Advice

[Girl6789]

Hello,

I posted after recent test results and feeling increasingly tired, having joint pain, pins and needles and loosing weight rapidly (65kg now 57kg 5ft 8)

My results were:

Serum ferratin 18 range (15-400)

Serum free T4 15 range (10-22)

Free T3 4.3 (3.3-6.8)

Serum TSH 0.44 range (0.3-5.5)

Total white blood count 7.8 10*9/L [4.0 - 10.0]

Red blood cell count 4.53 10*12/L [3.8 - 4.8]

Haemoglobin concentration 130 g/L [120.0 - 150.0]

Haematocrit 0.41 [0.36 - 0.46]

Mean cell volume 91 fL [83.0 - 101.0]

Mean cell haemoglobin level 28.8 pg [27.0 - 32.0]

Mean cell haemoglobin concentration 304 g/L [315.0 - 345.0]

Below low reference limit

Platelet count - observation 293 10*9/L [150.0 - 410.0]

Neutrophil count 4.9 10*9/L [2.0 - 7.0]

Lymphocyte count 1.9 10*9/L [1.0 - 3.0]

Monocyte count - observation 0.6 10*9/L [0.2 - 1.0]

Eosinophil count - observation 0.2 10*9/L [0.0 - 0.5]

Basophil count 0.1 10*9/L [0.0 - 0.1]

Spoke to gp who has done further vitamin tests which are

Vitamin D level 43

(<25 SEVERE VITAMIN D DEFICIENCY. PATIENT MAY REQUIRE PHARMCOLOGICAL PREPARATIONS.

25 - 50 VITAMIN D DEFICIENCY. SUPPLEMENTATION IS INDICATED

50 - 75 VITAMIN D SUBOPTIMAL

>75 ADEQUATE VITAMIN D)

Serum vitamin B12 level 285 ng/L [211.0 - 900.0]

If high clinical suspicion of PA or neuropathy,

with a normal B12 level, further investigate

with autoantibody testing.

Serum folate level 2 ug/L [4.0 - 20.0]

Below low reference limit

Low serum folate

Serum ferritin level 35 ug/L [15.0 - 400.0]

Speaking to Gp on Mon just seeing if anyone can advise me on these latest results I would greatly appreciate it.

Thank you

[SlowDragon Administrator]

How much levothyroxine are you currently taking Do you always get same brand of levothyroxine

Which brand

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

Ft4 is only 42% through range

Ft3 is only 29% through range

Helpful calculator for working out percentage through range

chorobytarczycy.eu/kalkulator

On just levothyroxine most people will need Ft4 at least 60-80% through range in order to get Ft3 at least 60% through range

So you need 25mcg dose increase in levothyroxine

Bloods should be retested 6-8 weeks later

Your vitamin levels are all low as direct result of being under medicated

For levothyroxine to work well we need GOOD vitamin levels

Is vitamin D until of measurement nmol or ng/ml

Are you in the U.K.?

Vitamin D in U.K. is usually nmol

Folate is deficient

B12 is far too low

You need testing for pernicious anaemia before starting on B12 supplements or regular B12 injections

GP must prescribe folic acid

Ferritin is far too low as well

Majority of hypothyroid patients gain weight, but a significant minority find it very difficult to maintain weight

You need coeliac blood test if not been tested yet

[Girl6789 in reply to SlowDragon]

Hello, currently on 200 teva as lactose intolerant. Test was at 8:40 fasting. Was an error on vitamin D it doesn't say unit on online access. I'm in the UK. It has been a series of battles since thyroidectomy 2 years ago. Will discuss with GP on Monday. Thank you

[SlowDragon Administrator in reply to Girl6789]

So lactose intolerance is extremely common as result of being coeliac or gluten intolerant

Are you on strictly gluten free diet?

Presumably you are strictly dairy free ?

[Girl6789 in reply to SlowDragon]

I'm on a gluten free diet and dairy free

[SlowDragon Administrator in reply to Girl6789]

With lactose intolerance and gluten intolerance you very likely need small doses of T3 prescribed alongside levothyroxine once all four vitamins are optimal

It’s going to take significant levels of vitamin supplements to improve

Email Thyroid UK for list of recommend thyroid specialist endocrinologists who will prescribe T3

NHS and Private

[e-mail]

[Girl6789 in reply to SlowDragon]

Thank you! That's really helpful

[SlowDragon Administrator in reply to Girl6789]

Were you gluten or lactose intolerant BEFORE starting on levothyroxine

[SlowDragon Administrator in reply to Girl6789]

Did you start levothyroxine after first thyroid lobectomty?

Or only after 2nd operation

[SlowDragon Administrator in reply to Girl6789]

Lactose intolerance as result of gluten intolerance often improves after year or two on strictly gluten free diet

coeliac.org.uk/healthcare-p...

coeliac.org.uk/information-...

[SlowDragon Administrator in reply to Girl6789]

So vitamin D is insufficient

GP should prescribe 1600iu everyday for 6 months

But likely to need higher dose than that with Hashimoto’s and mouth spray often works better

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

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

leedsformulary.nhs.uk/docs/...

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

mm.wirral.nhs.uk/document_u...

NHS Guidelines on dose vitamin D required

ouh.nhs.uk/osteoporosis/use...

But with Hashimoto’s, improving to around 80nmol or 100nmol by self supplementing may be better

ncbi.nlm.nih.gov/pubmed/218...

vitamindsociety.org/pdf/Vit...

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

amazon.co.uk/BetterYou-Dlux...

It’s trial and error what dose we need, with hashimoto’s we frequently need higher dose than average

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

grassrootshealth.net/projec...

Government recommends everyone supplement October to April

gov.uk/government/news/phe-...

Taking too much vitamin D is not a good idea

chriskresser.com/vitamin-d-...

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

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

2 good videos on magnesium

healthunlocked.com/thyroidu...

Vitamin D and Covid

Notice how much vitamin D many of these medics are taking

vitamind4all.org/letter.pdf

[SlowDragon Administrator in reply to Girl6789]

Low ferritin

As GP for full iron panel test for anaemia

They probably won’t do it ...but always worth trying

Look at increasing iron rich foods in diet

Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption

List of iron rich foods

dailyiron.net

Links about iron and ferritin

irondisorders.org/too-littl...

davidg170.sg-host.com/wp-co...

Great in-depth article on low ferritin

oatext.com/iron-deficiency-...

drhedberg.com/ferritin-hypo...

This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.

healthunlocked.com/thyroidu...

restartmed.com/hypothyroidi...

Post discussing just how long it can take to raise low ferritin

healthunlocked.com/thyroidu...

Never supplement iron without doing full iron panel test for anaemia first

Post discussing why important to do full iron panel test

healthunlocked.com/thyroidu...

Why low ferritin needs improving

healthunlocked.com/thyroidu...

Thyroid disease is as much about optimising vitamins as thyroid hormones

[Girl6789 in reply to SlowDragon]

Thank you for all the advice. I started with symptoms of gluten and lactose intolerance just before they found first nodule. I had started levo after my lobectomy and tried to get it under control but nodule was compressing oesophagus and affecting my ability to eat. Have had some many issues since then being and have seen an end once but will have a look at list that I can get as wasn't helpful.

[SlowDragon Administrator in reply to Girl6789]

Roughly where in the U.K. are you

Of course at moment several specialist endocrinologist are doing consultations on zoom.....distance no issue

[Girl6789 in reply to SlowDragon]

I'm near Bournemouth.

[Topsy33]

Folate and B12 need supplementing. Your symptoms point to those deficiencies and results confirm. I would suggest a good quality Methyl B complex such as Igenus...

[Tussa]

Have you checked your calcium levels? I had a thyroidectomy 2015 and have suffered from hypocalcemia since then. Not too uncommon after this kind of surgery 😔. Pins and needles is a sign when your calcium is low. Also weight loss.

One thing I learned the hard way is how important it is to have ALL electrolytes in balance. I found out just one year ago that I was also low in zinc and magnesium. If you take large amount of one mineral it depletes the others. Without enough zinc you get malabsorption. I was loosing a lot of weight. I started take hcl and zinc and after a couple of weeks I started to gain weight. And feeling much better overall.

[Batty1]

I feel for you I too have been on a roller of issues since thyroidectomy in 2016... agh