SlowDragonAdministrator

Sorry for your loss

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

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

Just vitamin D test

vitamindtest.org.uk

Ferritin is EXTREMELY low

cdn.mdedge.com/files/s3fs-p...

What vitamin supplements are you currently taking ?

B12 not brilliant

Pregnancy guidelines

thyroiduk.org/having-a-baby-2/

gp-update.co.uk/files/docs/...

See pages 7&8 on when to increase dose levothyroxine

btf-thyroid.org/Handlers/Do...

charlee23 in reply to SlowDragon

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.

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SlowDragonAdministrator in reply to charlee23

Ferritin was low at 14 and now even lower at 7

Did you read this link?

cdn.mdedge.com/files/s3fs-p...

Are you vegetarian or vegan?

What has GP prescribed

humanbean or SeasideSusie may comment

You obviously need to test Ft3 and vitamin D

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charlee23 in reply to SlowDragon

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.

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SlowDragonAdministrator in reply to charlee23

Ask for referral to haematologist

Ferritin of 7 should be addressed

What was vitamin D result?

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charlee23 in reply to SlowDragon

It was in the middle range.

Gp didn’t even see the issue about the ferritin. I nearly begged her to telL me what iron should I take.

What about the dose for the thyroid medication?? Any insight here?

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SlowDragonAdministrator in reply to charlee23

Vitamin D optimum is at least around 80nmol

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

Do you always get same brand of levothyroxine?

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charlee23 in reply to SlowDragon

Yes same brand hasn’t changed since the beginning.

Also I always test that way my bloods, so it would be accurate.

Just feeling the symptoms coming back, and now worrying how it will affect my ability to conceive.

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SlowDragonAdministrator in reply to charlee23

Low vitamins suggests under medicated

guidelines on dose levothyroxine by weight.....might help persuade GP to increase dose?

Many Hashimoto’s patients need higher dose than guidelines...especially if lactose Or gluten intolerant

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

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...

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SlowDragonAdministrator in reply to charlee23

Ft4 is only 37% through range

Helpful calculator for working out percentage through range

chorobytarczycy.eu/kalkulator

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SlowDragonAdministrator

As you have Hashimoto’s...Are you on gluten free diet ?

List of iron rich foods

healthline.com/nutrition/he...

charlee23 in reply to SlowDragon

Yes I have hashimoto and I am gluten free now

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SlowDragonAdministrator in reply to charlee23

How long been gluten free?

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charlee23 in reply to SlowDragon

Almost two years now.. and ferritin has been low as Most as I remember looking back.

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charlee23

I got reduced the antibodies significantly with the diet and vitamins, but I don’t believe these will disappear ever completely.

charlee23

I know they usually say that but I got told otherwise, to reduce. So now not sure weather to go back to the 125 or not.

I will try to get it tested next week and see if iron supplements do anything as well.

humanbean

I'm not impressed that your doctor thought a ferritin of 7 was fine for anyone, particularly a woman who is trying to conceive!

Ideally you would have an iron panel done - something like this :

medichecks.com/iron-tests/i...

I've given my reasons for suggesting people should know more about their iron than just a ferritin result in this post :

healthunlocked.com/thyroidu...

For anyone trying to lose weight, iron and ferritin are very relevant. See this post and watch the video :

healthunlocked.com/thyroidu...

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 :

bnf.nice.org.uk/treatment-s...

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

multipharmacy.com/images/P/...

The dose for the above, according to the BNF (British National Formulary) is :

Iron-deficiency anaemia (therapeutic)

By mouth using tablets

For Child 12–17 years

210 mg 2–3 times a day.

For Adult

210 mg 2–3 times a day.

Ferrous Sulfate 200mg - usually contains 65mg pure iron per tablet

i.ebayimg.com/images/g/q-AA...

The dose for the above, according to the BNF (British National Formulary) is :

Iron-deficiency anaemia (therapeutic)

By mouth using tablets

For Child 6–17 years

200 mg 2–3 times a day.

For Adult

200 mg 2–3 times a day.

Ferrous Gluconate 300mg - usually contains 35mg pure iron per tablet

i.ebayimg.com/images/g/i4sA...

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 :

medichecks.com/products/iro...

Note there is a 10% discount on all tests from Medichecks with the discount code given in this link :

thyroiduk.org/help-and-supp...

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.

Optimal levels of iron are given here. :

rt3-adrenals.org/Iron_test_...

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 :

dropbox.com/s/g8y4e7alm5ow0...

If you get asked to create an account or sign in to dropbox, just close the box.

Good luck.