Blood test results help

[Amy012]

Hi, I'd really appreciate advice on my latest test results. I was diagnosed hypothyroid in June, and following that, in August, with Hashimoto's. I've been up and then down and back up again with doses of Levothyroxine - currently on 75mcg. Latest bloods were at the end of October.

My doctor wants to reduce my dose back to 50mcg.

I'm not happy to do that as I still have symptoms (no periods for 11 months - which is the original reason for bloodwork, shortness of breath, dry throat, pain in hand, dry skin, brain fog...amongst other things!); also I 'should' be on a dose of just over 90mcg for my weight. She has kept me on dose of 75mcg, but I can see in my medical notes online that she has asked the Endocrinology dept for further guidance about whether to refer me for lack of periods and /or shortness of breath and thinks that my dose should be lowered to 50mcg because I could be over medicated, citing that shortness of breath could be an overmedicated symptom (I have had this symptom for over a year and it's progressively getting worse).

TSH - range for results 0.27 - 4.20 mIU/L

28 Aug: 4.95

26 Oct: 1.02

FT4 - range 12.0 - 22.0 pmol/L

28 Aug: 15.8

26 Oct: 17.8

FT3 - range 3.1 - 6.8 pmol/L

28 Aug: 4.18

26 Oct: 3.93

Anti-Thyroidperoxidase abs: <34 kIU/L

28 Aug: 377

26 Oct: 306

Anti-Thyroglobulin Abs: <115 kIU/L

28 Aug: 374

26 Oct: 285

FT4 is marginally improved; FT3 has gone down slightly, which is a bit worrying; my TSH level has gone down too. Could it be that I'm not great at converting T4 to T3? Am I on the right dose of Levothyroxine? (It's not been one consistent brand as the pharmacy can't seem to give me the same brand of 25mcg Levo each time, and this is always different from the brand for the 50mcg tablet! This is something I will address with the GP and pharmacy).

I have eliminated gluten and soy from my diet - since the beginning of September after reading some of the articles on GF diet and Hashimoto's.

I did have an intolerance test in early September showing mild intolerances to cow’s milk, whey protein, baker's and brewer's yeast, so I have also cut these out too with guidance from a nutritionist (replacing the cow's milk products with goat's milk products).

On previous advice from here I have been taking Vit D with K2 spray and a Vit B Complex spray since September (stopped 1 week before blood test). And my results here have improved slightly:

Vitamin D (25 OH): range: 50 - 175 nmol/L

28 Aug: 44

26 Oct: 67

Serum Folate: range: 8.83 - 60.8 nmol/L

28 Aug: 8.87

26 Oct:11.8

Vitamin B12 : range: Deficient <145 pmol/L Insufficient 145 - 300 Consider reducing dose >569

28 Aug: 364

26 Oct: 433

Ferritin: range: 13 - 150 ug/L

28 Aug: 102

26 Oct: 76.1

Magnesium: range: 0.7 - 1.0 mmol/L

28 Aug: 0.89

26 Oct: 0.82

I have in last week started to take selenium, magnesium, zinc and an iron supplements.

Any advice and guidance is very much appreciated - thank you.

[fuchsia-pink]

You are only over-medicated if free T3 is over-range.Your last results were

TSH: 1.02 [so within range and not suppressed]

free T4: 17.8 [58% through range]

free T3: 3.93 [22% through range]

This very clearly shows that you don't need a reduction in meds - if anything you need an increase, to bring free T4 up to at least 75% through range and then see how bad free T3 is then ... because, yes, at the moment your conversion isn't great.

At the same time, ferritin is still bad (albeit not as dreadful as in August) and vit D is still pretty poor at 67 - you are really aiming for low three figures

Hopefully SeasideSusie will pop up in a bit to comment, but ferritin may benefit from the iron supplements you are now on. How much vit D are you taking?

I'd also start doing research into getting lio to boost free T3 - start by getting the list of T3-friendly endos from Dionne at Thyroid UK - [e-mail] - good luck x

[Amy012 in reply to fuchsia-pink]

Thank you fuchsia-pink for taking the time to help me (and I've seen the note below re folate, not ferritin). Yes, my levels are low, hopefully they will increase with the supplements I'm taking. I had been taking 3,000iu dose of Vit D and K2 spray - but I think I probably need to increase this a little to get the level up a bit quicker.

Thank you for the advice around the levothyroxine dosing and advice on Endo's. I will email Dionne.

[SeasideSusie Remembering]

Amy012

I have in last week started to take selenium, magnesium, zinc and an iron supplements

Ferritin: range: 13 - 150 ug/L

28 Aug: 102

26 Oct: 76.1

Ferritin is recommended to be half way through range, so with that range it's about 82. I have also seen it suggested that a good level for females is 100-130.

I'm not sure why fuchsia-pink thinks your ferritin level is bad but "not as dreadful as August".

Why are you taking an iron supplement? Have you had an iron panel done to see if your serum iron and saturation are low? If not then your ferritin level doesn't suggest iron deficiency so you should check this out before supplementing with iron. If your serum iron and saturation are good then taking iron tablets may very well take them over range and too much iron is toxic. The best way to raise ferritin when iron deficiency isn't present is by eating liver and other iron rich foods, this has raised my ferritin but not affected my already good serum iron and saturation levels (I can't guarantee that it will be the same for everyone).

Have you tested zinc to know that you need to supplement? Zinc and copper should be balanced, if we are low in zinc we are often high in copper, so ideally both should be tested.

Vit D is recommended to be 100-150nmol/L by the Vit D Council/Vit D Society so you should be taking around 3,000-4,000iu D3 daily with your current level, retest in 3 months.

B12 and Folate need improving - B12 to top of range and Folate to at least half way through range. I don't use sprays because I don't like the amount of excipients they use, I raised my levels with 1 x Thorne Basic B quite quickly.

Best to sort out getting the same brand of Levo every time, you don't necessarily need a 25mcg tablet, either cut a 50mcg in half or alternate 100/50 to achieve 75mcg daily.

All these things need sorting before considering adding T3, we need optimal nutrient levels before the addition of T3.

[fuchsia-pink in reply to SeasideSusie]

I was referring to the folate result not ferritin - duh! But thank you for correcting my mistake adding your wisdom and expertise x

[SeasideSusie Remembering in reply to fuchsia-pink]

Ah, OK, easy done

[Amy012 in reply to SeasideSusie]

SeasideSusie Thank you so much for taking time to help me.

Re Iron - TBH I don't really know enough about all this and thought it would help optimise the ferritin level - I will look into doing an iron panel and go from there. I feel quite overwhelmed at times by all of the information - but I just want to feel normal again, so I'll try anything! Perhaps I should go a little slower at making changes and do more research. I'll do the same for the zinc and copper and hold off taking any of these supplements until I've found out more.

For the Vit D - I was taking 3,000iu (with K2), but in the last week increased to 4,000iu to get the level up a bit quicker.

B12 and Folate - I know these are not good levels and take your point about the fillers in the sprays. I wanted to take this supplement in the spray format because there is a history of Pernicious Anaemia in my family (where B12 cannot be absorbed through stomach). There is no one simple test for this autoimmune condition, making the diagnostic process more difficult, but as my levels haven't actually increased all that much I think I may have to get some more testing done privately. A lot of the symptoms for hypothyriodism can cross over with PA and having Hashimoto's already, makes it more likely...

That's really useful advice about alternating days between larger and smaller doses of Levo and making sure I get the same brand. I will speak to the GP again.

Thank you