Tsh

[Soundwell1]

Hi my latest thyroid test done by gp tsh 0.07 range 0 20 -4.50

T4 14 range 7.0 - 17

No t3 as expected

B12 259 no range

D vit 66.7

Gp has told me to go down to 75 levo.

Didn't take any t4 for 34 hours.

[SeasideSusie Remembering]

Soundwell1

Didn't take any t4 for 34 hours

Is that a typo and you meant 24 hours?

If it's actually 34 hours then you have a false low FT4.

If it's 24 hours then your FT4 is in a good place and no need to reduce Levo. Your GP is dosing purely by TSH which is wrong. TSH is a pituitary hormone, a signal from the pituitary to tell the thyroid to make hormone when it detects there's not enough. If TSH is low then the pituitary is satisfied and doesn't need to send the signal. If your left 24 hours between last dose and blood draw then your FT4 is reflecting your normal circulating amount.

Do you take Biotin or a B Complex? Did you leave it off for 7 days before the test?

B12 is low. If it's pg/ml or ng/L then it should be at least 550, preferably around 900ish:

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."

Check to see if you have any signs of B12 deficiency here:

b12deficiency.info/signs-an...

If you do 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.

Folate should also be tested when B12 is tested as they work together.

D vit 66.7

Presumably the unit of measurement is nmol/L. If so then your level is low. Are you supplementing?

The Vit D Council/Vit D Society recommend a level of 100-150nmol/L.

[Soundwell1 in reply to SeasideSusie]

Hi, it was meant to read 24 hours.

But what about the tsh it's gone very low just recently.

[SeasideSusie Remembering in reply to Soundwell1]

Soundwell1

As I said above, the pituitary is satisfied that it doesn't need to signal the thyroid to make hormone (because you have a good level of FT4) so the TSH stays low. Unfortunately most doctors don't understand that it the thyroid hormones results - FT4 and FT3 - that tell us if we are adequately medicated and only look at TSH, don't understand how it all works then freak out at a low TSH.

[fuchsia-pink]

Do you feel well on your current dose? You are not over-medicated just because your TSH is suppressed and your free T4 isn't over-range. Shame you didn't get a free T3 result.

[SlowDragon Administrator]

Never ever agree to dose reduction without getting FULL Thyroid test

Low vitamin levels frequently results in low TSH and reduces conversion of Ft4 to Ft3

Ft4 is nowhere near top of range

B12 and vitamin D too low

No folate or ferritin results

Do you have Hashimoto’s?

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also EXTREMELY important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially if you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies

You may need to get full Thyroid testing privately as NHS refuses to test TG antibodies if TPO antibodies are negative

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?

Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins

List of private testing options

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus ultra vitamin

medichecks.com/products/thy...

Medichecks often have special offers, if order on Thursdays

Thriva Thyroid plus vitamins

thriva.co/tests/thyroid-test

Blue Horizon Thyroid Premium Gold includes vitamins

bluehorizonbloodtests.co.uk...

Tell GP you Refuse to reduce dose until you have had full test results back including Ft3

GP should be testing for Pernicious Anaemia with B12 that low

Come back with new post once you get results

[Soundwell1 in reply to SlowDragon]

She did a test for intrinsic factor but came back normal. I had private test for another related methyl something test but can't remember what it was now, only last 6 months by medicheck and it came back normal.

I don't know what to do.

[Stourie in reply to Soundwell1]

Hi Soundwell, normal is just the doctors opinion. You need a copy of all of your results with ranges to know how "normal" your results are. They maybe aren't optimal which is so important. Jo xx

[SlowDragon Administrator]

So looking at your profile...you have type one diabetes...so that autoimmune

Highly likely your hypothyroidism is autoimmune too

Autoimmune thyroid disease (hashimoto’s) is confirmed by testing TPO and TG thyroid antibodies

Recommend you get FULL thyroid test ...TSH, Ft4, Ft3 and both TPO and TG antibodies privately via Medichecks

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?

Private tests are available as NHS currently rarely tests Ft3 or thyroid antibodies or all relevant vitamins

List of private testing options

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus ultra vitamin

medichecks.com/products/thy...

They also offer test without vitamins

Medichecks often have special offers, if order on Thursdays

Thriva Thyroid plus vitamins

thriva.co/tests/thyroid-test

Blue Horizon Thyroid Premium Gold includes vitamins

bluehorizonbloodtests.co.uk...

[SlowDragon Administrator]

Low B12

As GP has tested for PA and not giving B12 injections...you will need to improve yourself by self supplementing

Supplementing a good quality daily vitamin B complex, one with folate in not folic acid may be beneficial.

chriskresser.com/folate-vs-...

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

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

If you have Low B12 symptoms - you may need sublingual B12 lozenges for few/several months. Jarrow B12 sublingual 1000mg available on Amazon

b12deficiency.info/signs-an...

Low vitamin D and low B vitamins may be linked as explained here

drgominak.com/sleep/vitamin...

In YouTube video when Dr Gominak talks about vitamin D levels ...vitamin D at 40ng/ml (USA units) is equal to 100nmol (UK units)

youtu.be/74F22bjBmqE(Not working as expected?)

On levothyroxine we need optimal vitamin levels

NHS will only treat deficiencies

So you will see thousands of posts on here about how to improve low vitamin levels