New results - good/bad news: Following advice on... - Thyroid UK

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New results - good/bad news

Ljdaly74 profile image

Following advice on here, I have increased levo gradually from 50 to 125mcg as want to get optimal to conceive. Have been advised t3 to t4 conversion ratio is ok but t4 was on low side. Latest results show increase in t4 which is good, but tsh gone down so just had phone call from gp they want to decrease levo dose!! When i started saying all the advice i got here she started backing down but wants to refer me to endo.

All vitamins results were ok apart from ferritin and b12 so been supplementing but disappointed to see b12 has gone down. Ferritin increased but only slightly.

Grateful for any advice thanks

Serum TSH level 0.06 mu/L [0.3 - 5.0] decreased slightly

Serum free T4 level 12.9 pmol/L [7.9 - 16.0] increased from around 10

B12 decreased from 496 to 405

Ferritin increased 22 to 38

15 Replies

Good for you!

So your free T4 is now 61.7% through range. You don't have a free T3 result this time but know your conversion is good, so I would say to the endo that you are DELIGHTED your TSH isn't too high, and your emphasis now is surely to have your free T4 kept at least 60% through range - and possibly higher - and to monitor your free T3, because that's the active thyroid hormone which is needed in every cell in your body.

And tell him if you are feeling well; if your hair is good etc - all of which would confirm that you are on the right dose - or if you have symptoms which might require a slight increase in levo, given there's plenty of space in range for it to go up a bit.

As regards ferritin, do you try and eat liver (yuk) or liver pate regularly?

Thanks! Ooh thats good re t4 percentage will let GP know. No not tried liver yet for ferritin, will do. Supplements seem to have improved results a bit. Disappointed re b12 going down :/

Got below reply from endo, i am prescribed 100 levo but have been taking 125 as have spare. Think scuppered my chance of getting increase :(

Thank you for your message today, sent as Advice Conversation. I note the query about thyroid replacement therapy. I have read the email exchange you included with the message and I have seen the blood test results. The email exchange includes advice to aim for serum TSH in the lower part of the reference range. This is in line with standard practice and our local practice also. The last blood test result included TSH 0.08mU/L (which is below the reference range). I agree that on the basis of the available information, there is no indication to increase the dose of Levothyroxine.

Well they're not reducing it so I suppose that's something. Have you "confessed" to taking 125 mcg? They seems happy with what you're taking, so may as well increase the prescription to 125 ... and then if you feel rough later on you can use some of your "spare" to take say another 25 mcg on alternate days [I'm a big fan of having a bit of "spare" around :) ]

No not confessed, should i? How should i?!! My joints dont ache so much now so must be doing me good!

GP agreed to 125mcg 😁 so now can hopefully remain at good level

Brilliant! :)

SlowDragon profile image
SlowDragonAdministrator

What vitamin supplements are you currently taking?

Obviously you need TSH, Ft4 and Ft3 tested together

Important to test folate before TTC

Vitamin D needs testing too

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

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).

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...

As you have Hashimoto’s are you on strictly gluten free diet?

Ljdaly74 profile image
Ljdaly74 in reply to SlowDragon

Thanks have followed these instructions a few times now :) i know i am hash/hypo, have good t3/4 conversion, low t4 but now seems good range at over 60% through range. Vits have all been commented before mostly fine apart from b12 and ferritin (take vid d and folic acid for ttc)

SlowDragon profile image
SlowDragonAdministrator in reply to Ljdaly74

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

thyroidpharmacist.com/artic...

Apparently both folate and B12 are Goldilocks vitamins for pregnancy. Seems you don’t want too little or too much

statnews.com/2016/05/11/aut...

Read up on optimal levels

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)

Or Thorne Basic B or jarrow B-right are other options that contain folate, but both are large capsules and may be too high a dose

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...

humanbean profile image
humanbean in reply to Ljdaly74

Vits have all been commented before mostly fine apart from b12 and ferritin (take vid d and folic acid for ttc)

In a healthy person folic acid is converted into some form of folate before the body can make use of it. Unfortunately many people who have thyroid problems can't do that conversion very well.

To get enough folate people like us usually need to supplement methylfolate directly, rather than have lots of unconverted folic acid floating around.

It is worth pointing out that folic acid isn't something that occurs in nature. People get folate from food, not folic acid. The human body was never exposed to folic acid until it was developed in a laboratory in 1943.

For more info on the differences between folic acid and folates this article is well worth reading, particularly for women who want to conceive :

chriskresser.com/folate-vs-...

Amazon and other sites selling supplements usually have a large range of products which contain folate in some form rather than folic acid.

Edit : I see SlowDragon posted about folate/folic acid just before me. :)

Ljdaly74 profile image
Ljdaly74 in reply to humanbean

I get 5mg f.a. prescribed and blood results were fine

Ljdaly74 profile image
Ljdaly74 in reply to humanbean

Do GPs prescribe folate rather folic acid do you know?

humanbean profile image
humanbean in reply to Ljdaly74

I think GPs usually only prescribe folic acid.

If you go to Amazon and search for "folate supplements" you get many, many choices of products to buy. I recently bought these :

amazon.co.uk/gp/product/B07...

I take one, four times a week, so they will last me more than a year.

New results after 3 months:

Serum vitamin B12 level 436 ng/L [120.0 - 900.0]

Adequate B12 stores.If the patient is on IM B12

therapy, it is not necessary to monitor B12 levels

Serum ferritin level 52 ng/mL [15.0 - 300.0]

Ferritin >15 and <100ng/mL. With low Hb and MCV,

a normal ferritin in the presence of inflammatory

changes does not exclude iron deficiency.

Thyroid function test

Serum TSH level 0.14 mu/L [0.3 - 5.0]

Below low reference limit

Serum free T4 level 11.3 pmol/L [7.9 - 16.0]

Plasma fasting glucose level 5.6 mmol/L [3.5 - 6.0]

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