Hi everyone, I'm after some advice with regards my test results from Medichecks....
I've been diagnosed with hypothyroidism for about two years and have never really felt that the medication I take (50mcg levothyroxine daily) has helped my symptoms particularly (tired, moody/irritated and a foggy head that is getting worse). I've had NHS blood tests three times since diagnosis but each time my GP says all is fine (only ever test for TSH, nothing else). I recently had Medichecks blood test but would really appreciate some comment on what the results tell me:
Folate - Serum: 7.13 (range 3.89 - 79.45)
Vitamin B12: 43.5 (range 37.5 - 187.5)
Vitamin D: 39.5 (range 50 - 175)
TSH: 5.06 - (range 0.27 - 4.2)
Free T3: 4.6 (range 3.1 - 6.8)
Free Thyroxin: 14.8 (range 12 - 22)
Thyroglobulin Antibodies: 743 (<115)
Thyroid Peroxidase Antibodies: 350 (<34)
Any insight from those more learned than me would be really appreciated!
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Moop-kf
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You need immediate 25mcg dose increase in levothyroxine
Bloods should be retested 6-8 weeks later
Which brand of levothyroxine are you currently
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
But for some people (usually if lactose intolerant, Teva is by far the best option)
Teva, Aristo and Glenmark are the only lactose free tablets
Most easily available (and often most easily tolerated) are Mercury Pharma or Accord
Note Accord is also boxed as Almus via Boots, and Northstar 50mcg and 100mcg via Lloyds ....but beware 25mcg Northstar is Teva
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
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
I've had NHS blood tests three times since diagnosis but each time my GP says all is fine (only ever test for TSH, nothing else).
And therein lies the problem of totally inadequate NHS care for thyroid patients. Just testing TSH doesn't tell the doctor anything because TSH is not a thyroid hormone, it's a pituitary hormone which tells the thyroid to make thyroid hormone if it detects there's not enough. The thyroid hormones are FT4 and FT3 and it's essential that these are tested to know our thyroid status, unfortunately doctors seem to be totally ignorant of this fact.
TSH: 5.06 - (range 0.27 - 4.2)
Free T3: 4.6 (range 3.1 - 6.8)
Free Thyroxin: 14.8 (range 12 - 22)
First question has to be, did you do this test as we always advise, ie no later than 9am with nothing to eat or drink except water before the test, and last dose of Levo 24 hours before the test? If you take Biotin or a B Complex did you leave this off for 7 days before the test?
If you did and these results are accurate, then you are undermedicated. The aim of a treated Hypo patient on Levo only, generally, is for TSH to be 1 or lower with FT4 and FT3 in the upper part of their reference ranges.
Your TSH is over range, your FT4 is only 28% through range and your FT3 is 40.54% through range.
You need an increase in your dose of Levo.
Thyroglobulin Antibodies: 743 (<115)
Thyroid Peroxidase Antibodies: 350 (<34)
Raised antibodies confirm autoimmune thyroid disease, known to patients as Hashimoto's. Did you know you have Hashi's?
For thyroid hormone to work properly we need optimal nutrient levels, you have some shocking results here.
Folate - Serum: 7.13 (range 3.89 - 79.45) - top limit of range is actually 19.45
Folate is recommended to be at least half way through range, with that range it should be at least 12+
Vitamin B12: 43.5 (range 37.5 - 187.5)
Active B12 below 70 suggests testing for B12 deficiency according to Viapath at St Thomas' Hospital:
If you do then list them to discuss with your GP and ask for testing for B12 deficiency and Pernicious Anaemia. Do not take any B12 supplements or folic acid/folate/B Complex supplements before further testing of B12 as this will mask signs of B12 deficiency and skew results.
Vitamin D: 39.5 (range 50 - 175)
The Vit D Society and Grassroots Health recommend a level of 100-150nmol/L.
To reach the recommended level from your current level, you could supplement with 5,000iu D3 daily.
Retest after 3 months.
Once you've reached the recommended level then you'll need a maintenance dose to keep it there, which may be 2000iu daily, maybe more or less, maybe less in summer than winter, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. You can do this with a private fingerprick blood spot test with an NHS lab which offers this test to the general public:
Doctors don't know, because they're not taught much about nutrients, but there are important cofactors needed when taking D3.
D3 aids absorption of calcium from food and Vit K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems such as hardening of the arteries, kidney stones, etc.
D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds if taking D3 as tablets/capsules/softgels, no necessity if using an oral spray.
Magnesium helps D3 to work. We need Magnesium so that the body utilises D3, it's required to convert Vit D into it's active form. So it's important we ensure we take magnesium when supplementing with D3.
Magnesium comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds if taking magnesium as tablets/capsules, no necessity if using topical forms of magnesium.
Don't start all supplements at once. Start with one, give it a week or two and if no adverse reaction then add the next one. Again, wait a week or two and if no adverse reaction add the next one. Continue like this. If you do have any adverse reaction then you will know what caused it.
Medichecks include Ferritin in this test, what is your level?
Yes, SeasideSusie I did the test after fasting. I didn't know I had Hashimotos but suspected. I forgot to include the Ferritin result, it is 96.1 (13 - 150)
High thyroid antibodies confirms autoimmune thyroid disease also called Hashimoto’s
About 90% of primary hypothyroidism is autoimmune thyroid disease
Hashimoto's frequently affects the gut and leads to low stomach acid and then low vitamin levels
Low vitamin levels affect Thyroid hormone working
Poor gut function with Hashimoto’s can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common.
According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps, sometimes significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)
Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies
While still eating high gluten diet ask GP for coeliac blood test first or buy test online for under £20, just to rule it out first
The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported
In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned
Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.
1) 25mcg dose increase in levothyroxine (same brand of levothyroxine as now)
2) coeliac blood test
3) test for Pernicious Anaemia
4)vitamin D supplements - either prescribed by GP or self supplement
5) once had testing for PA - either will need B12 injections and daily vitamin B complex. Or daily vitamin B12 supplement and daily vitamin B complex
Bloods should be retested 6-8 weeks after each dose increase in levothyroxine
Unless extremely petite likely to need at least another 25mcg dose increase in to be on at least 100mcg
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 eventually on, or near full replacement dose
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.
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.
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
IMPORTANT......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
With Active B12 result below 70 recommended to be 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 Active B12 level has reached 70 (or serum B12 over 500) stop the B12 and just carry on with the B Complex.
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