Opinions appreciated on my blood results please

[PamBow]

I take 50 mcg of Levothyroxine not taken on day of fingerprick test. B12 inj not taken for 3 month prior to test.

[SeasideSusie Remembering]

PamBow

Thyroid hormones

TSH: 2.63 (0.27-4.20)

FT4: 14.2 (12-22)

FT3: 3.98 (3.1-6.8)

These results show that you are undermedicated. 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 reference ranges. You need to get your TSH down to 1 or below, your FT4 is just 22% through it's range and FT3 is 23.78% through range. You need an increase in your Levo of 25mcg now and retest in 6-8 weeks. Most likely you will need a further increase followed by retesting 6-8 weeks later. Continue until levels are where they need to be for you to feel well.

Raised Thyroglobulin (Tg) antibodies can suggest autoimmune thyroid disease aka Hashimoto's. Although your Thyroid Peroxidase (TPO) antibodies are in range, they aren't exactly low and I would expect they might also be raised if tested another time. You can have Hashi's with negative TPO antibodies and positive Tg antibodies.

**

Vit D isn't too bad but the Vit D Council/Vit D Society recommend a level of 100-150nmol/L. Are you currently supplementing?

**

Ferritin: 59.9 (13-150)

This is on the low side and it's recommended that ferritin is half way through range (82 with that range.

You can help raise your level by eating liver regularly, maximum 200g per week due to it's high Vit A content, also liver pate, black pudding, and including lots of iron rich foods in your diet

apjcn.nhri.org.tw/server/in...

Don't consider taking an iron supplement unless you do an iron panel, if you already have a decent level of serum iron and a good saturation percentage then taking iron tablets can push your iron level even higher, too much iron is as bad as too little.

**

Active B12 >150

This is showing high due to your B12 injections, even though you've been off them for 3 months. I thought it wasn't worth testing B12 when on injections because the results will always be skewed.

Do you also take a B Complex to balance all the B vitamins?

[PamBow in reply to SeasideSusie]

Thankyou for your patience with my not so good IT skills.

I decided to go with these tests due to lockdown and thought they might show an answer through the report as to why I feel so tired, brain fog nerve pain and swelling in knuckle joints.

The doctors report said overall good readings.

I was happy with their service etc but felt perhaps a little lacking in info on my results even though pull down paragraphs explained what things were but I didn’t understand it all.

I was advised a short while ago on this friendly knowledgeable site the same advice you have given me S Susie. I feel so relieved that you have been able to give me more informed answers.

Obviously my next step will be a doctors appointment . When I will need to be prepared for a little negativity.

Thanks so much

[PamBow in reply to SeasideSusie]

I don’t take any b complex vitamins Seaside Susie.

I was advised my calcium levels were low earlier on this year and told to buy over the counter Vit D . Is there a difference between Vit D and calcium tablets.

I was advised on this site that there are different types of calcium... I wasn’t sure which to take... I was taking D3 but stopped as during lockdown I was getting lots of fresh air and sun .By my results do I need D3 or calcium( which one) I understand if you can’t say . Another challenge for my doctor. Thanks again

[SeasideSusie Remembering in reply to PamBow]

PamBow

I don’t take any b complex vitamins Seaside Susie.

It's recommended to take a B Complex when taking B12 in any form, this is because it balances all the B vitamins. It's important to have a good level of Folate (B9) as folate and B12 work together.

Is there a difference between Vit D and calcium tablets.

Yes. Vit D is actually a hormone rather than a vitamin and it is needed so that calcium can be absorbed from the gut into the bloodstream. Our bodies make Vit D from the sun and from some foods - oily fish, egg yolks, liver and red meat. Calcium comes from dairy foods like milk and cheese and some green vegetables.

Vit D aids the absorption of calcium from food.

We should only take Vit D when we have been tested and our level is low.

We should only take calcium when we have been tested and our level is low.

Some prescribed Vit D tablets contain calcium and a GP should always test calcium before prescribing this combined supplement.

I was advised on this site that there are different types of calcium... I wasn’t sure which to take

Sorry but you have remembered that incorrectly. There are different forms of magnesium and you need to check which form would be most suitable for your needs. It is magnesium that is needed when taking Vit D as it helps convert D3 to it's usable form.

The following articles describe each form and what they are useful for:

naturalnews.com/046401_magn...

drjockers.com/best-magnesiu...

afibbers.org/magnesium.html

I was taking D3 but stopped as during lockdown I was getting lots of fresh air and sun

Well, that depends on what your Vit D level was. Also, some of us make Vit D from the sun easily but some of us don't. This article covers how much sun exposure we might need for our daily Vit D requirement but it wont necessarily be enough to raise our level if, say, we have Vit D deficiency:

nhs.uk/live-well/healthy-bo...

scroll down to How long should we spend in the sun?

With your current level of 78nmol/L, if you make Vit D easily from the sun you may not need to supplement, and your GP certainly wont prescribe anything with your level. If you are unsure whether you make Vit D well enough from the sun then you could take 1,000 to 2,000iu D3 daily but it would be a good idea to retest in 3 months to check your level.

[PamBow in reply to SeasideSusie]

I really appreciate all your input, especially using wording I understand.thank-you .

[PamBow]

Hi Seaside Susie. The results for my folate came back this morning after retest. Would you when you have time take a look at them please. Folate serum 6.6 ug/L>3.89

The reporting doctor says “ You have normal levels of folate today”. On the chart it is only about half an inch into the green. I am just so weary. I know it’s nothing compared to all these really poorly people. Thanks in anticipation.

[SlowDragon Administrator in reply to PamBow]

As SeasideSusie has said in earlier reply above

When on B12 injections it’s recommended to also supplement a vitamin B complex to keep all B vitamins in balance

This will improve folate levels

Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid.

thyroidpharmacist.com/artic...

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 after breakfast

Igennus Super B is good quality and cheap vitamin B complex. Contains folate. Full dose is two tablets per day. Many/most people may only need one tablet per day. Certainly only start on one per day (or even half tablet per day for first couple of 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...

Have you had 25mcg dose increase in levothyroxine yet?

Bloods should be retested 6-8 weeks after each increase

[SlowDragon Administrator in reply to PamBow]

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. Teva contains mannitol as a filler, which seems to be possible cause of problems. 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

Teva and Aristo are the only lactose free tablets

healthunlocked.com/thyroidu...

Teva poll

healthunlocked.com/thyroidu...

No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.

Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away

(Time gap doesn't apply to Vitamin D mouth spray)

[PamBow in reply to SlowDragon]

👍🏻

[SeasideSusie Remembering in reply to PamBow]

PamBow

I'm sorry I didn't see your reply but I didn't get notification because you didn't reply to me, you effectively replied to yourself. When replying to a particular member you need to click on the blue REPLY box directly beneath the message you are replying to and that triggers a notification to the member and it will show up as "PamBow in reply to SeasideSusie" as you have done in previous replies.

Alternatively, you can tag the member by putting @ directly in front of their user name, a list of suggestions will come up and you click on the member's name that you want then it will turn blue in your message, as I have done in this reply to you.

Your folate is on the low side, it would be better in double figures but I see that SlowDragon has suggested a couple of good, bioavailable brands which contain methylfolate. I like Thorne Basic B and I know that SlowDragon likes Igennus Super B.

[PamBow in reply to SeasideSusie]

Oh Seaside Susie, good to hear from you. Thankyou for replying. I can remember some where in our chats it was mentioned I was Locked out ....(due to maybe me confusing people when I couldn’t print my thyroid results and u came to the rescue. One of my problems is I don’t concentrate enogh🤣sorry. Yes I wondered whether it was a low reading . Am I still locked out Susie still...

Thankyou again( I cant say it enough.

[SeasideSusie Remembering in reply to PamBow]

PamBow

Not sure what you mean by "locked out". You are certainly allowed to post, as you can see

Some of your posts were closed, this is because you were spreading your results over multiple posts. This gets confusing when you are needing replies/guidance/suggestions on a batch of tests that were done together. So we leave one post open for replies and close the other posts and link to the post that's been left open. Otherwise your tests would be taken out of context and members would not see the whole picture.

We can only post one photo in the opening post of a thread. When we have a situation like yours, it's much better and less confusing for one photo to be put in the opening post and the other results typed in instead of making multiple new threads.

[PamBow in reply to SeasideSusie]

I’m a nightmare for you.... glad you understand and are patient.... must be my brain cells... I keep reassuring myself by thinking at least I try😪🤣👍🏻

[PamBow]

Thankyou Slow Dragon for replying.

I was waiting for the folate test to come through and then see if a doctors appt was available to discuss the 25 mcg increase in Levothyroxine. I’m not looking forward to discussing the increase as I’m not very good at putting things over. I did broach in the New Year and was told by the doctor my levels were ok. I try and take in all the gratefully received information but don’t know how to print off simplified info for doctor. The Medichecks doctors on thyroid and folate results both said my results are ok . I just thought they may be more informed about an increase in Levothyroxine.

That’s why I rely so much on HealthUnlockeds advice. I am overthinking things in my brain and energy levels are low. I try to-make myself do 10000 steps a day but that is dropping now to approx 3000.

I have started a B complex tablet but will get the ones you advise I will check the folate on the ones I take.

I’m so sorry if I have hindered anyone on this site.

[SlowDragon Administrator in reply to PamBow]

Suggest you print off your medichecks results to take along to GP

Also print these off and highlight relevant sections

Official NHS guidelines saying TSH should be between 0.2 and 2.0 when on Levothyroxine and Ft4 around 18

(Many of us need TSH nearer 0.2 than 2.0 to feel well)

See box

Thyroxine replacement in primary hypothyroidism

pathology.leedsth.nhs.uk/pa...

New NHS England Liothyronine guidelines July 2019 clearly state on page 13 that TSH should be between 0.4-1.5 when treated with just Levothyroxine

Note that it says test should be in morning BEFORE taking Levo thyroxine

Also to test vitamin D, folate, B12 and ferritin

sps.nhs.uk/wp-content/uploa...

Aim is to bring a TSH under 2.5

gp-update.co.uk/SM4/Mutable...

Also ....guidelines by weight might help push for dose increase

Even if we don’t start on full replacement dose, most people need to increase dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until on full replacement dose

NICE guidelines on full replacement dose

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

gp-update.co.uk/Latest-Upda...

Traditionally we have tended to start patients on a low dose of levothyroxine and titrate it up over a period of months.

RCT evidence suggests that for the majority of patients this is not necessary and may waste resources.

For patients aged >60y or with ischaemic heart disease, start levothyroxine at 25–50μg daily and titrate up every 3 to 6 weeks as tolerated.

For ALL other patients start at full replacement dose. For most this will equate to 1.6 μg/kg/day (approximately 100μg for a 60kg woman and 125μg for a 75kg man).

If you are starting treatment for subclinical hypothyroidism, this article advises starting at a dose close to the full treatment dose on the basis that it is difficult to assess symptom response unless a therapeutic dose has been trialled.

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...

Suggest you only produce some of these guidelines...and only if GP refuses to increase dose.

Only increase by 25mcg dose upwards at any one time

[PamBow in reply to SlowDragon]

Thankyou, ...you and Seaside Susie have given me much more confidence to approach the doctor.

Bye bye

[SlowDragon Administrator in reply to PamBow]

Come back with new post once you have seen GP

Let us know how you get on

Bloods should be retested 6-8 weeks after EACH dose increase

[PamBow in reply to SlowDragon]

Ok , bye Slow dragon

[SlowDragon Administrator in reply to PamBow]

One final thought

Many many people find it very helpful to take along a supportive friend or family member to GP consultation...(preferably male)...they don’t need to say anything. Just be there as a witness.

[PamBow]

What a good idea. 👍🏻

Thankyou