I'm fairly new to this forum, and to trying to interpret my results.
A little background: diagnosed with Graves disease in early 20's, levels came back to normal using Block and Replace therapy (I think that's what its called). Fine for a few years and then Graves came back in in my mid-late 20's, ended up having RAI (which I regret now!), and have been hypo ever since. I have never felt right since it came back, always shattered, mood all over the place, joints and muscles easily injured, always freezing - a real joy to be around as you can imagine :D. I also have had recurrent miscarriages (something I am utterly convinced is to do with my immune system but the Doctors don't seem to agree)
Anyway, I recently found this forum and have been encouraged to get a test via Thriva to look at all my levels and got the following results;
Active B12 - 77pmol/L (Normal) (Ref Range 75-175)
Ferritin - 48ug/L (Optimal) (Ref Range 13-150)
Folate - 28.2nmol/L (Normal) (Ref Range 8.83-60.8)
TSH - 0.85mlU/L (Normal) (Ref Range 0.270-4.2)
FT4 - 23pmol/L (High) (Ref Range 12-22)
FT3 - 4.4pmol/L (Optimal) (Ref Range 3.1-6.8)
TPOAb - 38.6kIU/L (High) (Ref Range 0-34)
T4 - 133nmol/L (Normal) (Ref Range 59-154)
TgAB - 16.1kU/L (Normal) (Ref Range 0-115)
Vit D - 74nmol/L (Sufficient) (Ref Range 75-175)
The test came with some advice from a Dr who said I would probably be best off lowering my thyroxine, this is actually really confusing as I was pregnant in March (unfortunately not now) and my GP tested my FT4 then and it was 20pmol/L - in the first trimester it is supposed to be under 19 - and so he suggested I increase my thyroxine.
I'm just after any advice people can give really. I'm taking 150/175mg of thyroxine on alternate days as per my GP's advice back in March. Should I maybe just drop it to 150? Should I speak to a GP (perhaps a different one?).
Thanks
Sarah
Written by
HypoSarah
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Thriva have a very confusing way of displaying their results on the bar graph, and their "normal" and "optimal" references are nonsensical.
If you log into your account and download the pdf list of your results, the normal reference ranges are on there, can you please add these reference ranges to your results (you can edit your post by clicking on the downward arrow next to MORE below your post, make changes then click SUBMIT).
You can find your results with their normal ranges as a pdf using the link in the help page
One important point, we can see that your TPO antibodies are over range. When you were diagnosed with Graves disease, was this confirmed by testing TSI or TRAb antibodies and they came back raised?
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 3,000-4,000iu 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.
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.
This is on the low side. Ferritin is recommended to be half way through range with some experts saying that for optimal thyroid function it should be 90-110.
Symptoms of low ferritin can include:
◾Weakness
◾Fatigue
◾Difficulty concentrating
◾Poor work productivity
◾Cold hands and feet
◾Poor short-term memory
◾Difficulty remembering names
◾Dizziness
◾Pounding in the ears
◾Shortness of breath
◾Brittle nails
◾Headaches
◾Restless legs
It's not recommended to take an iron supplement unless you do an iron panel to see if you have iron deficiency and a full blood count to see if you have anaemia.
You can help raise your level by eating liver regularly, maximum 200g per week due to it's high Vit A content, also liver pate, black pudding, and including lots of iron rich foods in your diet
Active B12 below 70 suggests testing for B12 deficiency so you are above that, but I prefer mine to be 100+
Folate - 28.2nmol/L (8.83-60.8)
Folate is recommended to be at last half way through range, so with that range it's 35+
If you want to improve your B12 and folate levels then I'd suggest a good, bioavailable B Complex containing methylcobalamin and methylfolate. My choice is Thorne Basic B. It may be best to avoid any B Complex containing Vit C as this keeps the body from using B12.
TSH - 0.85mlU/L (Normal) (Ref Range 0.270-4.2)
FT4 - 23pmol/L (High) (Ref Range 12-22)
FT3 - 4.4pmol/L (Optimal) (Ref Range 3.1-6.8)
The aim of a 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, if that is where you feel well.
Your FT4 is over range and your FT3 is just 35% through range, so you need an over range FT4 to produce just a fairly low level of FT3. These should be fairly well balanced and your results suggest poor conversion of T4 to T3.
Things that aid conversion are optimal nutrient levels and supplementing with selenium. Your nutrient levels aren't dire although getting ferritin up to half way through range - 82 with that range - should be a priority.
It's worth considering the addition of T3 to a slightly reduced amount of Levo (say 25mcg reduction to start with), but you would need a T3 endo to initiate a trial if it's allowed in your area, some areas don't allow T3 to be prescribed.
TPOAb - 38.6kIU/L (High) (Ref Range 0-34)
TgAB - 16.1kU/L (Normal) (Ref Range 0-115)
TPO antibodies are often raised when Hashimoto's is present (which is why I asked if your Graves had been confirmed by raised Graves antibodies). I wonder if you do have Hashi's, it's possible to have Graves and Hashi's running in tandem.
Some people with Hashi's find that a strict gluten free diet can help but there's no guarantee.
Thank you so much for all this information - it is really interesting!!
I never even considered I could have Hashi's alongside Graves.
I think my first port of call is to look into all the recommendations you have given with my nutrient levels - and maybe try a gluten free diet. Unfortunately as far as I'm aware T3 trials aren't available here in Sheffield - so I would need to go private, there is a Dr in Sheff on the list provided by ThyroidUK but I'm not in the right financial position at the moment to be able to get an appointment with him.
Thanks again for your response - it is so helpful!!
As you had Graves’ disease gluten is often a hidden issue
Have you had coeliac blood test done
Have you tried strictly gluten free diet
Finding endocrinologist prepared to allow T3 is difficult, and may be particularly difficult to find one happy to allow T3 when pregnant …but there are members on here who have had successful pregnancies on levothyroxine plus T3
Email Thyroid UK for list of recommend thyroid specialist endocrinologists...NHS and Private
tukadmin@thyroiduk.org
The aim of levothyroxine is to increase dose upwards in 25mcg steps until TSH is ALWAYS under 2
When adequately treated, TSH will often be well below one. Most important results are ALWAYS Ft3 followed by Ft4. When adequately treated Ft4 is usually in top third of range and Ft3 at least 60% through range (regardless of how low TSH is)
Extremely important to have optimal vitamin levels too as this helps reduce symptoms and improve how levothyroxine works
I don't always get the same brand, its just whatever the pharmacy gives me. Its usually Teva UK or accord though (at the moment its a mixture of the two 100's and 50's are Teva and 25's are accord).
I currently take a pre-natal vitamin supplement and a Vitamin D spray (3000 - I take two sprays of this as I have been advised that is good for fertility/pregnancy). I will admit I am not as diligent in taking them as I should be and have been working on this recently.
I've had a coeliac test recently, that came back negative. I haven't tried a gluten free diet but I do intend to after reading SeasideSusie's post.
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