Further bloods and advice on supplements - Thyroid UK

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Further bloods and advice on supplements


Hi there again,

I posted last week about levothyroxine, supplements and maybe adding t3 and had some great advice thank you. So I had my blood done at the doctors this week and got the results.

TSH 0.25 mu/L (0.30-5.50)

Free t3 3.8 pmol/L (3.1-7)

Free t4 23.0 pmol/L (11.5-22.7)

Ferretin 67 ug/L (6-81)

B12 423 ng/L (223-1132)

Folate ug/L (3.9-20)

Vit D 52 nmol/L (50-125)

So t4 has dropped slightly from last bloods at 25 as expected as I dropped 25mg on two days a week two months ago now. T3 stayed exactly the same, I am aware it’s still showing a poor conversation and have spoke to nuclear medicine who I am under they are contacting me about adding some t3 alongside my t4. TSH had gone up slightly from 0.1 but if t4 has dropped I guess that’s expected and should drop back again when t3 is added.

B12 went up slightly from 357 I had been taking multivitamins and a b complex but rubbish brands and stopped these a week before. I am aware it still needs raising further and I am going to supplement with one the items previously recommended and also a good B complex.

Folate has gone up slightly from 6.6 and presume this will increase more when I start the B12 and B complex supplements?

Ferritin is this level ok?

Vitamin D is obviously very low and just wondering which are the best products supplement wise to help with this please?

Only other question was I’ve been having a lot of chest and back pain recently, I have seen a physio etc but it’s just been getting gradually worse. I saw my doctor yesterday about this and they think it’s to do with reflux etc. I am not sure it is as doesn’t get worse after eating really, it’s not bad in the morning when usually something like that would be. They want me to try omeprazole for six weeks but I’m not sure whether this is the best thing to do when going to start supplements and maybe t3 in the near future?

Thanks for reading and any advice is greatly appreciated 😊

25 Replies

Do you always get same brand of levothyroxine Which brand of levothyroxine ?

Multivitamins are never recommended on here.

There’s no folate result

Vitamin D is far too low

Aiming to improve vitamin D to at least around 100nmol

B12 still too low

Most hypothyroid patients have LOW stomach acid

Omperazole is to treat HIGH stomach acid ....if you have to take it, it needs to be as far away from levothyroxine as possible

Any PPI should only be used for short course. Often people get left on them for years

Low stomach acid can be a common hypothyroid issue

Thousands of posts on here about low stomach acid


Web links re low stomach acid and reflux and hypothyroidism







Protect your teeth if using ACV with mother


Ppi and low vitamin levels




PPI and increased risk T2 diabetes


Thanks for your reply.

So sorry folate was 9.9 ug/L (3.9-20), it was 6.6 last time it was tested.

No don't always get same brand of levothyroxine, have been on accord and teva recently but have had mercuryphama and wockhart in the past. Picked up my prescription yesterday and did think is it worth asking pharmacy to stick to same brand. Although I take 125 mg five days a week so I know some comapines only make certain size tablets.

I have been reading some of the posts about low stomach acid and hypothyroid, I'm not keen to try omeprazole at all, I have in the past and not found its done much for me.

SlowDragonAdministrator in reply to rosegold-rockchick

Mercury Pharma brand makes 25mcg. 50mcg and 100mcg

Accord only make 50mcg and 100mcg

Different brands are not interchangeable.

100mcg in one brand will not be exactly same dose in another brand

So you are taking 125mcg x 5 and ......100mcg two days a week?

You have very poor conversion

Highly likely to need small dose T3 prescribed alongside levothyroxine

But you need vitamins optimal first

Folate isn’t bad, taking vitamin B complex will help improve both

Ok I will ask from now if I can be given the same brand.

Yes I'm taking 125mcg five times a week and 100mcg two days a week. With my t4 at 23 do I stay on the current dose when start adding t3 or reduce t4 as well?

What small dose of t3 would you suggest at first?

I'm going to order the vitamins tomorrow and start on them asap, I think by the time nuclear contact me and sort out prescribing the t3 it will be at least a few weeks at best.

Thank you again for all your advice 😊

SlowDragonAdministrator in reply to rosegold-rockchick

Starting one vitamin supplement at a time generally recommended

Wait 7-10 days to assess before adding another

Perhaps start with vitamin D, then vitamin B complex, then b12

Meanwhile look at increasing iron rich foods in diet to help maintain ferritin over 70

Endocrinologist should advise on how much T3

Suggest you retest TSH, Ft4 and Ft3 just before starting T3

Yes, if Ft4 is still this high, perhaps reduce to 100mcg daily. 3-4 days after reducing, SLOWLY add 5mcg T3 in morning......wait a week or so

If going ok, add 2nd 5mcg dose T3 roughly 12 hours later..

Probably hold at that for 6-8 weeks before retesting

Day before test

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

Ok thank you. Also is t3 the same as t4 in that you should take it at least and hour before food?

SlowDragonAdministrator in reply to rosegold-rockchick

By and large yes.....but it’s absorbed pretty quickly


Vitamin D

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

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


GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)


NHS Guidelines on dose vitamin D required


But on levothyroxine improving to around 80nmol or 100nmol by self supplementing may be better



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,

Calculator for working out dose you may need to bring level to 40ng/ml = 100nmol


Government recommends everyone supplement October to April


Taking too much vitamin D is not a good idea


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





Vitamin K2 mk7



2 good videos on magnesium


Vitamin D



Low folate and low B12

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


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



Low B12 symptoms


With B12 result below 500 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





Great thank you very much for the information, will have a read through and order some of the recommended supplements and hopefully feel a bit better soon 😊

If you’re getting Chest and back pain perhaps ask for a heart check up? Hows your blood pressure?

If it’s acid then the way to go is through your diet. Gluten free and low carb. Take out all added sugars. See Isabella wentz website. Good luck 🤗

Thank you for your reply 😊. I had a heart check last year all ok, blood pressure is fine always been a little on the low side.

Your level of b12 is going to need a high dose supplement. Superior no shots is expensive but dissolves easily under the tongue. Bare in mind that you only absorb 1-3% of oral b12 supplement. B12 is vital for life and is needed in every cell of your body so personally I would start the B12 with the b complex first first, then add the vit D3 with K2in. The b vitamins work together so that why you are best to start both products together. Any excess of B12 is excreted out in your kidneys. This is the case for all the vitamin bs but NOT b6.

Id also make sure when starting the b vitamin regime that you eat bananas regularly intially as your potassium level can be affected -you dont need to keep eating nanans just intially!

Your low B12 will definately be a consequence of your low stomach acid. Your low stomach acid is likely a consequence of hypothyroidism and hopefully should improve once you get the balance of T3& T4 treatment.

In the meantime you can try adding apple cider in - if I remember correctly its half a teasponn in a glass of water drank before each meal.

Low stomach acid means your body cant process the b12 that your are eating. Therefore if the high dose sublinguals dont improve levels you will need to move to b12 injections. I would look at the 10,000 mcg initially (Hydroxacolabamin) and then you can reduce once levels have come up. Stomach acid also lowers as we age so anyone over 50 needs to look at supplementation of b12 irrespective of hypothyroidism,

Also look at B12d.org on the site is an excellant symptom checker -lack of b12 affects every system in the body and therefore the symptoms are very diverse. You maybe surprised. One of the many symptoms is muscle weakness which can affect any muscle in the body including the stomachs sphincter muscle.

Low vitamin D cause generally, aches and pains, fatigue, non restorative sleep (ie you wake up feeling tired) -you need vitamin D to absorb calcium so insufficient means your bones will not be getting enough calcium to maintain themselves causing the aches and pains. Vit D also helps to fight off infectioms so its a good idea to keep the level optimal in the current climate. However you dont excrete out vitamin D so you can over do it. Look at Vitamin D. Org or grassroots they have excellant advice.

Thank you for your reply 😊. I will start the b12 asap and I already eat a banana a day so no problem there. I have read about apple cider vinegar and was going to try the carrot salad everyday that I have read about any uses apple cider vinegar. Will have a read up on vitamin D too, thanks again.

Please make sure you actually do have low stomach acid before trying to treat it. Not every hypo person has low levels, and you can cause damage if you increase your acid intake when not needed. Also, if reflux is a probable diagnosis, keep a diary of foods that could be triggering it. Reflux is not always triggered instantly, sometimes the effects are not experienced until some time after eating, or when two or more trigger foods are consumed. Personally, a carrot salad would make me feel very uncomfortable!!

Ok thank you for the information 😊, I have been keeping a diary for a while now but can't find any pattern or certain things that seem to set it off.

What was your pottassium level?

Thank you for your reply 😊. I didn’t have it done this time, last time I had it done was October and it was 4.5 mmol/L (3.5-5.5)

Thanks for your reply 😊. I didn’t have it done this time, it was last done in October and it was 4.5 mmol/L (3.5-5.5)

Was there a reason you were not offered B12 injections or was your initial test not that low? I and lots of other people find that sublingual or spray B12 ineffective against symptoms, even if it does put the level up - injections were life changing. They also mostly resolved my reflux issues as well. I have much the same issues as you.

Hi there, no I was never offered anything for b12 as result was 357 up to 423 this time and bottom of range is 223 so well within range to the doctors. I guess I'll try just taking supplements at first and see if that helps and then mayen consider injections in future if need to. Hoping it'd it is reflux it eases soon as its so uncomfortable 🙄

Hello, I had chest pain when my B12 and folate were low. It's very distressing and I even called 111, paramedics came to my house & checked my heart etc but everything was fine. It wasn't until I started supplementing did the chest pain and all the other horrible symptoms disappear. My GP wouldn't help me so I had to resort to self injecting. Best thing I did. I am petrified of feeling like that again so I make sure I do private blood tests to see where my levels are on a regular basis. Jo xx

Hi there thanks for your reply 😊. Yeah I've had a few times when the chest pain has been really bad and worries me a lot. Would your doctor not help because your b12 was in range to them? The b12 supplements suggested on here arrive today so hopefully they may help, but if I needed too how would I get the b12 to set inject etc please? Kind regards

No they wouldn't help me - they didn't test for B12 even though I was begging them to. Previously, they'd done a full blood count and everything was in range including MCV so they refused to do another. Eventually I went private which cost me loads of money but worth it, my MCV was just over range so I started self injecting. It was the worst experience I have ever been through (worse than Hashi's, ulcerative colitis, endometriosis, interstitial cystitis & migraines - and they are pretty terrible!!).

I buy the B12 ampules from a German company and the needles from Amazon. You get quite a lot of ampules in one box so it has lasted me ages.

It's so bad when doctors won't help, especially when people are in so much pain and discomfort, mine haven't been too bad but won't help when things are within range even though my vitamin d was just 2 over when they will treat! Did you just Google where to get b12 to self inject?

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