Recall i had Thyrodectomy 10 years ago. i had previously for years been on 50mcg levo with several butts of migraine. After the several advise on this platform that i am undermedicated, i am currently on Levo 100mcg and my migraine is reduced but not completely out. The below are my recent test (fasting) results and also vitamins after 21 days on 100mcg of Levo. I will appreciate you to provide me with adequate dosage for optimal maintenance. I am worried on out of range level of B12. I was on b12 (1000mcg) tablets medication for 2weeks before the test. could it have triggered the out of range level. All test were conducted after 12hours fasting.
Free T4 12.37 ( 7.2 - 16.4) pmol/L
Free T3 4.42 ( 3.6 - 6.0) pmol/L
TSH 1.32 ( 0.380- 5.330) mlU/L
D3(1.25-OH) 81.41 (26.1-95)pg/mL
Ferritin 102.88 ( 20 - 300)ng/mL
B12 1125 (133- 675) pmol/L
Transferrin 2.16 (2.5 - 3.8) g/L
Magnesium seru 0.87 ( 0.70 - 1.15) mmol/L
Your advise is very well appreciated.
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nk655chii
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All thyroid tests should be done after a minimum of 6-8 weeks on each new dose
So you have tested too soon
Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .
Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).
This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)
What vitamin supplements are you currently taking?
Magnesium looks rather low. Do you supplement magnesium or vitamin D?
If you were taking B12 supplements then this is why B12 results are high.
advised that testing 21 days after a dose change was no help, retest should be done 6-8 weeks after any change of dose to give levels time to stabilise. So there's nothing much we can say about your thyroid results until you retest at the appropriate time.
D3(1.25-OH) 81.41 (26.1-95)pg/mL
The test we are familiar with in the UK is the 25-hydroxy-vitamin D (Calcidiol) test which is measured usually in nmol/L and sometimes in ng/ml. You seem to have had the 1.25 dihydroxy-vitamin D (Calcitriol) test. I don't know the optimal levels for your test or how it compares to our test.
Ferritin 102.88 ( 20 - 300)ng/mL
Ferritin is recommended to be half way through range.
Transferrin 2.16 (2.5 - 3.8) g/L
This is part of your iron panel along with your Ferritin. As it is below range you should discuss this with your doctor, maybe ask for a full iron panel to be carried out which should also include Transferrin Saturation Percentage, Serum Iron and Total Iron Binding Capacity (TIBC).
B12 1125 (133- 675) pmol/L = 1,524pg.ml
According to an extract from the book, "Could it be B12?" by Sally M. Pacholok:
"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".
"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."
Yours is rather high and it would be a good idea to stop your B12 supplement altogether now. Our B12 store should be good for a couple of years. You may wish to retest your B12 in about 5-6 months to see how much you are holding on to.
Magnesium seru 0.87 ( 0.70 - 1.15) mmol/L
Testing magnesium is unreliable. About 99% of magnesium is stored in bone, muscles and soft tissues, leaving about 1% in the blood. So testing what's in the blood isn't giving an accurate picture of our magnesium status.
My test result on folate was 9.4 (3.1 - 20.5) ng/L
Your folate level is on the low side, this is recommended to be at least half way through range so with that range you'd aim for 12+
B12 1952 (133 - 675) pmol/L
In your opening post you gave your B12 level as 1125 (133- 675) pmol/L so I am confused as you have now posted a different result.
You have advised I skip b12 (1000mcg Puritan tablets) for now and retest after 6months. I am at lost the sudden out of range level..
Did you test B12 level before starting the Puritan tablets? If so what was the result?
My % saturation was 22.8 - ( 15 - 45)%
iron serum 12.4 (9 - 29) umol/L
Transferrin 2.6 (2.5 - 3.8) g/L - again you have given a different result from your original post above where you said it was 2.16 (2.5-3.8)
Ferritin 102.88 ( 20 - 300)ng/mL
Optimal iron levels are said to be:
Serum iron: 55 to 70% of the range, higher end for men - yours is 17% through range so is very low.
Saturation: optimal is 35 to 45%, higher end for men - yours is low according to this recommended level
Transferrin: Low in range indicates lack of capacity for additional iron, High in
range indicates body's need for supplemental iron - yours is low in range
Ferritin: Low level virtually always indicates need for iron supplementation; High level with low serum iron/low saturation indicates inflammation or infection - yours is 29.6% through range so is on the low side
Iron is complicated and you can see from your results and the recommended optimal levels that they are conflicting. Your serum iron and saturation are low yet which could suggest you may need iron supplements, yet your transferrin is low which doesn't suggest supplementing. I can't advise, you should go through these iron panel results with your doctor.
Thanks once again..my regrets, The Tranferrin is 2.16 and not 2.6g/L
secondly, the Medical lab called today for an amended error which is now 1951pmol/L. It's all their fault.
Thirdly, I did not test my B12 before supplementing with 1000mcg Puritan tablets. I took the tablets two weeks before test. It's likely my B12 was already optimal before I started supplementing. I will definitely retest after 6months.
Finally, I hope to see my GP to discuss further especially my Iron panels.
Thirdly, I did not test my B12 before supplementing with 1000mcg Puritan tablets.
Why did you start supplementing with B12 then? We always advise here to test before starting any supplements to know if we need to supplement and, if so, to guide us as to what dose we need. Some supplements can lead to problems or toxicity if taken when we already have good levels (eg calcium, iron, Vit D).
I think you most likely had a good enough B12 level, maybe even high, and didn't need to supplement. Best thing to do is take no B12 for 5-6 months then test. If it's possible to have Active B12 tested, rather than Total B12, then go for that one because it's the Active B12 that is available for the cells to use, the Total B12 test doesn't tell us how much active B12 is within the total. We can have a good Total B12 level but poor active B12 level.
It's not possible to name sources on the open forum. I don't use NDT so can't suggest any. You will need to make a new post asking for recommendations by private message. Your post will have replies turned off so that no-one puts information on the forum but it will remain visible.
Be aware that NDT without prescription is not available in the UK, it comes from overseas, and there is currently a shortage of Thai NDT. There are currently major delays with postal services and it may even take a while to leave the country from where it's supplied.
However, as has been pointed out in previous replies, you have retested too early. It would be wise to take the advice of members who have responded and retest at the correct time, i.e. 6-8 weeks after your dose increase, early morning before food and only water to drink, and last dose of Levo 24 hours before test. When you see those results you will know whether you have good conversion of T4 to T3 and whether Levo is OK for you, or whether NDT would be more suitable.
Dear Seaside, pls kindly respond to my new test result posted last night. i appreciate greygoose narration.but will also appreciate your view due to the detailed tips you have provided over time that drastically improved my well-being.
I wouldn't worry about the high Vit B12 level at all, but did you have folate tested? I only ask because mine was below range for years and no one mentioned it. I believe that, [and a very low Vit D level] caused many problems for me, as folate works with B12.
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