So these are my sons recent bloods. Diagnosed with hashimotos 2 years ago. Main issue is hair loss, fatigue dry skin.It’s affecting his psychological well-being now and he’s away at university. He’s gluten free.
Has been taking thyroxine for 2 years but only at 25mg! Gp will not raise! Hence doing private bloods. Bloods done at 8am not meds or vitamins taken.
Please can you offer advice on bloods and what to do next? Thanks
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Ferritin 80 ( 30-400)
Folate. 4.7 ( >2.9)
B12. 51. ( 25-165)
Vit D 61. (50-200)
TSH. 2.4 ( 0.27-4.2)
Free T3 5.0 (3.5-7.7)
Free thyroxine 16.4 (12-22)
Tgab 1438 (0-115)
Tpo 241 (0-115)
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This low. Ferritin is recommended to be half way through range although I have seen it said that for males 150 is a decent level. He should be eating iron rich foods to try and raise his level. It's not recommended to take iron tablets without first doing an iron panel to check serum iron and transferrin saturation, because if serum iron is already good then taking iron tablets can take it too high.
If he does have any then he should list them to discuss with his 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.
Vit D 61. (50-200)
This is too low. The Vit D Society and Grassroots Health recommend a level of 100-150nmol/L.
To reach the recommended level from his current level, he could supplement with 4,000iu D3 daily. His level will be good enough for any GP so he wont be prescribed it, he will need to buy his own.
Retest after 3 months.
Once he's reached the recommended level then he'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. He 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.
For D3 I like Doctor's Best D3 softgels, they are an oil based very small softgel which contains just two ingredients - D3 and extra virgin olive oil, a good quality, nice clean supplement which is budget friendly. Some people like BetterYou oral spray but this contains a lot of excipients and works out more expensive.
For Vit K2-MK7 I like Vitabay or Vegavero brands which contain the correct form of K2-MK7 - the "All Trans" form rather than the "Cis" form. The All Trans form is the bioactive form, a bit like methylfolate is the bioactive form of folic acid.
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 he does have any adverse reaction then he will know what caused it.
TSH. 2.4 ( 0.27-4.2)
Free T3 5.0 (3.5-7.7)
Free thyroxine 16.4 (12-22)
Tgab 1438 (0-115)
Tpo 241 (0-115) - shouldn't this be (0-34)?
His dose of Levo is too low. The aim of a treated Hypo patient on Levo only, generally, is for TSH to be 1 or below with FT4 and FT3 in the upper part of their reference ranges.
He should ask his GP for an increase in dose, 25mcg now and retest in 6-8 weeks, further increases may be necessary.
Fine tuning of the dose could be necessary in some patients
* aim of levothyroxine treatment is to make the patient feel better, and the dose should be adjusted to maintain the level of thyroid stimulating hormone within the lower half of the reference range, around 0.4 to 2.5 mU/l. If the patient feels perfectly well with a level in the upper half of the reference range, then adjustment is unnecessary
How can blood tests be used to manage thyroid disorders?
.....
Occasionally patients only feel well if the TSH is below normal or suppressed. This is usually not harmful as long as it is not completely undetectable and/or the FT3 is clearly normal.
There are also certain patients who only feel better if the TSH is just above the reference range. Within the limits described above, it is recommended that patients and their supervising doctors set individual targets that are right for their particular circumstances.
.....
Also, Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (the professional publication for doctors):
"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l. In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance. But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l. This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l).*"
You can obtain a copy of this article from Dionne at ThyroidUK:
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