
Only way to know is to try it
While still eating high gluten diet ask GP for coeliac blood test first or buy test online for under £20, just to rule it out first
My last results were:-
Vitamin D 71 - range 50 .00 - 140.00
Serum Ferritin 34
Haemoglobin 128 - range 115.00 - 165.00
Serum Folate 19
B12 350
Thank you for your help.
Can you add the ranges on vitamin levels please
Results look low, but need ranges to be certain
Ferritin aiming for half way in range. Obviously difficult to increase with diet. Plant based iron is harder to absorb
GP should be testing for Anaemia regularly
Eating spinach, pumpkin seeds and dark chocolate, plus daily vitamin C can help improve iron absorption
FERRITIN
healthunlocked.com/thyroidu...
drhedberg.com/ferritin-hypo...
restartmed.com/hypothyroidi...
Post about iron supplements
healthunlocked.com/thyroidu...
B12 looks low. Under 500 can cause symptoms for some patients with Hashimoto's
Supplementing a good quality daily vitamin B complex, one with folate in not folic acid may be beneficial.
chriskresser.com/folate-vs-...
B vitamins best taken in the morning after breakfast
Recommended brands on here are Igennus Super B complex. (Often only need one tablet per day, not two. Certainly only start with one tablet per day after breakfast. Retesting levels in 6-8 weeks ).
Or Jarrow B-right is popular choice, but is large capsule
If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before any blood tests, as biotin can falsely affect test results
endo.confex.com/endo/2016en...
endocrinenews.endocrine.org...
Vitamin D - is this measured in nmol?
Vitamin D - 71 nmol/L
Serum Feritin 34 - range - 13 - 150 ug/L
Serum Folate 19 - range <3 ug/L suggestive of folate deficiency
B12 350 - range 197.00 771.00 ng/L
Would I benefit from a B vitamin Supplement? Also I have decided to go gluten free for a few weeks to see if this helps my symptoms, would taking a probiotic or digestive enzymes help with symptoms also?
Thank you for all of your wonderful recommendations and help, this is such a helpful community to find.
Vitamin D is still a bit too low.
GP will only prescribe to bring vitamin D up to 50nmol. Aiming to improve vitamin D by self supplementing to at least 80nmol and around 100nmol may be better .
Once you Improve level, very likely you will need on going maintenance dose to keep it there.
Retesting twice yearly via vitamindtest.org.uk
Vitamin D mouth spray by Better You is good as avoids poor gut function.
It's trial and error what dose each person needs.
Frequently with Hashimoto's we need higher dose than average
Ferritin is very low. Aiming for at least 70 as result. As per reply above....See GP to discuss further testing and iron supplements
B12 is likely too low
Do you have symptoms of low B12
b12deficiency.info/signs-an...
If you do see GP for full testing for Pernicious Anaemia
Obviously as vegan B12 always needs supplementing
Supplementing a good quality daily vitamin B complex, as well, one with folate in not folic acid may be beneficial.
chriskresser.com/folate-vs-...
B vitamins best taken in the morning after breakfast
Recommended brands on here are Igennus Super B complex. (Often only need one tablet per day, not two. Certainly only start with one tablet per day after breakfast. Retesting levels in 6-8 weeks ).
Or Jarrow B-right is popular choice, but is large capsule
If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before any blood tests, as biotin can falsely affect test results
endo.confex.com/endo/2016en...
endocrinenews.endocrine.org...
Importance of Nutrients and Hashimoto's
I would very much appreciate your advice. I have just been to see a very renown Consultant in Cambridgeshire who was very dismissive of me today he found my blood test results unremarkable and I had to ask if a 25 mcg increase would help my fatigue and other awful symptoms. He agreed but didn’t seem to think I should be feeling unwell with these blood results!! I asked about going gluten free and taking supplements but he dismissed this saying it would not help!! I’m so upset and disappointed as I really thought I could get some answers today.
Thank you.
Was thepis consultant on the Thyroid Uk recommended list?
If so please email Dionne and explain not impressed
Did you get dose increase in Levothyroxine?
Or have you access to increase your Levothyroxine yourself?
There are over 100,000 members on here.....time and time again, we find vitamins need to be OPTIMAL
Obviously you need to work hard to improve vitamin levels
Ferritin is going to be difficult to improve on vegan diet without supplements
The ONLY way to know if gluten is an issue is to try strictly gluten free diet for 3-6 months
Have you had your adrenal function checked with cortisol levels. Dr Peatfield recommended I had this done and I felt much better after starting nutriadrenal, a natural supplement. GP may not think so but you can get a saliva test through Medicheck.
Thank you for replying, this is something I will discuss with my endocrinologist on Friday.
Push endocrinologist for 25mcg dose increase in Levothyroxine or 5mcg dose increase in Liothyronine
Personally would try increase in Levothyroxine First
Retesting bloods in 6-8 weeks
Latest blood test results
Advice on Blood test results
Help with blood test results
Strange blood test results...
Advise on blood test results 
