New test results including vitamins & iron

[KBA22]

Hi all - I recently completed my first at-home tests using Thriva (advanced Thyroid & vitamins/ferritin/folate tests). My recent results are below - for comparison purposes, I've also included Oct & Dec results taken via NHS.

- I undertook the test at 9am on an empty stomach.

- Before taking my third test, I had run out of meds and hadn't taken my 50mcg of Levothyroxine (Accord prescribed after my first test) for at least a month.

- As of a few days ago, I am now back on meds taking 75 mcg of Levothryoxine (25 mcg of Mercury Pharma + 50 mcg Accord).

- I am not on any supplements.

- Recently took Coeliac test and it's negative.

Question 1: My January Thriva TSH range seems excessive, or worse than my December results. Am I reading this correctly? Is it possible to regress if you've not had meds for 1 month? Over Christmas break I was taking sleeping pills and anxiety meds called Tranqipam for a few weeks. Could this impact results at all? I'm not on them any more.

Question 2: I took the vitamin/ferritin/folate tests because of comments on this forum. How do mine compare and why do you encourage people to get these tests done? How often should you test?

Question 3: I started going dairy free a few days ago. When should I take a test to see impact of going diary free before eliminating gluten? 1 -3 months after?

October 2020

TSH - 6.95 mU/L (0.3 - 4.2)

T4 - 12.5 pmo/L (9.0-23)

TPOAb - 378.26 iU/mL (0.0-5.0)

December 2020

TSH - 5.85 mU/L (0.3 - 4.2)

T4 - 14.2 pmo/L (9.0-23)

January 2021

TSH - 10.99 mIU/L (0.27 - 4.2)

T4 - 95 nmol/L (59-154)

FT3 - 4.6 pmol/L (3.1-6.8)

FT4 - 15.7 pmol/L (12-22)

TPOAb - 134.5 kIU/L (0-34) :Thyroid peroxidase antibodies

TgAB - 499.1 kU/L (0-115) : Thyroglobulin antibodies - results said 'out of range'.

B12 Active - 186 pmol/L (range 37.5-188)

My results seem to suggest I'm borderline out of a normal range. Should I take supplements here? Retest after 3 months?

Ferritin - 36ug/L(range 13-150)

Too low? Ferritin is recommended to be half way through range, correct? Should I take supplements here? Retest after 3 months?

Folate - 42.4 nmol/L (range 8.83-60.8)

Should be halfway between range, so should be ok, right? Retest after 3 months?

Vitamin D - 92.4 nmol/L (75-175)

Based on what I've read on the forum, I need to be somewhere between a level of 100-150nmol/L. Should I take supplements here? Retest after 3 months?

If you're still reading this, a big thank you! And just wanted to say I really do appreciate all the advice I get on this site. It's made a huge impact.

[SeasideSusie Remembering]

KBA22

I am only going to comment on the nutrient tests, the reason being that my brain can't follow the thyroid tests and the way you have reported them, it means constantly scrolling up and down to see what's what, sorry. In my opinion it's better to put the full TSH/FT4/FT3/antibody results all together for each date, eg

October

TSH

FT4

FT3

Antibodies

December

TSH

FT4

FT3

Antibodies

etc

So for your nutrients:

Vitamin B12 Active

- Jan 186 pmol/L (range 37.5-188)

My results seem to suggest I'm borderline out of a normal range. Should I take supplements here? Retest after 3 months?

You are high within the range. If you are already supplementing then you might want to reduce your dose. If you are not supplementing you don't need to. You would only supplement if the level is too low.

Ferritin

- Jan 36ug/L(range 13-150)

Too low? Ferritin is recommended to be half way through range, correct? Should I take supplements here? Retest after 3 months?

Yes, ferritin is recommended to be half way through range.

Don't consider taking an iron supplement unless you do an iron panel, if you already have a decent level of serum iron and a good saturation percentage then taking iron tablets can push your iron level even higher, too much iron is as bad as too little.

You can help raise your level by eating liver regularly, maximum 200g per week due to it's high Vit A content, also liver pate, black pudding, and including lots of iron rich foods in your diet

apjcn.nhri.org.tw/server/in...

Folate

- Jan 42.4 nmol/L (range 8.83-60.8)

Should be halfway between range, so should be ok, right? Retest after 3 months?

Yours is a good result. If you are retesting other nutrients I would include this but I wouldn't necessarily go out of my way to test it if nothing else needs testing. Once a year is enough.

Vitamin D

- Jan 92.4 nmol/L (75-175)

Based on what I've read on the forum, I need to be somewhere between a level of 100-150nmol/L. Should I take supplements here? Retest after 3 months?

That's a pretty good level for someone who doesn't supplement. I would want mine nearer 150. You could take maybe 2,000iu D3 along with cofactors magnesium and Vit K2-MK7 and retest in 3 months.

[KBA22 in reply to SeasideSusie]

Thanks Seaside Susie for your feedback. I've updated my data layout. Hopefully easier for all to read now.

[SlowDragon Administrator]

Levothyroxine is a REPLACEMENT thyroid hormone as your thyroid is now struggling to produce enough daily

When did you start on 50mcg levothyroxine?

50mcg is only a starter dose

Bloods should be retested 6-8 weeks after each dose increase

October and December results showed you needed 25mcg dose increase

January results clearly demonstrated that you absolutely must take levothyroxine everyday

You were lucky not to become seriously unwell, with no levothyroxine for a month

So next step is to retest thyroid levels 6-8 weeks after starting 75mcg levothyroxine

Always test as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

Likely to need further increase in levothyroxine

[SlowDragon Administrator]

Before taking my third test, I had run out of meds and hadn't taken my 50mcg of Levothyroxine (Accord prescribed after my first test) for at least a month.

So December test was after roughly a month on 50mcg levothyroxine

Presumably test was done by GP?

Dose levothyroxine should have been increased to 75mcg after this test result

Bloods should be retested 6-8 weeks after EACH dose increase

Likely to need further increase in levothyroxine

Unless very petite, most people will need dose levothyroxine at least 100mcg per day, or more

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.

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...