Recently had a private test with Medichecks before going off to the GP again as I got a call from a receptionist saying the “Dr. Wants you to reduce your Levothyroxine dose from 125mcg to 100”, so I asked for an appointment to find out why and arranged the private test. The GP test results give a similar picture about the TSH being suppressed.
Should also add that the thyroid check was suggested as I developed mild lymphodema following treatment for breast cancer and zolodronic acid infusions which I had an allergic reaction to and caused whole body swelling - lymphodema team thought thyroid medication might need adjusting.
Any advice or help would be very much appreciated please and thanks for taking the time to look at the results.
This is the review from the Medichecks doctor with my responses in bold and also a photo of the results.
*Your thyroid stimulating hormone is low which could suggest that your levothyroxine dose may be too high. Was on 125mcg but have been advised to reduce to 100mcg
*If your TSH always tends to be substantially below the normal range discuss with your GP whether a bone density scan is advised to monitor for the development of osteoporosis. You do not need to worry about the occasional low reading, only if you get repeated very low levels. My levels are usually slightly low/suppressed
*Your thyroid antibodies reveal no evidence of autoimmune thyroid disease. Does this mean that the Hashimotos I was diagnosed with has disappeared?!
*Your vitamin D levels are bordering on insufficient. This may progress to vitamin D insufficiency or deficiency if you don’t take steps to increase your vitamin D levels. Your levels of vitamin B12 and folate are normal. If I supplement with Vit D will this compensate the reduction in Levo? Recently started taking Foridix magnesium liquid and multi vitamin liquid as I read it’s easier to absorb than tablet form. Is the Vit B result on the low side too?
*You have high iron stores. Likely to be due to a high dietary intake of iron or supplements. Another possible explanation for this is fat deposits within the liver, this can occur when someone is overweight or obese. A Liver Check blood test will help to assess whether this is affecting your liver. Probably not diet related. I am slightly overweight (could do with losing a stone!) but not obese. My BMI is 26.7
Please see photo for thyroid results
Vitamin results:
Ferritin: 261 (13-150)
Folate: 5.02 (3.89-19.45)
Vitamin B12: 65.2 (37.5-188)
Active Vitamin D: 52 (50-175)
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*Your thyroid stimulating hormone is low which could suggest that your levothyroxine dose may be too high.
But it isn't. And, whilst the TSH might suggest that, the TSH on its own means nothing. The most important number is the FT3, and you FT3 is low because you cannot convert very well. But, as Medicheck docs are just NHS trained, I wouldn't expect them to know anything about T3 or conversion.
*If your TSH always tends to be substantially below the normal range discuss with your GP whether a bone density scan is advised to monitor for the development of osteoporosis.
Low/suppressed TSH does not cause osteoporosis, that theory has been debunked many times.
*Your thyroid antibodies reveal no evidence of autoimmune thyroid disease.
No, that doesn't mean your Hashi's has disappeared. Hashi's doesn't just disappear. But antibodies fluctuate, and diminish with time, as the thyroid gets smaller.
*Your vitamin D levels are bordering on insufficient.
No, increasing vit D levels will not compensate for the reduction in levo. You cannot replace a hormone with a vitamin.
Taking a mult-vit is a very bad idea for all sorts of reasons.
* If your multi contains iron, it will block the absorption of all the vitamins - you won't absorb a single one! Iron should be taken at least two hours away from any other supplement except vit C, which is necessary to aid absorption of iron, and protect the stomach.
* If your multi also contains calcium, the iron and calcium will bind together and you won't be able to absorb either of them.
* Multi's often contain things you shouldn't take or don't need : calcium, iodine, copper. These things should be tested before supplementing.
* Multi's often contain the cheapest, least absorbable form of the supplement : magnesium oxide, instead of magnesium citrate or one of the other good forms; cyanocobalamin instead of methylcobalamin; folic acid instead of methylfolate; etc. etc. etc.
* Multi's do not contain enough of anything to help a true deficiency, even if you could absorb them.
* When taking several supplements, you should start them individually at two weekly intervals, not all at once as you would with a multi. Because, if you start them all at once, and something doesn't agree with you, you won't know which one it is and you'll be back to square one.
And your vit B12 and folate are too low, yes.
*You have high iron stores.
You may be over-weight, but is it due to fat, or is it water- retention/mucin? Water-retention would not affect your liver.
Did you have your CRP tested at the same time? If that is high, it could be affecting your ferritin level.
Thanks so much for the advice and taking time to reply. If CRP refers to inflammation, there is no evidence of that in the test so that doesn’t seem to be a reason for the high Ferratin. I do think a part of my weight gain is water retention for which I’ve got some tablets but they don’t eliminate it all!
I stopped the floradix multi, I wasn’t sure it was effective anyway and am pleased to get your advice on taking the vitamins separately. I’ll keep on with the magnesium supplement and start on the vitamin D I think. I have an appointment with the GP in October as he reduced my Levo to 100mcg and wants to review it...I went along with it but am going to ask to increase the dose again. I’ll also ask to test vitamin levels too and see what the results are before asking about T3 treatment.
Hello again..have just been retested following reduction of Levo to 100mcg daily.
TSH is still suppressed but “improved” so I’m to stay on the low dose despite feeling rubbish! “The Lab declined to test T3 on this occasion”
TSH is now 0.022 (was 0.014)
T4 is 16.4
I requested vitamin retests too so these results are as follows with previous numbers in brackets
Vit D: 64 (52)
Vit B12: 303 (65.2)- can this be the same measurement unit?
Ferritin: 164 (265)
Folate: 5.3 (5.02)
No inflammation
GP said all looks good and Vit D is ok with 50 being adequate” but I don’t think there is much change and would like to start on supplements.
I was also wondering why the B12 results are so different too, do the GP/ Medichecks Labs use different measuring units or does this look right? It’s all a bit confusing and looking at the links you suggested last time I do feel as if I have a B12 deficiency but the GP didn’t see a problem.
I understand not to start supplements at the same time but am not sure how much to take or if anyone has recommendations of dosage, types or brands please?
Am thinking of making a private appointment with Endocrinologist but am not confident I’ll get the right treatment there either.
Thanks again for taking the time to help and advise.
I'm afraid none of those results mean anything without the ranges. But, your doctor should not be dosing by the TSH! It is wrong, wrong, wrong to reduce the dose to try and bring the TSH up, because the TSH cannot possibly tell you if you're on the right dose.
It is the FT3 the most important number, but failing that - the damned lab will only test it if the TSH is very low! - he should be at least looking at the FT4. Your doctor sounds very ignorant.
For the B12, the difference is that the NHS tests the total B12, and Medichecks tests the active B12 - different ranges - one of the reasons why it's so important to add the ranges. But it's too low on both of them. And, if your doctor knows nothing about thyroid, he knows even less about nutrients because they weren't mentioned at all in med school. Where as he had at least ten minuets on the thyroid!
Unfortunately I wasn’t given the ranges at the appointment and only got the numbers by quickly writing them down! I asked at the surgery reception for a print out of blood results and have to wait as “it takes time”.
Dr agreed that an endocrinologist might be more helpful but didn’t think he could do an NHS referral as my symptoms were well managed but if I liked he’d write me a letter to show to a private Endo!
I also said that given my symptoms I’d like to increase my dose and he said he’d prescribe another 25mcg for me to take 3 days a week....
I’ll come back to you with the ranges when I get the printed results from the surgery but in the meantime would it be ok to start supplements?
Thanks again I appreciate all the advice navigating this minefield!
The receptionist is just being difficult - how long can it take to print out one set of results?
You can only start on one supplement at a time, leaving about two weeks in between starting each one. So, if I were you, I would start with the B12 and B complex - the B12 is so obviously low - and take that for two weeks, by which time you should have got the print-out and can see what else you need to take.
Hello again, I finally have a print out of the last set of blood results taken in September and some of the ranges. I’ve also added in the August results for comparison. Please could you have a look, I would really appreciate some advice since the GP would only say that as TSH was suppressed I should to reduce Levo to 100. I tried that for 6 weeks but then asked if I could increase back to 125, he agreed but advised only for 3 days a week.
I started on B12 but struggled as the first dose made me feel like I’d had several espressos and also the smell of the tablets is awful! Haven’t started on Vit D yet. I’d also be grateful for advice on another type of Vit B supplement and your thoughts on selenium supplements too please? For a while I’ve wondered if it’s just the Hypo/Hashi that makes me feel low and slow, also think HRT may have helped with the anxiety/mood problems but can’t take that since I’ve had breast cancer. Trying now to tackle things holistically and ‘look after myself’ rather than rely on the GPS...also wondering if it’s worth bothering with an Endocrinologist appointment if they aren’t much more help or can’t prescribe T3.
I’m very appreciative of the time you take to look at all this information and the invaluable common-sense advice you give navigating this minefield.
I started on B12 but struggled as the first dose made me feel like I’d had several espressos and also the smell of the tablets is awful!
You're the second person to say that today. I have never noticed a smell with my B12 tablets. What exactly are you taking? What you should be taking is sublingual methylcobalamin. And, don't forget the B complex!
I don't have any thoughts on selenium. It didn't suit me, gave me a bad stomach, but they do say it helps with conversion. Conversion has never been my problem anyway, so perhaps I don't need it. But, lots of people do take it and are well on it.
My thoughts on endos, on the other hand, have been well documented! lol But, if you've got an appointment, why not go and see. Maybe he'll be different.
Are those all the tests you've had? Not much of a record, is it. Must have taken the receptionist all of two seconds to print that out! There's really not enough information there to form an opinion on. But your FT4/3 aren't saying over-medication.
Sorry for jumping in here but I’ve been looking for the information regarding low TSH and osteoporosis. My endo told me that these were connected and I knew I’d read that this wasn’t necessarily true. Can anyone help with a link please? I’d love to show him on my next visit. Thanks.
I think you're probably going to need more than one link. For every link saying it doesn't you show him, he's probably got one that shows it does. But, show him anyway, it might just be whistling in the wind with nothing to back it up. Ask him for details: how does the TSH affect bones? Does having a very high TSH mean you have very strong bones, then? Because that would be the obvious conclusion, if low TSH weakens them. lol Play the innocent: what does TSH stand for? Where does it come from? What does it do? How come it affects both thyroids and bones? Tie him up in knots!
If you do then list them to discuss with your GP when asking for further testing. In the meantime, if your Floradix Multivitamin contains B12 or B7 stop taking it as it will mask signs of B12 deficiency and skew results.
Folate: 5.02 (3.89-19.45)
This is on the low side, folate is recommended to be at least half way through it's range. You can improve this by eating folate rich foods and a good B Complex will also help, consider Thorne Basic B or Igennus Super B. Don't take B Complex until after further testing of B12 has been carried out and supplementation or injections started as the folate contained in it will mask signs of B12 deficiency.
Vitamin D: 52nmol/L (50-175) = 20.8ng/ml
The Vit D Council recommends a level of 125nmol/L (50ng/ml) and the Vit D Society recommends a level of 100-150nmol/L (40-60ng/ml).
To reach the recommended level from your current level, the Vit D Council suggests supplementing with 3,700iu if your level is 25, as yours is lower than that I would suggest you take between 4000 and 5000iu D3 daily. The 5iu in your Floradix multivitamin is totally worthless.
When you've reached the recommended 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).
Ferritin: 261 (13-150)
I would discuss this with your GP. Ferritin can be raised due to infection or inflammation and if that were the case then CRP would likely to be raised too.
*Your thyroid antibodies reveal no evidence of autoimmune thyroid disease. Does this mean that the Hashimotos I was diagnosed with has disappeared?!
Once tested positive for Hashi's, you have Hashi's. As antibodies fluctuate then you may just have been tested when they're low.
Once your nutrient levels have been optimised, if your conversion is still poor (high FT4 and low FT3) then adding T3 to your Levo may be beneficial but nutrient levels need to be optimal before starting T3.
I wouldn't start the Super B tablets until you've discussed further testing of your B12 with your GP, as mentioned above Active B12 below 70 suggests testing for B12 deficiency. If you start taking the Super B supplement then it will mask signs of B12 deficiency and skew results due to it containing methylfolate and methylcobalamin.
Don't forget you also need magnesium as a cofactor of Vit D.
Hello again..have just been retested following reduction of Levo to 100mcg daily.
TSH is still suppressed but “improved” so I’m to stay on the low dose despite feeling rubbish! “The Lab declined to test T3 on this occasion”
TSH is now 0.022 (was 0.014)
T4 is 16.4
I requested vitamin retests too so these results are as follows with previous numbers in brackets
Vit D: 64 (52)
Vit B12: 303 (65.2)- can this be the same measurement unit?
Ferritin: 164 (265)
Folate: 5.3 (5.02)
No inflammation
GP said all looks good and Vit D is ok with 50 being adequate” but I don’t think there is much change and would like to start on supplements.
I was also wondering why the B12 results are so different too, do the GP/ Medichecks Labs use different measuring units or does this look right? It’s all a bit confusing and looking at the links you suggested last time I do feel as if I have a B12 deficiency but the GP didn’t see a problem.
I understand not to start supplements at the same time but am not sure how much to take or if anyone has recommendations of dosage, types or brands please?
Am thinking of making a private appointment with Endocrinologist but am not confident I’ll get the right treatment there either.
Thanks again for taking the time to help and advise.
But assuming that your new results are from GP tests, please add the reference ranges for all of them as they will be different from the Medichecks ranges.
Your B12 test with your GP will be Total B12 with a wide range of something like 180-700 or similar. The Medichecks test is Active B12 with a much narrower range. Total B12 test shows both bound and unbound (free/active B12) whereas the Medichecks test is just the active B12 which is what is available to be taken up by the cells and is a better test.
Thank you for looking at this before bedtime. I’m afraid I didn’t get the ranges, just the numbers but have asked for a print out of all the most recent results so will come back to you as soon as I get that.
Hello again, I finally have a print out of the last set of blood results taken in September and some of the ranges. I’ve also added in the August results for comparison. Please could you have a look, I would really appreciate some advice since the GP would only say that as TSH was suppressed I should to reduce Levo to 100. I tried that for 6 weeks but then asked if I could increase back to 125, he agreed but advised only for 3 days a week.
I started on B12 but struggled as the first dose made me feel like I’d had several espressos and also the smell of the tablets is awful! Haven’t started on Vit D yet. I’d also be grateful for advice on another type of Vit B supplement and your thoughts on selenium supplements too please? For a while I’ve wondered if it’s just the Hypo/Hashi that makes me feel low and slow, also think HRT may have helped with the anxiety/mood problems but can’t take that since I’ve had breast cancer. Trying now to tackle things holistically and ‘look after myself’ rather than rely on the GPS...also wondering if it’s worth bothering with an Endocrinologist appointment if they aren’t much more help or can’t prescribe T3.
I’m very appreciative of the time you take to look at all this information and the invaluable common-sense advice you give navigating this minefield.
I was going to suggest from the first few posts that you try reducing your T4. But I’d have done it every other day 125/100. I suggest this because sometimes if T4 is too high (as in for the individual not as in over range) then it can impact conversion. This has been shown with your results. When T4 was high your T3 was lower and when T4 was reduced your T3 moved up a bit. Not much though. I’d try and get a new balance with the T4. Maybe 125 x5 and 100x2? Hold that for 6wks as well as still working on your Vits and Minerals. I take Selenium with added Zinc among other stuff in the hope that it aids conversion.
If you can get a history of tests going forward this will be really helpful when you have to go private or if you decide to self medicate. It’s your history that will tell if you will need T3 in the future. HTH 🤗
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I'm pretty sure the multi wouldn't have been effective, for the reasons I explained. 
Results Advice Needed Please
Advice on my results please.
Latest Medichecks results - advice please
