Blood Results - Newbie Help Pls: I have had... - Thyroid UK

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Blood Results - Newbie Help Pls

mondays profile image
6 Replies

I have had symptoms of internal tremors, dry hair, brittle nails, unusual feeling in neck and sore joints in hands upon waking since March. Bloods as follows:

B12 active 59.4 (37.5-188)

Ferritin 271 (13-150)

Folate 18.8 (8.83-60.8)

FT3 5.03 (3.1-6.8)

TSH 1.93 (0.27-4.2)

TPO 98 (0-34)

FT4 11.9 (12-22)

Vit D 48.9(50-175)

I was put on Levothyroxine 50mg which was good for first 11 days then symptoms massively increased so reduced to 25mg. Still no better.

GP says not Hashimotos as was not hyper before hypo and only prescribed meds as had some symptoms. No advice on vitamins. Also said not to try gluten free as could cause cardiac problems.

Really struggling now and would very much appreciate some advice please

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mondays
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SlowDragon profile image
SlowDragonAdministrator

TPO antibodies are above range

This confirms autoimmune thyroid disease

Not everyone starts Hashimoto’s with hyperthyroid phase, especially if cause is Ord’s thyroiditis - where thyroid shrinks

ada.com/conditions/thyroidi...

Standard starter dose of levothyroxine is 50mcg

Were these results from BEFORE Starting on levothyroxine?

Folate and B12 and vitamin D all on low side

Improving low vitamin levels can help improve symptoms and enable you to tolerate levothyroxine easier

Ferritin is likely high due to inflammation of Hashimoto’s

Which brand of levothyroxine did you start on

Many people find Levothyroxine brands are not interchangeable.

Many patients do NOT get on well with Teva brand of Levothyroxine. Teva contains mannitol as a filler, which seems to be possible cause of problems. Teva is the only brand that makes 75mcg tablet. So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half

Are you currently taking Teva?

Teva, Aristo and Glenmark are the only lactose free tablets

healthunlocked.com/thyroidu...

Teva poll

healthunlocked.com/thyroidu...

Once you find a brand that suits you, best to make sure to only get that one at each prescription.

Watch out for brand change when dose is increased or at repeat prescription.

academic.oup.com/jcem/artic...

Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).

Levothyroxine is an extremely fussy hormone and should always be taken on an empty stomach and then nothing apart from water for at least an hour after

Many people take Levothyroxine soon after waking, but it may be more convenient and perhaps more effective taken at bedtime

verywellhealth.com/best-tim...

No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.

Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away

(Time gap doesn't apply to Vitamin D mouth spray)

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

So how long since you started on 50mcg

And when did you reduce dose to 25mcg

SlowDragon profile image
SlowDragonAdministrator

Low vitamin D obviously needs improving

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 - shows GP should prescribe 1600iu per day for 6 months.....but likely easier to self supplement

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 to bring level to 40ng/ml = 100nmol

grassrootshealth.net/projec...

Government recommends everyone supplement October to April

gov.uk/government/news/phe-...

Taking too much vitamin D is not a good idea

chriskresser.com/vitamin-d-...

With your Vit D, are you also taking it's important cofactors - magnesium and Vit K2-MK7?

Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine

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...

Don’t start more than one supplement at a time and wait at least 2 weeks before adding another

SlowDragon profile image
SlowDragonAdministrator

A while after starting vitamin D

Perhaps consider supplementing 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

Difference between folate and folic acid

chriskresser.com/folate-vs-...

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 is another option that contain folate, but is large capsule

If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

mondays profile image
mondays

Thank you Slow Dragon. My answers as follows

Blood test results from 21 October. After being on 50mcg for 3 weeks. None taken before blood taken on day of blood test

Brand is Mercury Pharma

Reduced dose to 25mcg 2 weeks ago but symptoms seem to be getting worse not better.

I have purchased Vita sprint B12 In a liquid form. Not sure if will be of any use, I’ve not started taking it yet

Thanks re Vitamin D advice. I will order some

SlowDragon profile image
SlowDragonAdministrator in reply tomondays

Standard starter dose of levothyroxine is 50mcg

Bloods should be retested after 6-8 weeks

Testing after 3 weeks is too soon

Levothyroxine is, in vast majority of cases, for life

Dose has to be increased slowly upwards in 25mcg steps (retested 6-8 weeks after each dose increase) until on or around full replacement dose. That’s typically 1.6mcg per kilo of your weight

Taking too little, will reduce your own thyroid output, but not offer high enough replacement

Dose levothyroxine is increased slowly upwards in 25mcg steps until TSH is under 2. (Often well under 1 when adequately treated) Most important results are Ft4 and Ft3. Ft3 should be at least 50% through range.

Obviously symptoms get worse on lower dose

mondays profile image
mondays

Thank you for the advice. I’m going to start to phase in some changes and will report back on progress

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