My second test results just arrived. Can someon... - Thyroid UK

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My second test results just arrived. Can someone help. TY:)

Janaains profile image

I have done my second annual thyroid test via Medichecks. I feel fine apart from being quite tired. My belly is still little sensitive and gets bloated easily. I do take vitamin D/K2, B12 and eat healthy trying gluten free. I am on 125mcg of levothyroxine (Almus). Any advice on these results?

28-Jan-2021

CRP HS: 1.13 mg/L (< 5 R)

FERRITIN: 19.2 ug/L (13 - 150 R)

FOLATE - SERUM: 16.15 ug/L (> 3.89 R)

VITAMIN B12 - ACTIVE: 108 pmol/L (> 37.5 R)

VITAMIN D: 78.2 nmol/L (50 - 175 R)

TSH: 0.93 mIU/L (0.27 - 4.2 R)

FREE T3: 4 pmol/L (3.1 - 6.8 R)

FREE THYROXINE: 16.8 pmol/L (12 - 22 R)

THYROGLOBULIN ANTIBODIES: 57 kIU/L (< 115 R)

THYROID PEROXIDASE ANTIBODIES: 172 kIU/L (< 34 R)

13 Replies
SlowDragon profile image
SlowDragonAdministrator

Your results suggest you are under medicated

Ft4 is only 48% through range

Ft3 only 24% through range

Helpful calculator for working out percentage through range

chorobytarczycy.eu/kalkulator

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

Suggest you try 150mcg 3 x week

Retest in 6-8 weeks

Ferritin levels are far too low

Need to significantly increase iron rich foods in diet

Are you vegetarian or vegan?

Vitamin D could be higher

Gluten free diet needs to be absolutely strictly gluten free

Janaains profile image
Janaains in reply to SlowDragon

Thank you SlowDragon. Yes the test was early, no food, only water and last dose 24 hrs before. I am feeling tired all the time which explain low iron levels. I will look to start on some iron supplements and start including iron rich foods. Not veggie/vegan but i only eat chicken, fish. Would the T4 and T3 improve with better balanced vitamins? Or is it purely down to levothyroxine dose? Do vitamins only affect the conversion from T4 to T3?

SlowDragon profile image
SlowDragonAdministrator in reply to Janaains

Your relatively low Ft4 shows you’re not on high enough dose

Conversion may improve with optimal vitamin levels

But even if Ft3 was same as current Ft4....at 48% through range, that’s likely too low

SlowDragon profile image
SlowDragonAdministrator in reply to Janaains

Look at eating red meat, liver, pate etc

SeasideSusie profile image
SeasideSusieAdministrator

Janaains

I am on 125mcg of levothyroxine (Almus).

How is the 125mcg made up? Is it 100mcg plus half of a 50mcg Almus tablet?

Is it 100mcg Almus + 25mcg other brand tablet.

Almus don't make 25mcg tablets (Almus are made by Accord who only make 100mcg and 50mcg tablets).

Hi SeasideSusie i didn’t want mixing brands so I am splitting the 50mcg tablet in half every day and take full 125mcg at 6 am. Then have breakfast or coffee around 7:30am. I didn’t want another brand so therefore I am just splitting the 50mcg tablets. Does that affect potency if they are open and split?

SeasideSusie profile image
SeasideSusieAdministrator in reply to Janaains

Janaains

Good that you're sticking to the same brand. I've split Levo tablets with no problem at all so if you don't notice anything untoward it's fine to carry on. I think it's better than mixing brands :)

Your conversion rate based on your lab test results is 22 in a range of 20 - 40 nmol/s

tattybogle profile image
tattybogle in reply to

Please can you explain conversion rate v's conversion ratio ? It's not a term i've seen before so i don't really know what it means, or how it is worked out. Which research does the range come from ?

Sorry for the '20 questions' :)

in reply to tattybogle

For an example of rate, think water flow rates at litres per minute. There has to be a time element. Ratio--well you know what that is.

I got nothin' myself--I just cribbed the work of research endocrinologist Johannes Dietrich, who I understand to be a supporter or a mentor of sorts to ThyroidUK.

References for him include:

15. Dietrich, J.W., Ackermann, A., Kasippillai, A. et al. Adaptive Veränderungen des Schilddrüsenstoffwechsels als Risikoindikatoren bei Traumata. Trauma Berufskrankh 21, 260–267 (2019) doi:10.1007/s10039-019-00438-z doi.org/10.1007/s10039-019-...

17. 20 years of #SPINA_Thyr. twitter.com/SPINATeam/statu...

18. Hoermann R, Midgley JEM, Larisch R, Dietrich JW. Individualised requirements for optimum treatment of hypothyroidism: complex needs, limited options. Drugs Context. 2019 Aug 13;8:212597. doi: 10.7573/dic.212597. PMID: 31516533; PMCID: PMC6726361. pubmed.ncbi.nlm.nih.gov/315... doi.org/10.7573/dic.212597

19. Hoermann R, Midgley JEM, Larisch R, Dietrich JW. Functional and Symptomatic Individuality in the Response to Levothyroxine Treatment. Front Endocrinol (Lausanne). 2019 Sep 26;10:664. doi: 10.3389/fendo.2019.00664. PMID: 31616383; PMCID: PMC6775211. pubmed.ncbi.nlm.nih.gov/316... doi.org/10.3389/fendo.2019....

20. Dietrich, J W. SPINA Thyr (Version 4.1.0 (Bonfire)). RRID:SCR_014352. 2019. doi: 10.5281/zenodo.3596049 doi.org/10.5281/zenodo.3596049

21. Dietrich JW, Makimoto H, Müller P. Letter by Dietrich et al Regarding Article, "Thyroid Dysfunction in Heart Failure and Cardiovascular Outcomes". Circ Heart Fail. 2019 Apr;12(4):e005854. doi: 10.1161/CIRCHEARTFAILURE.118.005854. PMID: 30998389. pubmed.ncbi.nlm.nih.gov/309... doi.org/10.1161/circheartfa...

(hat tip to Diogenes)

Hello Janaains :

The conversion ratio used when on Levothyroxine only is said to be 1 / 3.50 - 4.50 T3 to T4 :

with most people preferring to come at around 4 or under :

So, if I divide your T3 of 4 into your T4 of 16.80 I get = 4.20 : so in the " acceptable " ratio but it could be a lot better - and from my experience I know that as my ferritin increased from 22 so did my conversion of the T4 into T3.

It's generally recommended that we need T4 in the upper quadrant of its range for optimum health and wellbeing , and since you are just under 50% through a dose increase in T4 should, in turn, increase your T3 proportionately.

Your vitamin D might serve you better if it was nearer 100 :

Building up ferritin can take time.

You are in range, so a prescription may not be offered, but guess you can ask.

I couldn't get on with the prescription iron tablets so purchased my own.

I used Solgar Gentle Iron + Spatone + eating liver weekly.

I now maintain my ferritin at around 100 with 1 tub weekly of Asda frozen chicken livers ;

They are very clean and mild :

Once defrosted, and flash fried down in a little oil I whizz down into a pate and keep in the fridge : a spoonful a day with a dollop of Hellmann's helps this medicine go down and my ferritin and calories topped up.

I'm with Graves post RAI thyroid ablation and now manage lingering Graves, thyroid eye disease and hypothyroidism.

Janaains profile image
Janaains in reply to pennyannie

Thank you for sharing pennyannie about fresh liver i will go and give this a go. Not sure my GP will give me iron subscription but I will get my own. I do feel tired really hope improving those levels will give me more energy.

pennyannie profile image
pennyannie in reply to Janaains

Hey there ;

Yes my conversion ratio on T4 only came in at 5.50 and my T4 was already up at 100% through the range :

It's two fold - build up vitamins and minerals to optimal levels , where necessary, and slowly increase your T4 medication up the range, as most people feel better when in the upper quadrant of the range.

This should in turn, should increase your level of T3 - as it is T3 that gives the symptoms - too low a T3 and you experience symptoms of hypothyroidism and too high a T3 and you can experience symptoms of over medication much like the symptoms associated with hyperthyroid :

If you go on the Thyroid UK website you can read much more information, including lists of symptoms of both under / and over active thyroid but here again, the water gets a bit muddied as some symptoms do cross both conditions.

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