Blood test results

[Hurtlocker]

Hello all..have just changed GP and had first blood test review...results were:-

TSH .1.9mlU/L (0.3. 4.5)

Serum Free triodothyronine

4.0pmol/L (3.1. .6.8)

Serum free T4 19.1pmol/L

(10.00. -22.00)

Regards ..

[SlowDragon Administrator]

Previous post suggests you might be taking T3 and Liquid levothyroxine?

What doses

For full Thyroid evaluation you need TSH, FT4 and FT3 tested. Also EXTREMELY important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially when Ft3 is low ....as yours is

What vitamin supplements are you currently taking

When were they last tested

Ask GP to test vitamin levels or test privately

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).

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

If/when also on T3, make sure to take last third or quarter of daily dose 8-12 hours prior to test, even if this means adjusting time or splitting of dose day before test

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

Thriva also offer just vitamin testing

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 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...

Results suggest you are poor converter and Ft3 is too low

[Hurtlocker in reply to SlowDragon]

Hi slowdragon..thanks for reply..came off liothyronine and liquid levo 8 weeks ago. Felt dreadful...back on 75mic per day tabs plus 1x25mic every other day..Tsh was 6.9 before I started extra 25mic dose does seem to be bringing it down..(1.9)!!still feel weak muscles and aches and dizzy..no energy after 11am!! Maybe not converting enough...taking vit D 1000 per day..vit B 12 1000 per day and Vit A 500 per day..Iron makes me feel dreadful and get the runs!! Note on blood tests says all normal...are they!@@think not yet..your views are appreciated...thankyou

[SlowDragon Administrator in reply to Hurtlocker]

So you need to test vitamins at next test or now

Supplementing a good quality daily vitamin B complex, one with folate in (not folic acid) may be beneficial.

Either instead of just B12 or as well as ....depending how low B12 was

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

once your serum B12 is over 500 (or Active B12 level has reached 70), stop the B12 and just carry on with the B Complex.

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...

See if Ft3 improves at next test

Meanwhile work on getting all four vitamins tested and optimal

[Hurtlocker in reply to SlowDragon]

Thank you replying...thought I was a poor converter all along...nobody bothered to check.. I was "normal" when blood tests came back but normal WHERE in range is 24% that is not normal is it..ok for some but not for me..How can I boost my conversion to T3...taking vits every day..have been for months so cant be deficient!!had celiac test.negative ...have doctor phone call tomorrow and I want all my facts in front of me!!have a stash if Thybon Henning T3..would taking a small dose of that as well as 75mic levo help conversion of T3 ??and help lethargy and aches and pains/muscle weakness etc..or should I trust the doc...they have not covered themselves in glory over thyroid problems have they!!! Regards...

[SlowDragon Administrator in reply to Hurtlocker]

Before considering adding T3 I would strongly recommend getting vitamin levels tested first

And trying absolutely strictly gluten free diet.

We need all our ducks in a row first...T3 isn’t easy to manage

[Hurtlocker in reply to SlowDragon]

Will get the ducks in a row..(great expression!!)starting with vits next week...let you know how I get on...Thankyou and happy Sunday...

[Hurtlocker in reply to SlowDragon]

Hi and Good morning...since our coversation last week I had a GP review and she said tests were all in normal range !!!but she wants to review in another month and wants TSH down further from 1.9 which she thinks will improve FT3 level ..will it??.so going with the flow at the moment and not rocking her boat.!!..she also said vits were all very good..so will ask for up to date vits again and let you know levels then.. incidentally can I increase conversion rate by natural means i.e foods.suppliments without taking more drugs!! Thankyou for your help..

[SlowDragon Administrator in reply to Hurtlocker]

A GP only looks at vitamins to see if they are deficient

NHS only prescribes to treat deficiencies

You need to get the actual results and ranges on vitamin tests

Any not done, test privately

Come back with new post once you get results

Trying absolutely strictly gluten free for 3-6 months minimum.

[SlowDragon Administrator in reply to Hurtlocker]

Make sure to get actual results and ranges on those vitamin results

You are legally entitled to printed copies of your blood test results and ranges.

The best way to get access to current and historic blood test results is to register for online access to your medical record and blood test results

UK GP practices are supposed to offer everyone online access for blood test results. Ring and ask if this is available and apply to do so if possible, if it is you may need "enhanced access" to see blood results.

Link re access

healthunlocked.com/thyroidu...

In reality many GP surgeries do not have blood test results online yet

Alternatively ring receptionist and request printed copies of results. Allow couple of days and then go and pick up.

Important to see exactly what has been tested and equally important what hasn’t been tested yet

[Hurtlocker in reply to SlowDragon]

Hi slowdragon...still not got those ducks in a row...!!latest blood results after starting trial of T3 in January are:-

Vit D 61nmol/L (50-75)

TSH 0.13mlu/L (0.3.4.5)

FT3 4.0pmol/L (3 .1-6.8)

FT4. 17.6pmol/L (10-22)

Report marked TSH abnormal...

Taking tiny dose of T3 .2.5mic as did start off taking 10...wanted to die! so reduced to 5mic then down to 2.5 (am only ) 3 weeks ago..taking 75mic plus 12.5 (half a 25mic tablet each night rather than alternate days with 25mic tablet to even things out..still feel weak.dizzy..eye probs wobbly legs...but a bit more energy through day... hope I am not killing myself!!!cant speak to doc till next week..worked to get vits up to optimal..still at it..but Tsh worrying..what do you think..thoughts appreciated

[Hurtlocker in reply to Hurtlocker]

Forgot to say 75mic plus half tablet of levo per day...

[SlowDragon Administrator in reply to Hurtlocker]

No folate, ferritin and B12 results

Vitamin D far too low

Reading through previous replies above ....1000iu vitamin D was never going to be enough

Likely to need 3000-5000iu daily

Are you currently taking any magnesium supplements or vitamin K2

Better You vitamin D mouth spray with vitamin K2 is very effective as avoids poor gut function

Aiming for vitamin D at least around 80nmol and around 100nmol maybe better

Folate and ferritin at least half way through range

Serum B12 at least over 500

Active B12 at least over 70

What vitamin supplements are you currently taking

Are you on absolutely strictly gluten free diet

[SlowDragon Administrator in reply to Hurtlocker]

That tiny dose T3 is not doing you any favours

Taking almost any dose T3 suppresses TSH

Suggest you drop T3 and go back to just levothyroxine at higher dose

What brand levothyroxine are you currently taking

Do you always get same brand

Look at taking 100mcg daily and retest in 6-8 weeks

How much do you weigh in kilo?

guidelines on dose levothyroxine by weight

Even if we frequently 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 eventually on, or near 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.

Also here

cks.nice.org.uk/topics/hypo...

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.

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...

Frequently necessary to be absolutely strictly gluten free

All four vitamins need to be OPTIMAL before considering trial of T3

[Nanaedake]

I can't see a vitamin D level on previous posts. What is it? Are you now taking 100mcgs levo and for how long?

[SlowDragon Administrator]

Have you had coeliac blood test

If not get that done

While still eating high gluten diet ask GP for coeliac blood test first or buy test online for under £20, just to rule it out first

healthcheckshop.co.uk/store...?

Assuming test is negative you can immediately go on strictly gluten free diet

(If test is positive you will need to remain on high gluten diet until endoscopy, maximum 6 weeks wait officially)

Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse

For many Graves and Hashimoto’s patients strictly gluten free diet is essential

chriskresser.com/the-gluten...

amymyersmd.com/2018/04/3-re...

[SlowDragon Administrator]

Ft4 is 71% through range

Ft3 only 24.32% through range

Helpful calculator for working out percentage through range

chorobytarczycy.eu/kalkulator

Looking for both to be similar % through range...likely at least 50-60% through range

See if Ft3 improves at next test