I received the attached results today from medicheck. Finger prick was done first thing (7.45am) before I took my morning dose of Levo or had my first coffee, breakfast or supplements.
I also had my blood drawn at the GP’s at 8.20am on the same day for my first review since starting 50mcg of Levo 6 weeks ago. The GP results are as follows:
TSH: 2.95mu/L [0.35-3.5]
FT4: 13pmol/L [8.0-21.0]
Peroxidase antibody: not tested
I have access to my online records and see a note saying ‘no further action needed’. I guess this is because my TSH and T4 is in range. However, I’m aware I’m not optimal as my symptoms remain.
I am taking the following supplements:
Vit D - 4000lu
Selenium - 200mcg
Fish Oil - 1000mg
I had a medicheck vitamin test on the 15/07/2019 and my results were:
Ferritin: 145ug/L [30-400]
Magnesium: 0.96mmol/L [0.7-1]
Zinc: 16.43umol/L [11.1-19.5]
Folate: 4.58ug/L [>3.89]
Vitamin B12 Active: 58.2pmol/L [37.5-188]
Vitamin D: 53.1nmol/L [50-175]
So my Vit D is definitely going up.
What do you recommend? Should I ask for a Levo increase?
Thanks in advance.
Rob
Written by
DaddyCool2001
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Yes as TSH needs to be 1 or below and FT3 and FT4 in the upper half of the range.I presume it is 50 mcg you are taking not 50mg! It is a very low starting dose.
Continue with your Vit D at 4,000iu daily. Are you also taking D3's important cofactors - magnesium and Vit K2-MK7?
Are you using an oral spray or sublingual D3 - recommended for best absorption when Hashi's is present.
Active B12 at 52.5 needs further investigation. A result below 70 suggests further testing for B12 deficiency according to Viapath at St. Thomas' Hospital:
List any that you do have to show your GP when asking for further testing for B12 deficiency/pernicious anaemia.
Folate has improved, are you taking a B Complex? If so then stop taking it because the folate included in it will mask signs of B12 deficiency and skew results of any further testing.
As Treepie says, 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 reference ranges, if that is where you feel well. Use the following information, if necessary, to support your request for an increase in your Levo:
Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (the magazine for doctors):
"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l. In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance. But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l. This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l).*"
*He recently confirmed, during a public meeting, that this applies to Free T3 as well as Total T3.
You can obtain a copy of the article by emailing Dionne at
tukadmin@thyroiduk.org
print it and highlight question 6 to show your doctor.
You can also refer to NHS Leeds Teaching Hospitals who say
Thyroxine Replacement Therapy in Primary Hypothyroidism
TSH Level .................. This Indicates
0.2 - 2.0 miu/L .......... Sufficient Replacement
> 2.0 miu/L ............ Likely under Replacement
You need 25mcg increase now, retest in 6-8 weeks, continue increasing/retesting every 6-8 weeks until your levels are where you need them to be for you to feel well.
Thanks. I’ve printed off the Leeds Pathology info and have emailed tuk. I do have some symptoms of b12 deficiency yes. I had bought some Jarrow b12 1000mcg but was waiting for these results before starting to take them. I take d3 softgel capsules but haven’t tried the k2-mk7 and I don’t take a B complex no.
Off to the GP tomorrow to fight for an increase I guess. Thanks again😊
OK, so besides your increase in Levo you need testing for B12 deficiency as mentioned.
Don't let your GP fob you off with your "B12 is within range". Take the information from Viapath at St Thomas', there is the option to print as a PDF, use this to get the further testing. Doctors are supposed to use symptoms as a guide rather than numbers where B12 is concerned so make sure you list your symptoms to show him.
You may need B12 injections or you may need oral supplements. These should be started first, then a couple of days later start with a good B Complex to balance all the B vitamins. Good B Complex brands suggested here are Thorne Basic B or Igennus Super B. The Igennus has more B12 at the recommended serving suggestion so as you will likely need B12 injections or a separate oral supplement then the Thorne Basic B might be the better choice.
It's good to know the softgels are working for you even though you have Hashi's. Out of all the swallowed supplements, softgels have superior absorption to tablets or capsules.
The Vit D Council recommends a level of 125nmol/L and the Vit D Society recommends a level of 100-150nmol/L. Once you've reached this level then you'll need a maintenance dose to keep it there, 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 an NHS lab which offers this test to the general public:
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 if taking tablets/capsules/softgels, no necessity if using an oral spray
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 if taking tablets/capsules, no necessity if using topical forms of magnesium.
Check out the other cofactors too (some of which can be obtained from food).
Don't start all supplements at the same time. Start with one, leave it 1-2 weeks and if no adverse reaction then add the second one. Continue like this. If you have any reaction then you will know what caused it.
Wow! What an awful telephone consultation with a GP I’ve just had. I explained that following my blood tests (see above) I’d like to try an increase in Levo. She said you are now in ‘range’ so that isn’t required. I went through my symptoms and she said ‘you have subclinical hypothyroidism, you are not hypothyroid. We don’t have to treat you with Levo for your autoimmune diseases, sometimes the thyroid can get better itself’! I referred to the NICE guidelines which notes ‘aiming for a stable TSH in the lower half of the reference range’ and she said maybe I was interpreting the guidance wrong, or reading the ‘pregnant patient’ guidance. She said she’d get back to me.
So I’ve emailed her the NICE guidance, Leeds Pathology guidance and the BTF Leaflet.
I’m off to North Cyprus tomorrow if she decides not to increase my Levo I’m going to buy a years worth of T3 and do it myself. Sod them!
Well I didn’t get a call back from the GP, however, as I have access to my online records I see she did have time to liaise with the on-call consultant.
She notes “If TPO is raised - pt is only 'at risk of developing' b'coz the other tests are still subclinical hypothy. In view of Partial clinical benefit consultant oncall Endocrine Mentioned we will initially Need to do other blood tests for b12, hba1c, 9 am cortisol. He has reviewed the patient's recent and previous blood tests. Mentioned that current TSH is in normal reference range. I have also disucssed teh above exerpt from NICE CKS with Prof Dhattaria and therefore: After blood tests consultant agreed To consider increasing dose to 50mcg and 75mcg on alternate days For 6 weeks then repeat TSH. As per nice guidance if no Relief of symptoms in 3-4 months then levothyroxine must be stopped.”
It’s good to see they are at least going to test my b12😂
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