Just wondering if anyone can help me out with my test results.
I’m currently on 125mg Levothyroxine after having a complete thyrodectomy in 2015. I can see my TSH levels are in the normal range but still quite high, also in low in Vit D. I’m not taking any supplements for this currently. I feel pretty lethargic at times and am having trouble getting my weight back down to where it was before I had my thyroid removed. Plus a few others things that go with having an underactive thyroid.
Am I right in thinking that if my thyroid stimulating hormone is maintained in the lower half of the normal range (i.e. less than 2.5) then I should start to feel and function somewhat normally? Also, can it be that my dosage is too high which is causing the T4 problems in being converted by the T3?
These are my recent test results from 07/04/20.
CRP HS <5 0.63 my/L
Ferritin 13- 150 141 ug/L
Folate-Serum >3.89 >19.8 ug/L
Vitamin B12 Active >37.5 57.3 pmol/L
TSH 0.27 - 4.2 3.75 mlu/L
Free T3 3.1-6.8 3.37 pmol/L
Vitamin D >50-175 44.5 nmol/L
Free Thyroxine 12-22 18.3 pmol/L
Throglobin Antibodies <115 13.5 kIU/L
Thyroid Peroxidase Antibodies <34 <9 kIU/L
Sorry for all the questions and thanks in advance for your help.
Written by
Curlybrown
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Can you add the reference ranges please, ranges vary from lab to lab.
The aim of a Hypo patient on Levo, generally, is for TSH to be 1 or below with FT4 and FT3 in the upper part of their ranges. We can see that your TSH is too high.
Vitamin B12 Active - 57.3 pmol/L
Active B12 below 70 suggests testing for B12 deficiency, see Viapath at St Thomas' Hospital:
If you do have any then list them to discuss with your GP and ask for testing for B12 deficiency and Pernicious Anaemia. Do not take any B12 supplements or folic acid/folate/B Complex supplements before further testing of B12 as this will mask signs of B12 deficiency and skew results.
also in low in Vit D. I’m not taking any supplements for this currently.
What's the Vit D result? Important to supplement at the right level based on the result.
You may or may not be able to get D3 prescribed, personally I wouldn't bother, you will get a much better supplement yourself.
The Vit D Council recommends a level of 125nmol/L and the Vit D Society recommends a level of 100-150nmol/L. To reach the recommended level from your current level, based on the Vit D Council's suggestions you could supplement with 4,000-5,000iu D3 daily
Retest after 3 months.
Once 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:
Your thyroid antibodies are negative and with good Ferritin and Folate results it doesn't suggest that you've got an absorption problem (unless you're already supplementing?) The cheapest and cleanest way to supplement is with an oil based softgel which contains minimal ingredients (no excipients). I would suggest you look at Doctor's Best D3, I use this brand and it raised my severe deficiency of 15nmol/L to 202 in 2.5 months and I still use it for my maintenance dose.
Doctors don't know, because they're not taught much about nutrients, but there are important cofactors needed when taking D3 as recommended by the Vit D Council.
D3 aids absorption of calcium from food and Vit 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 D3 as 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 magnesium as tablets/capsules, no necessity if using topical forms of magnesium.
TSH is high, as mentioned. FT4 is 63% through it's range and FT3 is only 7.3% through range. You really need to get your TSH down to around 1, address the low B12 level and Vit D level, then see where FT4/FT3 lie. If FT3 is still low that would indicate poor conversion and you may benefit from the additionof T3 to your Levo.
Supplementing with selenium and zinc is said to help with conversion so you may want to try those, but you might want to test their levels first.
Also, can it be that my dosage is too high which is causing the T4 problems in being converted by the T3?
I'm afraid I don't understand what you mean there. If your dose was too high your TSH would be very low and your FT4 would be high. As your TSH is high in range with FT4 63% through range, there is plenty of room for an increase in your Levo, 25mcg now, retest in 6-8 weeks. Ask your GP for an increase, using the following information to support your request if necessary:
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
Also, 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.
Many people find Levothyroxine brands are not interchangeable.
Once you find a brand that suits you, best to make sure to only get that one at each prescription.
Watch out for brand change when dose is increased or at repeat prescription.
Many patients do NOT get on well with Teva brand of Levothyroxine. Though it is the only one for lactose intolerant patients. Teva is the only brand that makes 75mcg tablet. So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half
B vitamins best taken in the morning after breakfast
Igennus Super B complex are nice small tablets. 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 Thorne Basic B or jarrow B-right are other options that contain folate, but both are large capsules
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
Can I just add a fully functioning working thyroid would be supporting you on a daily basis with approximately 100 T4 + 10 T3.
T4 is Levothyroxine, a storage hormone which your body needs to be able to convert into T3 the active hormone that the body runs on, and I read T3 is about 4 times more powerful than T4., and I read most people need about 50 T3 a day just to function.
Personally I just think it makes common sense that if there has been a medical intervention and the thyroid either surgically removed or ablated with RAI that both these vital hormones be on the patent's prescription for if, and probably when required.
Some people can get by on T4 alone, some people at some point in time simply stop being able to convert the T4 and some people simply need both these essential hormones dosed and monitored independently to bring them both into balance and range and to a level of wellness acceptable to the patient.
The ability to convert the Levothyroxine can be compromised if your vitamins and minerals are not optimal, so these need to be supplemented and maintained at good levels.
Even with optimal vitamins and minerals you will be aware that you have lost your own natural production of T3 and this little bit actually constitutes about 20% of your overall wellbeing and ultimately over time this down regulation may take it's toll on your body.
The thyroid is a major gland responsible for full body synchronisation, and the controller of your mental, physical, emotional, psychological and spiritual wellbeing and your engine controlling your inner central heating system and your metabolism.
If you lost your Thyroid through Graves Disease you might like to take a look at the following website :- Elaine Moore Graves Disease Foundation website :
However you lost your thyroid you may find the following book very useful :
Written by a doctor who has hypothyroidism, Barry Durrant-Peatfield writes in an easy, sometimes funny, insightful way, and Your Thyroid and How To Keep It Healthy is relevant, as living without a thyroid isn't much fun, so we do need to understand all that it does so to try and compensate accordingly.
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