So confused by my blood results.

[Vizsla72]

Hi all, I have been on 50 Micrograms of Levothyroxine for over a year now but have been experiencing lots of the original symptoms over the last few months. My doctors are not undertaking non-urgent blood tests so I purchased a kit from Medichecks testing Thyroid levels and vitamins.my vitamins and inflammatory readings are all good but my iron is low and my TSH and Autoimmunity are high. Please can someone offer some advice. I have emailed my doctor and sent them the images hoping they review my dosage. Many thanks.

[SlowDragon Administrator]

50mcg levothyroxine is only a STARTER DOSE

GP should increase levothyroxine by 25mcg and bloods will need to be retested in 6-8 weeks

High thyroid antibodies confirms autoimmune thyroid disease also called Hashimoto’s

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

Low vitamin levels are extremely common with autoimmune thyroid disease

Ask GP to test vitamin levels

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)

Is this how you do your tests?

[Vizsla72 in reply to SlowDragon]

Thank you! My vit D and B12 were normal and my ferritin levels were low 12.4 with my base line being 13.

My blood test was taken at 6.40 before food or drink and 24 hour’s after my last dose.

My lack of knowledge and my GP not requesting follow up appointments have meant I’ve probably been under medicated for months.

Thanks for your help.

[SlowDragon Administrator in reply to Vizsla72]

Insist that GP does full iron panel test for anaemia

You can have low ferritin and “normal” iron levels

Low vitamin levels are direct result of being under medicated

Hypothyroidism causes low stomach acid, this reduces absorption of nutrients leading to low vitamin levels

Low iron and/or low ferritin frequently linked to hair loss

Never supplement iron without doing full iron panel test for anaemia first

Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption

List of iron rich foods

dailyiron.net

Links about iron and ferritin

irondisorders.org/Websites/...

drhedberg.com/ferritin-hypo...

This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.

healthunlocked.com/thyroidu...

Thyroid disease is as much about optimising vitamins as thyroid hormones

Helpful post about iron supplements and testing

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

restartmed.com/hypothyroidi...

Post about iron supplements

healthunlocked.com/thyroidu...

And see last reply here from Humanbean

healthunlocked.com/thyroidu...

Post discussing just how long it can take to raise low ferritin

healthunlocked.com/thyroidu...

[Vizsla72 in reply to SlowDragon]

So helpful - thank you! I am very grateful.

[SlowDragon Administrator]

guidelines on dose levothyroxine by weight

Even if we 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 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.

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...

[SlowDragon Administrator]

“vitamins and inflammatory readings are all good but my iron is low”

Please add actual results and ranges on these vitamin results

Looking for OPTIMAL Levels

Vitamin D at least around 80nmol and around 100nmol maybe better

Active B12 at least over 70

Folate at least half way through range

Ferritin at least around 70

What vitamin supplements are you currently taking, if any

[Vizsla72 in reply to SlowDragon]

Vitamin D reading - 69.3 (so lower end of normal range)

Vitamin B12 reading - 118 ( right in the optimum range)

I am currently taking no vitamin supplements but do eat a varied, healthy diet.

[SlowDragon Administrator in reply to Vizsla72]

No folate result?

[Vizsla72 in reply to SlowDragon]

No unfortunately. Sorry.

[Vizsla72 in reply to SlowDragon]

Ferritin level is 12.4 on a range of 13 - 150 so that is quite low. Ive always had low iron but am on no supplements at present.

[SlowDragon Administrator in reply to Vizsla72]

Insist on full iron panel test for anaemia when you speak to GP

[Vizsla72 in reply to SlowDragon]

Will do - am going to create a fuss tomorrow 😬

[SlowDragon Administrator in reply to Vizsla72]

Ask GP to test B12 and folate together

NHS tests serum B12 - looking for result over 500

[SlowDragon Administrator]

Which brand of levothyroxine are you currently taking?

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

Teva, Aristo and Glenmark are the only lactose free tablets

dropbox.com/s/6h3h0qi4eqwi6...

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

[Vizsla72 in reply to SlowDragon]

This is interesting as the brand I am given changes regularly. I am currently taking MercuryPharma. I never realised it would matter but I will discuss this with my GP too. Thank you.

[SlowDragon Administrator in reply to Vizsla72]

Rare for GP to be aware of different brand issue