Blood tests

[Mandcol]

Does anyone know what thyroid hormones my doctor is checking when he has put LTHY on the blood form?

[SlowDragon Administrator]

Perhaps means ....Low Thyroid ?

NHS rarely tests more than TSH

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also EXTREMELY important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially if you have autoimmune thyroid disease (Hashimoto's) diagnosed by raised Thyroid antibodies

Ask GP to test vitamin levels and thyroid antibodies

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, or NDT 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 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...

[Mandcol in reply to SlowDragon]

Thank you so much for your reply. The GP actually said we need more than your TSH testing which amazed me but when I looked on the blood form it just says LTHY. Hopefully he is not just testing TSH. Thanks again.

[SarahJLD in reply to Mandcol]

Has he ticked any boxes on the form?

[Mandcol in reply to SarahJLD]

There are no boxes, it just says LTHY. Thanks for replying.

[Lora7again]

My GP requested a full thyroid function test for me last year when I had been admitted to hospital with a suspected thyroid storm. What he got was just the TSH because the labs saw the TSH was in range even though it was very low and didn't test anything else. Most GPs can get the TSH and T4 tested but they have to request it directly to the lab. I do my own private blood test with Medichecks because it is more detailed. However my GP refuses to acknowledge it and prefers to use the NHS labs which only test my TSH!

[Mandcol in reply to Lora7again]

Thank you for your reply. This condition is just so frustrating, why don’t gaps learn by the fact that they see so many of us unwell?

[Mandcol in reply to Mandcol]

I meant GPs !

[helvella Administrator Thyroid UK in reply to Mandcol]

You may not realise that you can edit, or delete, any posts or responses you have made here.

HealthUnlocked have produced some help for how to do this. You can find this here:

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When you edit the original post in a thread, you will also have the option to add (or remove) a single image. (To replace an image, remove the existing image, then add the new one.) This is the same process as writing a new post:

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I am pointing this out purely to ensure that you know your options.

(If you make extensive changes, it is sometimes helpful to add a comment so that people can see that you have made changes.)

[LindaC in reply to Mandcol]

Got it first time GAPS [in understanding]

[vocalEK in reply to Mandcol]

Yes, I thought "gaps" was rather appropriate, under the circumstances.

[helvella Administrator Thyroid UK]

LTHY is the ICE code for Thyroid Function Test.

ICE is Integrated Clinical Environment - where lab and medical computer systems are all linked.

Slightly more information from the Leeds laboratory - might not be exactly the same everywhere.

Thyroid Function Tests (TFT)

A request for TFTs generates a first line analysis of TSH and fT4; total T3 and/or TPO antibodies are added depending on the clinical details given with the request.

leedsth.nhs.uk/a-z-of-servi...

[Mandcol]

Many thanks, I am in Leeds so hopefully it will be more than TSH.

[helvella Administrator Thyroid UK in reply to Mandcol]

It says it will include Free T4.

[Mandcol]

Thanks for your help and advise.

[TaraJR]

I wondered if LTHY means you're taking LevoTHYroxine? I assume are you taking T4..?

[Mandcol in reply to TaraJR]

Thanks for your reply. Someone let me know it means they are testing TSH and FreeT4. I am not taking Levo at the moment.

[SlowDragon Administrator in reply to Mandcol]

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested.

EXTREMELY important to test vitamin D, folate, ferritin and B12 as well

[Mandcol]

Thanks for your reply.i am going to have private bloods done as I am getting nowhere with my GP.

[SlowDragon Administrator in reply to Mandcol]

Did you get FULL thyroid and vitamin testing done?

[Mandcol in reply to SlowDragon]

Yes I went privately and got full bloods done before I spoke to my GP. He then referred me to an endocrinologist .

[SlowDragon Administrator in reply to Mandcol]

So were your four vitamins optimal?

What vitamin supplements are you currently taking

What were thyroid results?

You may need to start T3 slowly/split dose into 2 or 3 smaller doses

Either 2 x 10mcg - approx 12 hours apart

3 doses - approx 8 hours apart

[Mandcol in reply to SlowDragon]

These were my results, the lab didn’t comment on my vitamin results though I noticed they were low in range. I take vit d 2000mg. Thanks for taking the time to reply

Taken in artificial light

[SlowDragon Administrator in reply to Mandcol]

Vitamin D, folate and B12 are all too low

What vitamin supplements are you currently taking

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

Folate at least half way through range

B12 at least over 500

[SlowDragon Administrator in reply to Mandcol]

Vitamin D

GP will often only prescribe to bring levels to 50nmol.

Some areas will prescribe to bring levels to 75nmol or even 80nmol

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

amazon.co.uk/BetterYou-Dlux...

It’s trial and error what dose we need

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-...

Web links about taking 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...

2 good videos on magnesium

healthunlocked.com/thyroidu...

Vitamin D and Covid

vitamind4all.org/letter.pdf

[SlowDragon Administrator in reply to Mandcol]

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-...

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 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...

Low B12 symptoms

b12deficiency.info/signs-an...

With B12 result below 500, recommended to be taking a B12 supplement as well as a B Complex (to balance all the B vitamins) initially for first 2-4 months, then 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.

B12 sublingual lozenges

amazon.co.uk/Jarrow-Methylc...

cytoplan.co.uk/shop-by-prod...

healthunlocked.com/thyroidu...

healthline.com/nutrition/me...

[Mandcol in reply to SlowDragon]

Thank you so much for all the info you have sent. I will buy the better you vit d Instead of the capsules I am taking and I will buy some folate. Ever since my thyroid problems started I have had stomach problems which when I went privately to see a naturopath I was told was leaky gut. This is maybe why my vitamin levels are low. I have tried everything to treat the stomach pains but without success though it is worse now that my thyroid levels are all wrong again. I really appreciate the time you have given to help me and will read all the info you have sent and start to improve my vitamin levels. I will also try splitting my t3 into 2 doses. Thanks again😀

[SlowDragon Administrator in reply to Mandcol]

Are you on strictly gluten free diet?

If not it’s always worth trying

Poor gut function with Hashimoto’s can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common.

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps, sometimes significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

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

chriskresser.com/the-gluten...

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

thyroidpharmacist.com/artic...

drknews.com/changing-your-d...

restartmed.com/hashimotos-g...

Non Coeliac Gluten sensitivity (NCGS) and autoimmune disease

ncbi.nlm.nih.gov/pubmed/296...

The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported

ncbi.nlm.nih.gov/pubmed/300...

The obtained results suggest that the gluten-free diet may bring clinical benefits to women with autoimmune thyroid disease

nuclmed.gr/wp/wp-content/up...

In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned

restartmed.com/hashimotos-g...

Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.

[Mandcol]

I did go gluten free about 3 years ago for a couple of months and as I didn’t feel any better I gave up. I still avoid gluten most of the time as I eat a very natural healthy diet but if my stomach doesn’t improve as my thyroid levels get better I will eliminate all gluten again from my diet. Thanks again for your help, it’s a shame I don’t get the same support and info from my gp or Endo who don’t seem to understand the struggle at all.

[humanbean]

hs-CRP - CRP is a measure of inflammation, and a result below 1 is optimal, so no worries with that one.

Ferritin - your result is very good.

Magnesium - the magnesium test is not very reliable, and I'm not sure how to interpret a result which is over the range anyway. Less than 1% of the body's magnesium is in the blood stream, and there is no way that I know of to tell how much magnesium is elsewhere in the body. If magnesium runs low in the blood the body will steal it from elsewhere in the body.

ncbi.nlm.nih.gov/pmc/articl...

Read the section on distribution of magnesium in the human body in the above link.

Anyone supplementing magnesium should only do so if their kidneys are reasonably functional. Excess magnesium will be expelled in the urine if the kidneys work adequately. If the kidneys are in poor shape there is a risk of magnesium building up to dangerous levels.

Cortisol - A result which is at the top of the range first thing in the morning i.e. between about 8am and 9am is optimal. If your blood was taken early for the test then your result isn't bad at all. If a test has reference ranges dependent on the time the blood was taken it is a good idea to tell us when your blood was taken so we know which reference range to use.

TSH - your result being over 10 along with below range Total T4 and Free T4 tells us that you are overtly hypothyroid and should be on levothyroxine. Your Free T3 is roughly 14% of the way through the range which is very low in range. Hopefully, if your doctor gets his finger out and prescribes Levo you should start to feel better.

If you google "gp-update hypothyroidism" you get given a file to open which you can download. This is what it says about beginning treatment :

Starting levothyroxine treatment

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 1.6μg/kg/day (approximately 100μgfor 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 well being. It is reasonable to take levothyroxine at night rather than in the morning, especially for individuals who do not eat late at night. There is no evidence to support the use of combined T3/T4 preparations above the use of levothyroxine alone.

On the subject of when to take Levothyroxine, there are lots of people who take it at night, there are others who take it in the morning, and as long as you find a time of day or night that suits you you can take thyroid hormones whenever you want. Don't be scared of experimenting. Personally, I take my own thyroid hormones in the middle of the night when I get up to go for a pee.

Rules for taking thyroid hormones and avoiding supplements and food are given on this reply to someone else by SeasideSusie .

healthunlocked.com/thyroidu...

Antibodies - Your results don't show you as having autoimmune hypothyroidism. Bear in mind that antibody results fluctuate a lot and so this outcome could change the next time you get tested.

I've run out of steam for now, sorry. I'll try to remember to come back and deal with your vitamins tomorrow.

[Mandcol in reply to humanbean]

Thank you so much for your reply. You said my ferritin levels were ok but I thought my folate was fairly low. Is this the same thing ?

[humanbean in reply to Mandcol]

No, they aren't the same thing. Ferritin is a measure of your iron stores. Folate is one of the B vitamins, specifically vitamin B9, but I've hardly ever seen it called that, it just tends to be called folate or folic acid.

And yes, I would agree that your folate is too low.

Your level is 15 (8.83 - 60.8) which is approx 12% of the way through the range.

Optimal for folate is upper half of the reference range i.e. roughly 35 - 61 with the reference range you've given.

One of the best supplements for folate is methylfolate which is easily available on sites that sell supplements e.g. Amazon.

To get your level up buy one bottle of methylfolate at a dose of 1000mcg per day with suffiicient tablets to last 2 - 3 months. After that, get your folate tested. If it is within the optimal range then great. If it is nearly optimal perhaps you could just carry on with a daily Vitamin B Complex which contains methylfolate.

If you need to continue taking methylfolate to maintain your levels you could buy tablets which contain 400mcg methylfolate, and take one a day. Alternatively you could buy more of the same methylfolate I mentioned earlier at 1000mcg per tablet and just take one, say 3 days per week.

Doctors usually prescribe folic acid for people with low folate. Something you might not know, but folic acid was developed in 1943, it isn't a natural form of a vitamin. Not a single person had ever taken folic acid before then in the entire history of mankind.

The body has to convert folic acid into methylfolate in the body, and not everyone can convert very well, and this is particularly common in people with thyroid disease. Taking methylfolate directly avoids the problem because the body can make use of it directly.

This article on folate and folic acid is worth reading :

chriskresser.com/folate-vs-...

[Mandcol in reply to humanbean]

Thanks again, your information isreally helpful. I bought Solgar folate which says on the bottle ‘as metafolin’. Is this what I should be taking?

[humanbean in reply to Mandcol]

I think metafolin is fine.

[Mandcol]

Thanks for the link and I wish you good health. I am so glad I found this site, I felt so on my own with my thyroid problems as I think it’s hard for family and friends to understand what you’re going through.