Help needed for thyroid blood results

[Nico101]

Hello everyone and a Happy New Year.

I was hoping to get some advice regarding my latest blood test. I overmedicated around late summer and have been trying to come down slowly and find the right dose based on the excellent advice given on here.

I have currently come down to 1 1/4 grain of NDT and need to know if I've gone too far and need to go up a bit, or I'm still taking too much.

Any advice would be much appreciated, as still don't feel right - although I'm considerably better than when I was overmedicated!

Also, despite supplementing with zinc, my last GP blood test showed it to be very low. Is that a thyroid thing, too?

Thank you all in advance

In case it's relevant, that last test I had done was an NHS one on 10.10.19 and the results were as follows:

TSH: <0.03 mu/L 0.35 - 4.94

FT4 16.9 pmol/L 9.00 - 19.00

FT3 7.6 pmol/L 2.6 - 5.7

[SeasideSusie Remembering]

Nico101

Usual questions first:

Do you have Hashi's?

When did you take your last dose of NDT before each of the blood tests?

NHS test October 2019

TSH: <0.03 mu/L 0.35 - 4.94

FT4 16.9 pmol/L 9.00 - 19.00 = 79% through range

FT3 7.6 pmol/L 2.6 - 5.7 = 161% of range

New test on reduced dose:

TSH: 1.65 (0.27-4.2)

FT4: 11.9 (12-22) = minus 1% of range

FT3: 6.31 (3.1-6.8) = 87% through range

When on NDT it's usual to see a low, even supressed TSH and lowish FT4. Your TSH would seem to be too high and your FT4 too low; however, some people can manage with such a low FT4 when on combination hormone replacement, others need it much higher up the range.

I have currently come down to 1 1/4 grain of NDT and need to know if I've gone too far and need to go up a bit, or I'm still taking too much.

If you increase your NDT then your FT3 will most likely go over range.

As you say you still don't feel right then I wonder if the ratio of T4:T3 in the NDT is not right for you. You may be one who is better on Levo plus synthetic T3 so that you can tweak the doses to find the right balance of each hormone to suit your own needs.

But, of course, if you have Hashi's then there may be some Hashi's activity going on that's messing with your results and symptoms.

As your GP has tested zinc and it's very low, has any comment been made? Are you supplementing with enough zinc and eating zinc rich foods? Copper and zinc should be balanced so has copper also been tested?

[Nico101 in reply to SeasideSusie]

Yes, I have Hashi's. And the latest test was taken at 9am on an empty stomach with my meds taken about 12.30 the night before. No biotin for a week.

I was surprised at my zinc levels and immediately upped my intake. I do eat zinc-rich foods, too, and have no copper that I can think of. I'm going to ask for another test and get them to do copper, too. See what the balance is. No comments from GP except to say my zinc was low - not exactly a surprise given their lack of knowledge about nutrition. I was the one that asked for my zinc to be tested after reading something about it on here.

If I go on levo, I will have a battle on my hands getting T3. Is it possible to compromise by taking a lower dose of NDT and adding some levo to it? I'm sure I've read about people mixing the two on other posts.

[SeasideSusie Remembering in reply to Nico101]

Yes, there's no reason why you can't mix NDT and Levo to get the right balance of T4 and T3.

[Nico101 in reply to SeasideSusie]

Brilliant. I'll make a GP appointment tomorrow.

I'd rather go into the appointment knowing what dosage to ask for and what brand. Is there a brand that contains no lactose and magnesium stearate, by any chance? I'm sure I recall someone asking that before on here.

Any thoughts on the ratio? I appreciate I may have to tweak it, but it would be good to have some idea of where to start.

Thank you so much for the help. I finally feel like I'm starting to get to grips with this and that the right dose is almost within reach.

[SeasideSusie Remembering in reply to Nico101]

Teva is the only lactose free Levo in the UK but it does contain magnesium stearate. Other than that you are probably looking at a lactose free liquid levothyroxine if your GP is willing to prescribe it.

You would have to start with adding 25mcg Levo and see how you go, wait the usual 6-8 weeks and see how you feel and what your results are like. Then it's a case of taking it slowly, maybe increase by just 12.5mcg, wait 6-8 weeks, and so on.

[Nico101 in reply to SeasideSusie]

Would I need to decrease my NDT accordingly?

[SeasideSusie Remembering in reply to Nico101]

It's all down to experimenting to find the right balance. Don't change both at once.

Your current results look like you need more T4 but your FT3 may be in a good place or it might possibly be OK a little lower.

NDT contains a ratio of T4:T3 at approx 38mcg T4 to 9mcg of T3 so if you reduce your NDT you are reducing both T4 and T3.

1 and 1/4 grain of NDT Is giving you approx 47.5mcg T4 and 11.24mcg T3.

So to start with I would just add some Levo. Take it slow and leave about 6 weeks between each dose adjustment.

[Nico101 in reply to SeasideSusie]

Brilliant. Just the info I needed. Thank you so much.

[greygoose]

Hypos do tend to have low zinc and high copper, yes.

[Nico101 in reply to greygoose]

Thank you. I hadn't realised until recently it could be a problem. I read something about it on here and started taking a supplement months ago then had a test expecting it to be ok with the supplementation. I was shocked it was so low. I've since quadrupled my intake. I managed to get my selenium and D3 levels up so quickly I had expected the same with the zinc, but not so.

Perhaps I should try a different supplement.

[greygoose in reply to Nico101]

Do you mean a different brand? I take Vegavero, which seems to be quite good. Or, try taking vit C with it, to aid absorption.

[Nico101 in reply to greygoose]

Sorry, yes, a different brand. I use the liquid Good State one. All their others are great - my selenium went up so much I'm slightly over the high end of the scale. The same brand keeps my potassium and magnesium optimal, too.

My first dose of the day is in my smoothie, which also contains vit C. I eat a mainly plant based diet, so I'm getting vit C throughout the day as I drink water with the zinc in it. Could magnesium and/or potassium interfere with the uptake? I put that in my water, too, at the same time. I've never seen that anywhere as being a problem, but you may know more about it.

I use Vegavero supplements for other things and find them generally good. The Vegavero Q10 I use also has vit C and zinc in, too. I'll get my bloods checked before I worry too much. Perhaps it's finally gone up. I had IBS AND bowel disease to contend with until recently, but now my digestive system is perfect, so I should be absorbing nutrients much better - fingers crossed.

[greygoose in reply to Nico101]

Could magnesium and/or potassium interfere with the uptake?

Not as far as I know, no.

[Nico101 in reply to greygoose]

Thanks. Good to get confirmation.