After consulting an endocrinologist privately he commissioned blood tests, some of which my GP had refused to perform. I am due to see the Endo again on 6 September but I wonder if anyone would comment on my results before I see him. The tests were carried out at my GP's surgery and he wasn't happy to be asked to do them. For clarification I was given an intramuscular injection of 120mg Depomedrone on 8 August for pain relief and the blood tests were done on 29 August. I was informed that this injection might raise the cortisol level slightly. The Endo prescribed Erfa 2.5 grains daily and I took that dose for 3 weeks but became hyper with profuse sweating. I've since reduced the dose to 1.5 grains daily. I have also recently been diagnosed with Atrial Fibrillation and am taking medication to thin my blood and slow my heart rate.
Serum free T4 9.5pmol/L range 12-22
Serum free T3 3.0 pmol/L range 3.1-6.8
Serum TSH 0.20 mu/L ranbge 0.27-4.20
Cortisol level 116nmol/L range 133-537
Serum B12 172 ng/l range 197-771
Serum folate 2.0 ug/L range 1.9-25
Serum adjusted calcium 2.16 mmol/L range 2.20-2.55
Serum total 25-OH Vit D 44nmol/L range 50-120
To say I feel ill is an understatement. On top of the usual thyroid hypo symptoms I am exhausted, breathless, pins and needles and numb areas in my legs, agonising cramps in feet and calves - the list goes on.
Any comments will help me build my case with the Endo and my GP.
As usual very many thanks for reading.
Written by
marlathome
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Do not start any supplement for your folate deficiency or B12 before further testing. These will mask signs of B12 deficiency.
You may well be started on B12 injections. Folic acid can be started AFTER the injections have been started.
Serum adjusted calcium 2.16 mmol/L range 2.20-2.55
Below range, this should be addressed by your doctor.
Serum total 25-OH Vit D 44nmol/L range 50-120 = 17.6ng/ml
Too low but not low enough for Vit D deficiency (that is <25) so maybe you will be told to buy your own supplements, which is actually the most sensible thing to do.
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, based on the Vit D Council's suggestions you could supplement with 4,900iu D3 daily (nearest is 5,000iu)
For best absorption an oil based softgel is recommended, eg Doctor's Best, avoid tablets and capsules. Some people prefer an oral spray (eg BetterYou) or sublingual liquid which are absorbed through the mucous membranes in the oral cavity so bypass the stomach.
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).
Don't start all supplements at once. Start with one, give it a week or two and if no adverse reaction then add the next one. Again, wait a week or two and if no adverse reaction add the next one. Continue like this. If you do have any adverse reaction then you will know what caused it.
Cortisol level 116nmol/L range 133-537
Serum cortisol tests aren't something I can comment on but this is obviously below range so needs addressing by your doctor.
Serum free T4 9.5pmol/L range 12-22
Serum free T3 3.0 pmol/L range 3.1-6.8
Serum TSH 0.20 mu/L ranbge 0.27-4.20
How long had you been on the reduced dose of NDT? If less than 6 weeks then your levels wont have stabilised.
However, these results show a below range FT3 and when one takes NDT one would expect to see a low, maybe suppressed TSH, lowish FT4 and FT3 in the upper part of the range.
When did you take your last dose of NDT before the test?
Thanks for your very comprehensive reply - I'm going to print this out and follow your suggested links so that I can read all your advice before next Friday's appointment.
To answer your questions - I have been taking erfa for almost 2 months now but previously I was taking 100mcg of levo. I had my last dose of erfa the evening before the blood draw at 9am the following day. Thyroid antibodies were not tested - they were last tested in 2017 and came back "normal" - I have no thyroid gland after Hashi's 30 years ago.
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
Vitamin D is far too low. GP will only prescribe to bring vitamin D up to 50nmol. Aiming to improve 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.
Your bloods kinda look like mine did a few years ago. Diagnosed with adrenal insufficiency first and then central hypothyroidism. All stemming from a pituitary tumor and resulting surgery. My suggestion (I’m not a doctor) would be to make an appointment ASAP as these conditions are life threatening. Must address adrenal insufficiency before hypothyroidism. Good luck to you.
I think it's pretty obvious from these results that you couldn't have been 'hyper' - over-medicated - on 2.5 grains NDT. Unless, of course, these labs were done incorrectly, and you left too long a gap between your last dose and the blood draw.
Were you on levo before you started the NDT? How much? How do you take your NDT? Do you take it on an empty stomach, leaving at least an hour before eating and drinking anything other than water? Do you take any other medication/supplements at the same time?
Thanks a lot for this. I understand what you say about not being over medicated but I had all the hyper symptoms that I recognise - profuse sweating, tremors, breathlessness, tachycardia etc. My fear is that the diagnosis of atrial fibrillation masks or contributes to this scenario because many of the symptoms are identical. It's very confusing.
I was on 100mcg (or is it mg?) Levo prior to NDT. I take the 1 grain first thing in the morning on an empty stomach with water an hour before food; 1 grain in the afternoon an hour after lunch and half a grain before bed. I've cut that back to 1.5 grains now spread the same way and am monitoring the heart and other symptoms.
I take magnesium supplement before bed and an antidepressant.
I had all the hyper symptoms that I recognise - profuse sweating, tremors, breathlessness, tachycardia etc.
They can also be hypo symptoms. Many of the symptoms of hypo are the same as symptoms of hyper.
However, if you were on 100 mcg levo, and he changed you to 2.5 grains of NDT, it wouldn't be surprising if you had hyper symptoms! That was far too much. Even 1.5 grains was a massive increase in dose. 1 grain would have been a good starting point, and then you could have increase by 1/4 grain every two weeks as needed.
So, you'll be absorbing the morning dose, no problem. But taking it an hour after food is probably not long enough - 2-3 hours is better. But, in the evening you probably aren't absorbing anything at all. An antidepressant should be taken at least two hours away from thyroid hormone, and magnesium four hours. So, that would go some way to explaining your low levels.
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