Hi I have just had blood test results back. Taken at 9 am after fasting and did not take medication before which is currently 25mg
TSH 3.49 range 0.30-4.20
Free T4 11.6 range 11.0-22
Ferritin 71ug/L range 28-200
B12 219 range 180-640
Folate 3.7 range 3.0-20.0
Has anyone got any advice as my results were shown as normal
Didn’t get an antibody result by the looks
Thank you in anticipation
Sewingbee24
Is this a GP test or private?
When were you diagnosed hypothyroid and how long have you been on 25mcg Levo?
Has anyone got any advice as my results were shown as normal
TSH 3.49 range 0.30-4.20
Free T4 11.6 range 11.0-22
They are classed as normal just because they are within range; however, they are not optimal. I expect you aren't feeling very well with these results.
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 if that is where you feel well.
Your TSH is far too high and your FT4 has only just scraped into the bottom of the range.
You need an increase in your dose of Levo, 25mcg immediately, retest in 6-8 weeks, another increase followed by another re-test 6-8 weeks later, repeat until levels are where they should be for you to feel well.
If your GP is reluctant to increase your dose, use the following information which shows that at the very least TSH should be below 2, if not lower, all from reputable sources which should be acceptable for your GP:
From GP online
gponline.com/endocrinology-...
Under the section
Cardiovascular changes in hypothyroidism
Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L.
From the British Thyroid Foundation:
btf-thyroid.org/thyroid-fun...
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:
tukadmin@thyroiduk.org
print it and highlight Question 6 to show your GP.
**
Ferritin 71ug/L range 28-200
Ferritin is recommended to be half way through range and some experts say that the optimal ferritin level for thyroid function is between 90-110 ng/ml.
Your level isn't too bad at all really but you can improve it 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
bda.uk.com/resource/iron-ri...
You should not take an iron supplement unless an iron panel has been done to see if you are iron deficient, and with a ferritin level of 71 this is unlikely. Taking an iron supplement when your iron level is already good will cause problems, too much iron is as bad as too little.
**
B12 219 range 180-640
This is very low and you should check to see if you have any signs of B12 deficiency:
b12deficiency.info/signs-an...
b12d.org/submit/document?id=46
If you do have any 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.
Come back and tell us what your GP says.
**
Folate 3.7 range 3.0-20.0
This is very low but not folate deficiency, you are in the "indeterminate" category:
cks.nice.org.uk/anaemia-b12...
Folate level
◦Serum folate of less than 7 nanomol/L (3 micrograms/L) is used as a guide to indicate folate deficiency.
◦However, there is an indeterminate zone with folate levels of 7–10 nanomol/L (3–4.5 micrograms/L), so low folate should be interpreted as suggestive of deficiency and not diagnostic.
You should discuss this with your GP when discussing your B12. If you are prescribed anything for your low folate do not start taking it until after 12 injections or supplements have been started.
**
You need Vit D testing as well.
Hi there thanks for the reply. This was a GP test I asked for as I haven’t had a review since diagnosed 2/3 years ago. I will ask for an increase in my medication though and to test further for B12 deficiencies and pernicious anaemia. I don’t eat red meat so am unable to increase iron levels that way. Do you have any other suggestions? I have gone gluten free and don’t drink alcohol so have tried to alleviate my symptoms that way. I guess I have felt like this for so long it feels ‘normal’ but obviously not
I don’t eat red meat so am unable to increase iron levels that way. Do you have any other suggestions?
Check out the link I gave to iron rich foods.
Another one here: everydayhealth.com/pictures...
haven’t had a review since diagnosed 2/3 years ago.
Then your GP has been totally negligent and ignored guidelines for intiation and titration:
cks.nice.org.uk/topics/hypo...
Initiation and titration
The dose of levothyroxine (LT4) should be individualized on the basis of clinical response and thyroid function test (TFT) results. Treatment must be monitored regularly to determine an adequate dose and to avoid both under- and over-treatment.
The NICE clinical guideline recommends:
Consider starting LT4 at a dosage of 1.6 micrograms per kilogram of bodyweight per day (rounded to the nearest 25 micrograms) for adults under 65 years of age with primary hypothyroidism and no history of cardiovascular disease.
Consider starting LT4 at a dosage of 25–50 micrograms per day with titration for adults aged 65 years and over, and adults with a history of cardiovascular disease.
The British National Formulary (BNF) recommends:
For adults aged 18–49 years — initially 50–100 micrograms once daily; adjusted in steps of 25–50 micrograms every 3–4 weeks, adjusted according to response; maintenance 100–200 micrograms once daily.
For adults aged 50 years and over, with cardiovascular disease, or severe hypothyroidism — initially 25 micrograms once daily; adjusted in steps of 25 micrograms every 4 weeks, adjusted according to response; maintenance 50–200 micrograms once daily.
Total, total failure on your GP's part. I'm disgusted.
I have just spoken to my doctor who has increased my Levi to 50mcg with immediate effect. As B 12 etc is ‘in range’ nothing else is being tested except for vit D on my next blood test in 5 weeks
Sewingbee24
Well at least that's a start, well done. Make sure you are retested with your GP in 6-8 weeks' time - not 5 weeks, that's too soon for levels to have settled.
Watch out for change of brand of Levo.
Are you continuing with your 25mcg prescription and just doubling the dose or having a new prescription for 50mcg?
What brand do you currently take and are you OK with it, as in no side effects?
As B 12 etc is ‘in range’ nothing else is being tested except for vit D on my next blood test in 5 weeks
It doesn't matter that it's in range. With B12 it's not the numbers that should be taken into account, it's whether the patient has symptoms. Did you check the lists I gave you? Do you have any of those symptoms?
I believe it’s just a doubling of my 25mcg which I have just had a new pack. This is Teva and I don’t have any side effects. There is a huge list of B12 symptoms and the only two I have is insomnia and breathlessness. I’m pretty active and don’t sit around. The dr said just take a multivitamin with B12 in!
Sewingbee24
The dr said just take a multivitamin with B12 in!
Oh lordy no! Don't do that. Multivitamins aren't recommended for many reasons, they contain too little of anything to help low levels or deficiencies, tend to contain the cheapest, wrong form and least absorbable of active ingredients, and often contain things we should test for first and only supplement if found to be deficient, eg calicum, iron, iodine. There will be nowhere near enough B12 in a multi to help at all.
I'm surprised that with such a low level of B12 you don't have any symptoms.
You could pop over to the Pernicious Anaemia forum here on HealthUnlocked, post your B12 and Folate results with their reference ranges and see what they say:
If you're fine with Teva then there's no reason not to carry on with it, it just happens to be the brand many people do have a reaction to, it seems to be due to the fact that they use mannitol instead of lactose.
Thanks for your help, I will post again with an update once I have increased my dose. I’ll also post my B12 results on the Pernicious anemia forum. Will they advise re B12 supplements or isn’t it as easy as that?
I’ll also post my B12 results on the Pernicious anemia forum. Will they advise re B12 supplements or isn’t it as easy as that?
I'm not sure. Keep us updated 
Thanks yes I will
Hi just an update. My new prescription for Levo is Accord at 50mcg and not Teva. Do I continue to take this and see what happens if anything?
Sewingbee24
It's your choice really.
If you need lactose free Levo then stick to the Teva as you know you are OK with it.
You could try the Accord and if you don't get on with it you can always ask the GP for another prescription and stipulate Teva brand, or ask the pharmacist to only dispense Teva.
A small number of people have found that Accord, since the name change from Activa, is different and has caused them problems. However, it seems that the majority of us who have used Actavis for many years haven't found a problem since changing it's name to Accord. It's obviously a very individual thing.
Ok thanks I’m not lactose intolerant it was just the first medication that I was given. I’ll give it a go
Looking on your profile you’re 55, so standard starter dose levothyroxine is 50mcg
See/contact GP and get dose increase in levothyroxine to 50mcg
Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine
Which brand of levothyroxine are you currently taking?
Likely to need several further increases in levothyroxine over coming months
Most people when adequately treated will have TSH around or under one, Ft4 near top of range and Ft3 at least half way through range
Guidelines on dose by weight is 1.6mcg levothyroxine per kilo of your weight, so unless extremely petite likely to need at least 100mcg levothyroxine per day. But frequently necessary to increase dose SLOWLY Upwards in 25mcg steps
Request vitamin D is tested and thyroid antibodies
Or test privately
B12 and folate far too low as detailed by SeasideSusie
Thanks for your reply. I’m on Teva at the the moment. I’ll contact the doctor regarding an increase in Meds. This isn’t a test they requested I’ve done this myself. Medication hasn’t been reviewed since I’ve been on it either
Teva brand upsets many, many people
Obviously difficult if it’s the only brand that you have tried so far, to know if it suits you or not
Are you lactose intolerant?
Teva is lactose free
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, or Aristo (100mcg only) are the only lactose free tablets
Most easily available (and often most easily tolerated) are Mercury Pharma or Accord
Accord is also boxed as Almus via Boots, and Northstar 50mcg and 100mcg via Lloyds ....but doesn’t make 25mcg tablets
beware 25mcg Northstar is Teva
List of different brands available in U.K.
thyroiduk.org/if-you-are-hy...
Teva poll
healthunlocked.com/thyroidu...
Once you find a brand that suits you, best to make sure to only get that one at each prescription.
Watch out for brand change when dose is increased or at repeat prescription.
New guidelines for GP if you find it difficult/impossible to change brands
healthunlocked.com/thyroidu...
academic.oup.com/jcem/artic...
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
verywellhealth.com/best-tim...
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
REMEMBER.....very important....stop taking any supplements that contain biotin a week before ALL BLOOD TESTS as biotin can falsely affect test results - eg vitamin B complex
I am not lactose intolerant and take escitalopram at 10 mg. do I need to take this 2/4 hours after thyroid medication? My dr has agreed to increase my Teva to 50mcg eventually! And refused to retest B12 and advised a multivitamin 🤦♀️
You clearly need 25mcg dose increase in levothyroxine NOW
guidelines are quite clear that most people will need at least 100mcg levothyroxine per day….so looks like your GP doesn’t understand thyroid disease at all
But at least you got dose increase to 50mcg.
Might be a battle to get further increases over coming months
Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine
Multivitamins are never recommended on here, far too little of what we do need plus usually cheap and poorly absorbed ingredients
As a non meat eater you will need to self supplement to maintain optimal vitamin levels
NHS only tests and treats vitamin deficiencies. Down to you to maintain optimal vitamin levels
Come back with new post once you get next test results after 8 weeks on 50mcg levothyroxine and improving low vitamin levels
Yes any medication must be minimum 2 hours away from levothyroxine
Depression is common hypothyroid symptom and should improve as dose levothyroxine is increased, especially as Ft3 improves
Antibody results take longer than normal bloods my endocrinologist prefers my TSH to be less than 1 my results are stable between 0.2. - 0.3 that’s when I feel at my best Hope this helps
Thank you. My TSH level has Ben been 3. something from day one! I’m hoping increase in meds will help, I’ve had antibody test done this year and it was 349. My TSH level was point blank pointed out by my dr that it’s fine In Range, I had to ask for increase in meds too
So high thyroid antibodies confirms autoimmune thyroid disease also called Hashimoto’s (with goitre) or Ord’s thyroiditis (no goitre)
Recommend you get vitamin D tested now yourself via NHS private testing service
Low vitamin D is extremely common with autoimmune thyroid disease
Aiming for vitamin D at least around 80nmol and around 100nmol maybe better
Come back with new post once you get results
Only add one supplement at a time
Start self supplementing vitamin B complex and after week or so add separate sublingual B12
Low folate and low B12
supplementing a good quality daily vitamin B complex, one with folate in (not folic acid) may be beneficial.
This can help keep all B vitamins in balance and will help improve B12 levels too
Difference between folate and folic acid
chriskresser.com/folate-vs-...
Many Hashimoto’s/Ord’s patients have MTHFR gene variation and can have trouble processing folic acid.
thyroidpharmacist.com/artic...
B vitamins best taken after breakfast
Thorne Basic B is an option that contain folate, but is large capsule. You can tip powder out if can’t swallow capsule
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)
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
endo.confex.com/endo/2016en...
endocrinenews.endocrine.org...
Low B12 symptoms
b12deficiency.info/signs-an...
With serum B12 result below 500, (Or active B12 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 serum B12 is over 500 (or Active B12 level has reached 70), stop the B12 and just carry on with the B Complex.
B12 sublingual lozenges
amazon.co.uk/Jarrow-Methylc...
You’re under medicated. Do you have symptoms? my tsh has to be under 0.6 to fell well. T4 and T3 (which your doc needs to take every time) should be 75% up through the range ideally.
I’ve managed to get meds increased to 50 mcg for now, hopefully this helps. I just think I’m carrying on normally but feel I could be a lot better. This group has been a complete eye opener. When I spoke to the dr yesterday I was asked why I thought B12 should be higher, why vit D needs to be done…..I definitely hit a brick wall, as they say, things can only get better!
Do your reading before you go and tell them what you want and why. Most GPs seem to struggle with thyroid conditions and can sometimes take on board the comments made by more knowledgeable patients!! Some however can’t get over it - arrogance etc - and won’t be told anything. At which point, its time to move to a new GP!!
From my own experience, try and read blood tests as whats normal for you? A lot of us look at the normal range and say no problems but normal ranges can be over a number of ages etc. So if you had any earlier ones to compare would be great, just on first glance some of the numbers while in the healthy norm so that is great, look a tad on the lower end IE Vitamin, T4 etc so you might want to examine those with your doc, but again I am not a Dr and they all seem to fall into a normal range so all good, you might need some supplements etc to boost some numbers but best advice is to ask your Dr about the numbers that might look a little lower end of normal.
Blood results help please
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