I had my blood test privately and here are the results. I'm not too great at working out what to do next. I am current on an elimination diet. The blood was taken at 9.30 a.m and 2 month into this diet. I didn't have Levo for 36 hours (as I take it at night) before and had nothing but water in the morning.
Considering I hadn't had magnesium supplements for a while I was quite surprised to see these results
Any help would be most appreciated
36 hours is too long ...so Ft4 is likely a little higher
Next time
If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test
If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal
Ft3 is likely too low
Are you currently on strictly gluten free diet?
Have you noticed any benefits?
Vitamin D, folate and B12 all slightly low
What vitamin supplements are you currently taking
Thanks for responding so quick
I am on the AIP diet so no grains, no dairy, no nuts, not pulses, no nightshade veg, etc...so you eat loads of green veg and meat and fish (although I must admit I try to keep proteins to one meal a day )
I feel a little more energetic and less brain fog, plus I have lost some of the extra pounds I could never shift and fewer digestive issues. The hot flushes have reduce from dripping and burning back to burning skin on face an arms.
I take Selenium+ACE+D, Magnesium, but it looks like I don't need to and sometimes B12 but the one I have has iron with it and as I am eating a little ore meat than usual it haven't taken it lately.
I have a pain around the liver area and gallbladder has polyps, and I know Levo can affect the liver (all investigation come up as normal).
I am a bit lost about what to do next, how much B12 should I take? on its own or as a B complex?
I need to reintroduce food now, starting with egg yoke so may help a little.
Suggest you get some selenium with vitamin E on its own
I would start with separate vitamin D (Plus vitamin K2 MK7)
After 2 weeks add in vitamin B complex
Retest thyroid and vitamins 6-8 weeks after adding last supplement
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
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...
B vitamins
supplement a good quality daily vitamin B complex, one with folate in (not folic acid) may be beneficial.
This can help keep all B vitamins in balance and will help improve B12 levels too
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...
Low B12 symptoms
b12deficiency.info/signs-an...
Thank you I will do my best to digest all the info.
Thank you very much for your help.
I will share these results with my GP and see how she reacts! not holding my breath.
GP unlikely to understand the relevance of low Ft3
You have plenty of room for 25mcg dose increase in levothyroxine
Ft4 only 41% through range
Ft3 only 15% through range
The aim of levothyroxine is to increase dose upwards until Ft4 is in top third of range and Ft3 at least half way through range (regardless of where TSH is) ...important to have optimal vitamin levels too as this helps reduce symptoms and improve how levothyroxine works
guidelines on dose levothyroxine by weight...might help in your argument for dose increase in levothyroxine
Even if we don’t start on full replacement dose, most people need to increase levothyroxine 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.
A small Dutch double-blind cross-over study (ArchIntMed 2010;170:1996) demonstrated that night time rather than morning dosing improved TSH suppression and free T4 measurements, but made no difference to subjective wellbeing. It is reasonable to take levothyroxine at night rather than in the morning, especially for individuals who do not eat late at night.
BMJ also clear on dose required
bestpractice.bmj.com/topics...
At the moment I am on Levo, 100mcg and I now weigh around 57 KG depending on the day 
would it be better total T3
So you may have poor gut absorption ....
Yes quite likely to need addition of small doses of T3 alongside levothyroxine
Email Dionne at Thyroid U.K. for list of recommended thyroid specialist endocrinologists who will prescribe T3
Thank you
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