Recent Check

[SMXX]

Requested a thyroid check with the doctor and have just checked the results.... I’m guessing that they’ll state no action as within normal range !! What else can I do ?? It’s rising every time it’s checked... x

[SlowDragon Administrator]

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

Can see you recently started on B12 injections.....low B12 often linked to being hypothyroid

Ask GP to test vitamin D, folate and ferritin levels plus thyroid antibodies

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 .

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 vitamins including folate (private blood draw required)

medichecks.com/products/thy...

Thriva Thyroid plus antibodies and vitamins By DIY fingerpick test

thriva.co/tests/thyroid-test

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off if go on thyroid uk for code

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

monitormyhealth.org.uk/thyr...

Medichecks - JUST vitamin testing including folate - DIY finger prick test

medichecks.com/products/nut...

Medichecks often have special offers, if order on Thursdays

[SMXX in reply to SlowDragon]

Thank you so much ... things are slowly starting to make sense to me. I’m going to call doctor tomorrow and discuss the blood results as only had them taken on Thursday(it was 4pm) so not early in the morning as you’ve suggested is best for supporting treatment. I think I’ll also order the additional tests needed too.

Is there any Nice Guidance to refer to as we have for B12 and pernicious anaemia?.

Thanks again for your help it’s much appreciated x

[SlowDragon Administrator in reply to SMXX]

Getting GP to recognise you need treatment is often tricky

See flow chart on page 2

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

New NHS England Liothyronine guidelines July 2019

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...

NICE guidelines

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

Medics will deny time of day of testing is important....research shows otherwise

Very important when you test TSH ....

researchgate.net/publicatio...

“According to the current TSH reference interval, hypothyroidism was not diagnosed in about 50% of the cases in the afternoon.”

“Further analysis demonstrated inadequate compensation of hypothyroidism, which was defined in 45.5% of the morning samples and in 9% of the afternoon samples”

ncbi.nlm.nih.gov/pubmed/252...

TSH levels showed a statistically significant decline postprandially in comparison to fasting values. This may have clinical implications in the diagnosis and management of hypothyroidism, especially SCH.

Median TSH graph......TSH should be under 2

healthunlocked.com/thyroidu...

TSH daily variation

healthunlocked.com/thyroidu...

[SMXX in reply to SlowDragon]

Very interesting.... I’ve just logged back into my medical records and this graph (added to original post) Is very telling. The increase in TSH since diagnosis of pernicious anaemia, vitamin D and folate deficiency !! Thanks again 😊 x

[SlowDragon Administrator in reply to SMXX]

Exactly demonstrates what we see on here time and time again

PA is autoimmune.....makes autoimmune thyroid disease likely

Do you already have low vitamin D and low folate diagnosed?

What was vitamin D level and what prescribed

Same question for folate

You need ferritin tested too

[SMXX in reply to SlowDragon]

My Vitamin D was 42 and I was prescribed the standard blue capsules (can’t remember what they are called) my Folic acid was very low but has been for a long time (cannot find the numbers - they haven’t retested me) they have prescribed 5mg Folic to take daily.

Cannot find anything for folate. To date they haven’t retested me for Vitamin D either since diagnosis of deficiency.

[SlowDragon Administrator in reply to SMXX]

They won’t retest either of them

It’s down to us the patients to get FULL Thyroid And vitamin testing

Suggest you test vitamin D now if not doing full thyroid and vitamin testing

vitamindtest.org.uk

Aiming to improve to at least around 80nmol

Vitamin D mouth spray with vitamin K2 works well as absorbed in mouth not gut

Often cheaper on Amazon

betteryou.com/vitamin-d-k2

[SMXX in reply to SlowDragon]

Thanks 😊... so helpful!!

I’m going to order some tests tonight and take the steps needed to get myself sorted. X

[SlowDragon Administrator in reply to SMXX]

Remember to do blood test as early as possible in morning before eating or drinking anything

If taking any supplements that contain biotin stop a week before ALL BLOOD TESTS

Only do test on Monday or Tuesday morning and post back via tracked 24 hour postal service

Come back with new post once you get results

[SlowDragon Administrator in reply to SMXX]

NHS only prescribe Folic acid ...it’s used to treat low folate

[SlowDragon Administrator in reply to SMXX]

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 assuming you have 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

(NHS budget only allows one test every 2 years)

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

Calculator for working out dose you may need

40ng/ml = 100nmol

grassrootshealth.net/projec...

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 vitamin D

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...

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.

[SlowDragon Administrator in reply to SMXX]

As you have B12 injections it’s recommended also to supplement a good quality daily vitamin B complex, one with folate in (not folic acid) may be beneficial.

Rather than just NHS prescribed folic acid

This can help keep all B vitamins in balance and will help improve B12 levels too between injections

Difference between folate and folic acid

chriskresser.com/folate-vs-...

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

thyroidpharmacist.com/artic...

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...

[SMXX in reply to SlowDragon]

I’ve just included another pic of results... don’t know if they are related but we’re abnormal. MCV and MCH ?? X

[SlowDragon Administrator in reply to SMXX]

Probably due to Low folate and/or low B12

healthline.com/health/mch#h...

[McPammy]

That TSH looks elevated. My private only Endocrinologist informed me that a TSH over 2.5 is hypothyroidism. However, the NHS won’t treat hypothyroidism until your TSH gets beyond 10. Most other countries treat at 3. So if you where living in Germany you’d be getting treated now.

Check your T4 and T3 levels too. If your GP won’t then try to get your bloods done privately. Also check your B12, Ferritin, Vit D and folate as these help converting T4 to T3.

[SMXX in reply to McPammy]

Thank you for this... it’s so damn frustrating that we have to fight and struggle for treatment. I’ve got pernicious anaemia so this makes sense that I’ve elevated TSH results and is slowly adding up with my symptoms and struggles. X