Blood test results for Erfa medication, do I need to increase or decrease dosage?

[Scout1]

Hi

I wonder if there is someone that would very kindly advise me about by blood results on this wonderful Health Unlocked. I am currently on Erfa 60mg a day.

I would really appreciate your thoughts on how my bloods are doing in reflection to the amount of Erfa I am taking please. If there is any tweaking you suggest to the medication, pleas3 comment. Man6 many thanks Scout xx

Serum total 25-OH vit D level - (HHD) - Normal No Action

47nmol/l

Ref Range: <50 nmol/l suggestive of Vit D insufficiency.Assay measures Total Vitamin D. Repeat measurementwhilst on supplementation not recommended.

05-May-2020

Serum ferritin - (SIM1171) - Normal No Action

37ug/L

Female Reference Range 11 - 307 ug/l ,

Male Reference Range 24 - 336 ug/l

Serum ferritin < 100 ug/l in non-dialysed patients is likely to be iron responsive. Consider iron therapy if anaemic.

05-May-2020

Serum free T3 level - (SIM1171) - Normal No Action

6.5 pmol/L

4.00 - 6.60pmol/L

Please note provisional new reference interval for FT3, effective as of 7/10/2016.

05-May-2020

Serum free T4 level - (SIM1171) - Normal No Action

8.7 pmol/L

Reference range 7.9 - 20.0 pmol/l

Ist Trimester low limit 6.7 pmol/l

2nd Trimester low limit 5.8 pmol

3rd Trimester low limit 6.1 pmol/l

05-May-2020

Serum TSH level - (SIM1171) - Normal No Action

3.37

mu/l

0.34 - 5.60mu/l

[SeasideSusie Remembering]

Scout1

When did you take your last dose of Erfa before the blood test? When on NDT it should be 8-12 hours before blood draw.

Are you taking any supplements?

[Scout1 in reply to SeasideSusie]

Yes took night before

[SlowDragon Administrator]

Looking at previous posts...as you have PCOS presumably you have Hashimoto’s

Vitamin D is too low

Ferritin too low

No B12 or folate tests?

What vitamin supplements are you currently taking

Are you on strictly gluten free diet?

[Scout1 in reply to SlowDragon]

Thanks Slowdragon. No not on gluten free diet. I thought my vitamin d was good. Never had it mentioned by dr or consultant that I have hashimotos disease. How would I know?

[SlowDragon Administrator in reply to Scout1]

Most medics call Hashimoto’s here in UK as autoimmune thyroid disease diagnosed by high thyroid antibodies and/or ultrasound scan of thyroid

hashimotoshealing.com/hashi...

pcosdiva.com/2015/08/got-pc...

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

Ask GP to test vitamin B12 and folate levels Plus thyroid antibodies

Low ferritin GP should do full iron panel test for anaemia ....but GP probably won’t agree

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 .

If/when also on T3, or NDT make sure to take last third or half of daily dose 8-12 hours prior to test, even if this means adjusting time or splitting of dose day before test

Is this how you do your tests?

Vitamins - NHS will only prescribe for deficiencies

So it’s down to individuals to maintain optimal levels

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 with Hashimoto’s 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, with hashimoto’s we frequently need higher dose than average

Government recommends everyone supplement October to April

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

ncbi.nlm.nih.gov/pubmed/286...

Vitamin D deficiency is frequent in Hashimoto's thyroiditis and treatment of patients with this condition with Vitamin D may slow down the course of development of hypothyroidism and also decrease cardiovascular risks in these patients. Vitamin D measurement and replacement may be critical in these patients.

endocrine-abstracts.org/ea/...

Evidence of a link between increased level of antithyroid antibodies in hypothyroid patients with HT and 25OHD3 deficiency may suggest that this group is particularly prone to the vitamin D deficiency and can benefit from its alignment.