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[80-10]

Hi all. I have just had the results of blood tests carried out with Medichecks and wonder if anyone can help me with adjusting medication.

I had a TT a couple of years ago and thyroid readings have not been too bad since, fluctuating a bit, but I have always felt well since its removal, SO much better than before. My hyperthyroidism gave me frequent palpitations, heart missing a beat, tense body, not to speak of damage to my eyes, resulting in eye surgery in 2011.

Over the last couple of weeks I have noticed that my heart is missing a beat fairly frequently, and my body feels on edge, although I myself am not on edge (does that make sense??), symptoms that I recall so well before the thyroidectomy.

This led me to believe that my medication, levothyroxine, probably needs adjusting. So I had the blood tests done. These are the results...

TSH 0.176 (0.27- 4.2), FT3 4.24 (3.1- 6.8)

FT4 18 (12 - 22)

FERRITIN 125 (13 - 150), FOLATE 7.3 (3 - 8.9), VIT B12 112 (>37.5), VIT D 72.4 (50-175)

THYROGLOBULIN ANTIBODIES 12.8 (<115), THYROID PEROXIDASE ANTIBODIES 9(<34)

Since December 2019, I have been taking Levo Mon-Thurs 100mcg, and Fri-Sun 75mcg. I did have blood tests in Feb 2020,

TSH 0.4438 (0.28-4.6 different norms from above as done in Italy), FT3 2,89 (1,70-3.70), FT4 1.09 (0.70-1.50), after which I kept on the same medication.

So, after latest blood tests, looks as though I need to reduce the dosage.

If any of you have had the patience to look through this, would you have any suggestions as to a new dosage? I was thinking maybe:

Mon 75, Tues 100, Wed 75, Thurs 100, Fri, Sat, Sun 75.

What do you reckon?? Thanking you in advance.

Take care everybody and stay safe.

[Lalatoot]

Why would you need to reduce the dosage? Your FT3 is not even half way through the range and your FT4 is not over range. This means you are not overmedicated.

Funny heartbeats also occur when undermedicated. I think if you reduce you will make things worse.

[80-10 in reply to Lalatoot]

Thanks Lalatoot. It's just that TSH is so low. That's what made me think I was over medicated.

[SlowDragon Administrator]

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)

Is this how you do your tests?

Assuming it was

Well currently results show

Ft4 only 60% through range

Ft3 only 31% through range

So you are unlikely to benefit from dose reduction in levothyroxine , unless T3 is added

Poor conversion of Ft4 to Ft3 is common issue

It may be that symptoms are because Ft4 is a bit too high for you

But it may be due to Ft3 being too low

Vitamin D and Folate could be slightly better

What vitamin supplements are you currently taking?

Selenium supplements can help improve conversion

Presumably you have Graves’ disease?

Have you tried strictly gluten free diet?

[80-10 in reply to SlowDragon]

Hi Slowdragon, thanks for your response.

Yes, I did the blood tests in the correct way, and, yes I was originally diagnosed with Graves. Just a bit confused, if it is possible that my FT4 is a bit high for me, would not a slight reduction in levo be something to try? Despite having thyroid problems since 2000, and probably even before, I am still trying to get my head round understanding this wretchedly complicated organ!!

I am taking no vitamin supplements, only calcium. I would be keen on taking silenium, give that a try, and maybe Vit D and Folate. Would you have a suggestion as to the sort of dosage? Also, should vitamins be taken some time away from the levo?

May I ask you a question. Have you ever heard of thyroid regeneration after a thyroidectomy? The reason I ask is that some 6 months after my thyroidectomy, I had a scan on my neck. (In Italy, not UK). I live a good part of the year in Italy and am under an endocrinologist there, and he did the scan. (Interestingly, I was also seeing an endocrinologist in the UK, since 2007 in fact, and in all that time he never suggested a scan, never ever had one in the UK, neither before nor after the thyroidectomy. I was told by the Italian endo, that he could see residual remains of the thyroid on either side, which the UK endo said was not possible and did not even want to see the pictures. After this Mr UK said I would probably be better to stick with the Italian! He's probably right.

Thank you for your time. Stay safe.

[SlowDragon Administrator in reply to 80-10]

Never ceases to amaze me how thorough other countries are (Poland often comes up as very good on thyroid testing)

Yes there are a few cases been mentioned on here about regrown. Well done Italian endo for organising scan

Are you taking calcium because parathyroids were damaged/removed?

If you reduce levothyroxine your Ft3 is almost certain to drop too. Though this doesn’t always happen, if TSH rises due to drop in levothyroxine, then conversion might improve

You could leave dose levothyroxine as it is and work on improving conversion by improving vitamins

Or you could reduce levothyroxine slightly and work on Improving vitamins

Vitamin D

GP will often only prescribe to bring levels to 50nmol.

Some areas will prescribe to bring levels to 75nmol

leedsformulary.nhs.uk/docs/...

GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)

mm.wirral.nhs.uk/document_u...

NHS Guidelines on dose vitamin D required

ouh.nhs.uk/osteoporosis/use...

But on levothyroxine improving to around 80nmol or 100nmol by self supplementing may be better

ncbi.nlm.nih.gov/pubmed/218...

vitamindsociety.org/pdf/Vit...

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

Test twice yearly via vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function. There’s a version made that also contains vitamin K2 Mk7

It’s trial and error what dose we need

Government recommends everyone supplement October to April

gov.uk/government/news/phe-...

Also read up on importance of magnesium and vitamin K2 Mk7 supplements when taking vitamins

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

[80-10 in reply to SlowDragon]

Thank you so much. I have lots to study!!

[pennyannie]

Hello 80 - 10 :

Just to say a fully functioning working thyroid would be supporting you on a daily basis with approximately 100 T4 + 10 T3. I just think that if there has been a medical intervention and the thyroid surgically removed or ablated with RAI that both these vital hormones need to be on the patient's prescription for if, and probably when needed to maintain a level of acceptable health for the patient.

T4 - Levothyroxine is a prohormone that needs to be converted by the body into T3 , the active hormone that the body runs on. I read T3 is about 4 times more powerful than T4 and that the average persons uses about 50 T3 daily just to function.

Your ability to convert the T4 into T3 can be compromised if your vitamins and minerals are not maintained at optimal levels, and ferritin, folate B12 and vitamin D play very important roles in maintaining your core strength and stability.

Some people can get by on T4 alone, some people at some point in time simply stop converting the T4 into T3 and some people simply need both these essential hormones dosed and monitored independently to bring these two vital hormones into balance and a level of well being acceptable to the patient.

As you can see from the above just loosing your own natural production of T3 has meant you have lost around 20% of your overall well being and over time this can be very wearing,

and the logical solution might be to supplement with T3 and T4 thyroid hormones, which you may find easier to obtain in Italy as currently T3 is very difficult to have prescribed on the NHS.

The thyroid is a major gland and is responsible for your full body synchronisation, including your mental, physical, emotional, psychological and spiritual wellbeing, your inner central heating system and your metabolism.

Since you have Graves Disease, it is imperative that you are dosed and monitored on your T3 and T4 blood test results with the aim being to get both hormones in the upper quadrants of their relevant ranges, balanced to around a 1/4 ratio of T3 to T4. and obviously at a level that you find acceptable.

Graves is an autoimmune disease and as such, it's for life. It's in your blood and your DNA.

Graves people have antibodies that latch on to their T3 receptors, driving down your TSH - as that is how you went ' hyper ' in the first place. You could draw a parallel with your foot stuck down on the ' gas ' pedal - these receptors may still be influencing a TSH blood reading, but since you have lost your engine, your thyroid, they have no bearing on your levels of thyroid hormones.

These antibodies can still be present in your blood, and for Graves disease patients especially, the TSH blood test is known to be an unreliable marker and used in isolation, not worth the paper it's written on.

You might like to take a look at the following :-

Your Thyroid and How To Keep It Healthy is written by a doctor who has hypothyroidism. It is written by Barry Durrant - Peatfield and a relatively easy read on all things thyroid and though we do not now have this amazing little in size though major in it's usage we do need to know how to compensate accordingly.

Elaine Moore has Graves disease and went through RAI thyroid ablation in the late 1990's. Finding no help with her continued symptoms, and as a medical technician, she started her own research into this badly understood and poorly treated autoimmune disease, and wrote a book to help others who might be in a similar situation. Roll on a good few years and there are several books and a very well researched and respected website covering all things Graves, and just like this amazing website, there is an open forum where the community help each other, and where Elaine also takes an active role.

I'm with Graves diagnosed in 2003, RAI thyroid ablation in 2005 and became very ill some 8 years later. Thanks in the most part to the above recommendations I am now self medicating, buying my own full spectrum thyroid hormones, much improved and getting my life back on track.

[80-10 in reply to pennyannie]

Thank you so much for your in-depth reply. I shall read mark learn and inwardly digest!!

[pennyannie in reply to 80-10]

Be careful of indigestion !!!

[SeasideSusie Remembering]

80-10

FOLATE 7.3 (3 - 8.9)

I think you've made a typo there. Medichecks Folate range is 3.89 - 19.45 I believe if you look at the green bar graph that comes with your results.

Folate is recommended to be at least half way through range so that would be about 12+ with that range.

[80-10 in reply to SeasideSusie]

Hi Seaside Susie. Yes, you are right about the typo, the numbers were right, but dots and dashes all of a kimbo!

What I should have typed, as follows...

7.3 ug/L (Range: > 3.89)

Thanks for spotting that!

Just going through the results again, don't quite follow something they wrote about Vit D ......

Vit D 72.4 nmol/L (Range 50 - 175)

Deficient <30

Insufficient 30 - 50 Consider reducing dose >175

Don't get that last bit. I don't take Vit D supplement, not sure what they mean.

Can you throw any light?

Thanks Seaside Susie.

[SeasideSusie Remembering in reply to 80-10]

80-10

Vit D 72.4 nmol/L (Range 50 - 175)

Deficient <30

Insufficient 30 - 50 Consider reducing dose >175

Don't get that last bit. I don't take Vit D supplement, not sure what they mean.

That's just standard blurb which goes on all result reports, they're giving the ranges..

There are categories for Vit D, each having their own range, which they always quote.

Deficient = <30

Insufficient = 30-50

Sufficient = above 50 but I can't remember the upper limit although it may be 175.

Then above 175 they suggest reducing your dose of D3 if you supplement. They're not assuming that you take a supplement.

My response for Vit D is always:

The Vit D Council recommends a level of 125nmol/L and the Vit D Society recommends a level of 100-150nmol/L. (I always keep mine as close to 150nmol/L as possible and now that there has been shown to be a link between Vit D level and the immune system's response to Covid 19, I think it's a good idea to ensure we all have a decent level).

To reach the recommended level from your current level, based on the Vit D Council's suggestions you could supplement with 3,000iu 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:

vitamindtest.org.uk/

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.

naturalnews.com/046401_magn...

drjockers.com/best-magnesiu...

afibbers.org/magnesium.html

As for supplements, I have always done very well with Doctor's Best D3 softgels, a nice clean supplement with no excipients, just D3 and extra virgin olive oil, small gel cap and very reasonably priced.

For K2-MK7 I like Veravego or Vitabay.

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.

I hope that helps

[80-10 in reply to SeasideSusie]

Gosh thanks for that very in-depth reply!! Very grateful, and it really does help. So I know what I'll be doing today, getting my head round all that!!!

Thank you for taking the time