For full Thyroid evaluation you need TSH, FT4 and FT3 tested.
Also very important to test vitamin D
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
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
I would appreciate a different response, as this copy paste is received every time I post a question, seems like it is not read fully before the reply. I get vitamins tested once every often. So these are ok. What is not Ok I have mentioned in my post hoping to get a more relevant advise and not just a general info how to get tests done.
I am pescatarian, my GP just advised to drink Iron supplements from behind the counter, nothing special, sO I got the highest what I could to boost it up.
Vit D was tested all ok.
I had tested t3 as you can see it was high at the time of pregnancy and hence I was told to reduce from 125 to 100.
Now im not sure if I should increase back to 125 as feel puffed all the time.. it is hard to get t3 tested every time, but looking at other numbers it should have dropped significantly.
Obviously you need to get TSH, Ft4 and Ft3 tested together...making sure to test as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test
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.
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.
What can people supplement with to raise their iron?
Iron salts are the most commonly prescribed iron supplements
1) The higher the iron content of any iron supplement, the fewer people there are who can tolerate it. Always check the label for the pure iron content.
2) People used to be told that iron tablets should be taken on an empty stomach. This advice can be found in lots of places, but it is now out-of-date. People tolerate iron much better with food. It will slow down absorption of the iron, but it reduces the risk of low tolerance and side effects.
3) Iron is best absorbed when taken with vitamin C. Iron supplements can cause constipation. To reduce this risk taking high dose vitamin C can help because it can cause diarrhoea. Adjust the dose of vitamin C as necessary. With constipation take more, with the runs take less.
The usual prescribed iron salts supplements are ferrous sulfate, ferrous fumarate, and ferrous gluconate. For info on their iron content :
Many iron supplement products containing iron salts are available for sale on the internet, but personally I buy mine from pharmacies. In the UK they don't need a prescription, they just need the pharmacist's permission. If you get refused, try a different pharmacy. I've only been refused once - by Boots. I normally get iron from Tesco Pharmacies or Lloyds or non-chain independents.
If you go to a pharmacy show them a picture of what you want. Please note that brand of iron salts supplements aren't important - it is the iron content that is important
Ferrous Fumarate 210mg - usually contains 69mg pure iron per tablet
The dose for the above, according to the BNF (British National Formulary) is :
Treatment of iron-deficiency anaemia
By mouth using tablets
For Child 6–11 years
300–900 mg daily.
For Child 12–17 years
1.2–1.8 g daily in divided doses.
For Adult
1.2–1.8 g daily in divided doses.
Iron or Ferrous Bisglycinate - over the counter product, not prescribed, available from pharmacies or supermarkets or online
Contains varying amounts of iron per tablet, a maximum of about 25mg of pure iron per tablet but could be substantially less, so always check the bottle and patient information leaflet.
Liquid products - over the counter products, usually with low levels of pure iron per dose. Some people say they absorb iron better from liquid products than with tablets.
Spatone - 5mg iron per sachet
Floradix - 7.5mg iron per 10ml dose
Holland & Barrett - 7mg iron per dose
What is the MAXIMUM safe amount of iron per day that people can take with iron salts?
If you look at the info for ferrous fumarate 210mg above, it contains 69mg iron per tablet, and doctors prescribe a maximum of 1 tablet 3 times a day i.e. a total of 207mg pure iron per day. That might be too much for many people to tolerate, and shouldn't be a starting dose for anyone. I would suggest people try one tablet a day, and add a second if they can tolerate it. Or they can just try a supplement with less iron in it if tolerance is an issue. Take iron supplements with food.
Testing iron and ferritin levels
This is the best test I know of - it requires a finger- prick blood sample to be sent back to the lab through the post :
Sometimes Medichecks has higher discounts on Thursdays or during their sales. Discounts can't be combined.
How long will I need to take iron supplements for?
Everyone who is supplementing iron needs to test their iron and ferritin regularly, because iron is poisonous in overdose and the body has no normal means of getting rid of it. It is normal for women to lose iron via their periods, and everyone loses a tiny amount of iron in their faeces, but there are no other ways of losing iron other than by giving blood.
Testing should be done in the early stages of supplementing every 4 - 6 weeks or so. It is important to know how quickly your levels of iron and ferritin rise and you can only find out by testing. If iron absorption is very slow and levels rise very slowly, then reducing the frequency of testing may be possible - but be very careful.
People's absorption of iron varies tremendously. Some people with very low ferritin and iron can raise them to "normal" within six months, but of course it depends on starting point, dose of iron taken, what problems are causing the low iron in the first place.
Personally, I wanted to raise my iron and ferritin to optimal, rather than just being "normal". It took me 21 months to get my ferritin to mid-range, which is optimal for many people. But even then my serum iron was low in range. I just live with that now, and accept that my serum iron will be below optimal. I pushed my iron up to optimal once, and my ferritin ended up over-the range. I wouldn't do that again. I prefer to keep anything iron related optimal or lower NOT optimal or higher.
There are some people who can never get their iron optimal, so they just have to do the best they can. Working on improving gut health can help e.g. going gluten-free, probiotics, getting hypothyroidism well-treated, investigating intolerance of certain foods e.g nightshades, high-histamine foods, SIBO.
Other types of iron supplements - Haem and ferritin supplements
I have no personal experience of these. They are expensive and most of them have to be imported from the US because they are rarely sold in the UK and will attract import charges and VAT which adds even more to the price. Helvella describes them in this document :
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