I wrote a post several weeks ago with regards to being diagnosed with Graves' Disease 23 years ago and undergoing radioactive iodine 6 years later. I have been on 175mcg levothyroxine daily indefinitely since then but a year ago I was diagnosed with anaemia (reduced mean cell volume of red cells, low ferritin and iron). I underwent loads of blood tests, stool tests and a gastroscopy and endoscopy with no findings or answers as to why I was anaemic. In March this year, I was given a months supply of iron by my GP and sent on my way no further forward and with no idea as to what is going on with me. Lots of lovely members recommended that I get a full blood report done so I could get a better picture as to what is going on. I had these done and they've now come back with some findings which have confused me even more. My symptoms are fatigue, brain fog, loss of concentration, headaches, occasional weakness/dizziness and tiredness; except my bloods showed my free T4 was off the scale, along with my cortisol levels. I have attached the full bloods below and hope that someone can help me understand what could possibly be going on here? This is the first time I've been overactive since having radiation in 2004, except I feel everything other than overactive?!!!
TSH: 0.50 (range 0.27-4.20)
T4 Total: 125.0 (range 66-181)
Free T4: 24.6 (range 12.0-22.0)
Free T3: 5.43 (range 3.1-6.8)
Anti-thyroidperoxidase abs: 11 (range <34)
Anti-thyroglobulin abs: <10 (range <115)
Vitamin D: 51 (range 50-175)
Vitamin B12: 454 (range 145-569)
Serum Folate: 34.70 (range 8.83-60.8)
Ferritin: 48.1 (range 13-150)
Magnesium: 0.88 (range 0.7-1.0)
Cortisol: 614.0 (range 113-456)
Many thanks in advance,
Rachel.
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RachFow85
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The high FT4 does not mean you are 'over-active' - which is a physical impossibility anyway, with no thyroid - nor even over-medicated. It means you are a poor converter and need your FT4 that high just to get your FT3 to mid-range. Most hypos need their FT3 higher than that, so you are experiencing symptoms because your T3 is too low - T3 is the active hormone, which causes symptoms when too high or too low. So, it looks like you either need an increase in levo - which will take your FT4 a lot higher - or you need T3 added to a reduced dose of levo - which is very difficult to get, in the UK.
I'm not expert on nutrients, but I would want my B12 higher than that - the top of that range is very conservative and would be not much more than the bottom of the range in Japan! I'd want mine at least over 550.
Your vit D is also low. And you already know your ferritin is too low - did they do a full iron panel?
You probably have low stomach acid, being hypo (which technically, you still are) which means that you cannot digest your food properly and absorb nutrients. Did they measure your stomach acid whilst doing all those tests?
Your vitamin D is too low. The optimum level often quoted on this forum is 100 - 150 nmol/L.
You need supplements. To work out your supplement dose use this calculator (which assumes an optimal level of 40 ng/mL, which is equivalent to 100 nmol/L) :
1) Always supplement with vitamin D3, never vitamin D2.
2) The best supplements are small capsules containing oil and vitamin D only. Doctors Best is one popular brand, but there are others. Some people prefer to take mouth sprays. I don't know anything about those - they have far more ingredients in than the capsule type.
3) Vitamin D helps to raise the amount of calcium you absorb from your diet. That calcium needs to end up in your bones and teeth, not lining your arteries. To achieve this you need to take two cofactors - Vitamin K2 and Magnesium. There are many, many posts on this subject on the forum, so do a search for info. SeasideSusie's replies to other members are well worth reading on this subject.
Vitamin B12 - Your result is better than many I see, but I think the UK top of range is far too low. I aim to keep my own result at about 1000 ng/L.
Folate - Optimal for folate is upper half of the reference range, so for the range you've given you are looking for a result between about 34.8 - 60.8. Yours is so close to that I wouldn't worry about it.
Ferritin - Optimal for this is roughly mid-range or a bit higher, say 50% - 75% of the way through the range. For the range you've supplied this would be (very) roughly 85 - 120. I think it is very unlikely that you are anaemic with a ferritin of 48, but you might feel better with a higher level. To find out how to increase levels of iron with food, see this website :
If you wanted to take supplements you would be advised to get an iron panel done first. For future reference, iron and ferritin testing should be done as early in the morning as possible, while fasting i.e. using the same conditions as thyroid function testing. If you are actively supplementing iron then it is a good idea to stop taking them for a week before testing.
Magnesium - The magnesium test is not a reliable one. Less than 1% of the body's magnesium is found in the bloodstream. If the blood runs low in Magnesium the body just steals it from other tissues. So a blood test for magnesium could show perfectly good levels but the person being tested could still be deficient.
For everything you ever wanted to know about magnesium :
As long as people have functioning kidneys they should be able to excrete excess magnesium in the body without too much problem. Many people rely on this, and supplement sensible levels of magnesium. Testing isn't worth doing. Just take a sensible dose of about 250mg - 400mg or thereabouts (lower end of that range for women). For info on supplementing and the options available :
I can't be sure, but I think the credit for that must go to SeasideSusie .
It would be very hard to find the definitive first mention on this forum of vitamin K2 and magnesium as necessary co-factors when taking vitamin D, mainly because the search function is not sophisticated.
I was on a very high dose of Levothyroxine a few years ago 175mcg. Now I only take 100mcg a day and I will reduce it more soon. The Levothyroxine only worked for me after I started taking Vitamin D3 (which I still do). I had gained 3 stone in weight, which did not come off until I started Vitamin D. My level then was 11.
You have had RAI and had your thyroid burnt out in situ and been made hypothyroid.
You could be over medicated but you are not as your T3 is in range.
You are allowed an over range T4 if it converts to an acceptable level of T3 for you :
Your TSH is the least important result and since you haven't a thyroid and your feedback loop - the HPT axis broken - and likely Graves antibodies sitting on TSH receptors sites this alone makes this measure the least reliable of the 3 thyroid blood test results above.
Hyperthyroid and hypothyroid are both the extreme ends of the same T3 stick :
It is T3 that causes all the symptoms - too high a level of T3 for you and you have " hyper " symptoms whilst too low a level of T3 for you and you have " hypo " symptoms :
Ideally we need to find your level of T3 which is higher than where it currently is as your symptoms are that of hypothyroidism and under medication.
The accepted conversion ratio when on T4 - Levothyroine only is 1 - 3.50 - 4.50 T3/T4 :
with most people peferring to come in at round 4 or under - so to find your conversion ratio you simply divide your T3 into your T4 and I'm getting 4.53 - so your conversion isn't great, I've seen and experienced worse, but I think once you build up your core strength vitamins and minerals you will find your conversion of the T4 improve.
However what really matters is the fact that you have " lost " your own natural T3 thyroid hormone production which actually equates to around 20% of your overall well being and overtime making up this shortfall of T3 becomes more and more challenging.
I now aim to maintain my core strength vtamins at optimal and I also take adrenal glandular due to RAI damage. I seem to feel at my best with a ferritin at around 100, folate around 20, B12 around 500++ and vitamin D at around 100 ( range dependant but aim for a full 50% +
through ) :
I don't know about cortisol :
Before self medicating I needed to spend over a year building up my core strength.
I then started adding in the adrenal glandular and my ever so achey achey shaky lower back started to improve and I thought, maybe there's something in this !!!
When I started self medicating I increased my T4 dose up to 150 mcg - it didn't improve my conversion of T4 into T3 but I got massive headaches.
I then trialled both a T3/T4 combo and lastly Natural Desiccated Thyroid.
Both options worked - I didn't stay on the combo very long as Icouldn't sustain the source of T3 that suited me and switched to NDT and it's where I have remained as it feels softer on my body and now in my third year on the full spectrum thyroid hormone replacement option.
No GP I've ever known of knows to tell their patients to tale ascorbic acid with iron! It aids absorption and will boost your hb in no time.....google it!! After my hip p, my hb was so low that they were going to give me a blood tranfusion, I asked them to give me a month. Bought ferrous fumarate 200mgs from Boots and took a 25mg tab with each one 4 times daily. They couldn't believe it!! Mt hb was above normal within a month. All this knowledge could save the NHS SOOO much!!
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