Thyroid Function Test Results

[K1V1]

I have done my Thyroid test & health screening recently. I am on t3 (12.5mg) dose at present, feel like need more. Please advise suitable guidance to add supplement or medicines to feel better. Many thanks

[SlowDragon Administrator]

Taking any dose of T3 will significantly reduce TSH

Taking such small dose T3 is shutting down your own thyroid output but not offering anywhere near high enough replacement.

How do you take your T3

As 2 doses of 6.25mcg?

Have you tried adding a third dose - 3 doses roughly 8 hours apart

Your current dose T3 is the sort prescribed ALONGSIDE levothyroxine

What dose and brand of levothyroxine have you tried

Can see your previous posts show you are homozygous Dio2 but you might still do better with some levothyroxine alongside T3

Vitamin D, Folate, ferritin and B12 all too low because you are under medicated

What vitamin supplements are you currently taking

What time of day was this test done

Cortisol is very low if test was done early morning

[K1V1 in reply to SlowDragon]

Good Afternoon SlowDragon,I really appreciate your reply & guidance.

I take 12.5 mg Tiromel from Turkey dose around 6 in the morning. I have increased my t3 6.25mg dose in the afternoon & seems to feel much better. I will now try 12.5 - 6.25 - 6.25mg doses 8 hours apart as you have suggested. I do not take any t4 Levothyroxine due to DIO2 conversation issue. I am going to see my GP on 29/7 to request some t4 dose.

I take 20 different vitamins as shown below, but as you said due to insufficient t3 & t4 hormones they may be too low.

I took 6.25mg t3 dose around 9pm day before & no food except water during night until blood was taken at 11:20am next morning. Blood sample was sent by post next day delivery. Which was delivered to Lab 08:00 hrs next morning on 23/7. Lab processed the blood sample around 10:39am. What is your suggestion for low Cortisol ?

[SlowDragon Administrator in reply to K1V1]

I have removed photo

Vitamin D

You need good quality, not cheapest option

Common to need high dose, especially when under medicated for thyroid

Better You vitamin D mouth spray with K2 is good choice

Likely to need 3000iu-4000iu daily to increase vitamin D to least around 100nmol

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...

Vitamin D and thyroid disease

grassrootshealth.net/blog/t...

Or SeasideSusie recommends a vitamin D soft gel. She might pop along and comment

[SlowDragon Administrator in reply to K1V1]

Suggest you consider adding 25mcg or 50mcg dose levothyroxine alongside T3

Currently taking only a tiny dose of T3 is just turning your own thyroid output off and not offering anywhere near high enough replacement

Which brand of levothyroxine have you tried

Liquid levothyroxine can give better results if tried all brands of tablets and can’t tolerate

Cortisol is low because you are under medicated.

[SlowDragon Administrator in reply to K1V1]

I do not take any t4 Levothyroxine due to DIO2 conversation issue. I am going to see my GP on 29/7 to request some t4 dose.

DIO2 doesn’t mean we can’t convert, it means the brain needs some extra T3 added alongside levothyroxine

thyroiduk.org/deiodinase-2-...

To explain this paper briefly, the Deiodinase 2 gene activates triiodothyronine (T3) and the researchers found that a tiny change in this gene could mean that although the body gets enough T3, the brain doesn’t.

The patients on this study were given levothyroxine (T4) only for a set period and then combination treatment of both levothyroxine and liothyronine (synthetic T3). The patients who had normal genes did not feel any different on T4/T3 combination treatment. However, those who had one variant gene (inherited from one of their parents) felt better on the combination treatment and those with two variant genes (inherited from both parents) felt better still.

This means that there is a possibility that patients who are on levothyroxine alone, still have symptoms and have the variant Deiodinase 2 gene may improve with the addition of liothyronine .

I have heterozygous Dio2 and prescribed small dose T3 alongside levothyroxine (5mcg x 3 doses per day at roughly equal 8 hour intervals)

[K1V1 in reply to SlowDragon]

Do you suggest any changes in taking supplements List I have in attached photo ?

Supplements List

[humanbean]

CRP (C-Reactive Protein) - This is a measure of inflammation and can indicate infection when it is high. Yours is well in range but the lower the result the better. Optimal level is < 1.

Ferritin (iron stores) - Yours is 10% of the way through the range. Optimal is (very roughly) 60% - 80% of the way through the range for men. For women it would be a bit lower, say 50% - 70% of the way through the range. So, since you are male you would feel best at a level of about 215 - 290.

Magnesium - This is a poor and inaccurate test because only about 0.5% of the magnesium in the body is found in the blood. The body will "steal" magnesium from other tissues to put it into the blood if the amount in the blood is too low. So, blood levels could look great but the patient may still be deficient in other tissues.

If the body has too much magnesium it ought to be excreted via the kidneys/urine. So, supplementing magnesium should be fine as long as the kidneys are functional. What you choose to do with your slightly over-the-range result is up to you. You might find this link (published by a kidney journal) of interest :

ncbi.nlm.nih.gov/pmc/articl...

Cortisol - Interpreting your cortisol level depends on the time of day your blood sample was produced. It could be anything from low in range to over the range.

Thyroid Function - Most people need a TSH (Thyroid Stimulating Hormone) which is lower than yours in order to feel well, suggesting that you are under-medicated. TSH lowers with higher thyroid hormone levels. Most people who take T3 find their TSH reduces dramatically, and could well be under the range. Since yours is nowhere near the bottom of the range you are obviously taking too little T3.

Your Total T4 and Free T4 are below range because you are taking T3 only. If the body gets given some T3 it will almost always reduce output of T4 (assuming you still have a thyroid?)

Your Free T3 is only 35% of the way through the range. Although there is a lot of variation amongst patients, as a general rule people need T3 to be about 50% - 70% of the way through the range - but that is when they take T4 as well. Since you only take T3 I would suggest you need a result which is more like 60% - 90% of the way though the range. It may even need to be over the range for you to feel well.

Antibodies - both your antibodies are well in range, suggesting that you don't have Hashimoto's Thyroiditis / autoimmune thyroid disease. Antibody levels can vary a lot though, so this might change.

Since you don't appear to have autoimmune thyroid disease it isn't possible to say in conjuction with your current results what could have caused your hypothyroidism. It could be low iodine, although this would be fairly uncommon in the UK. Another possibility is pituitary (P) or hypothalamus (H) problems. Testing for P and H problems is difficult to get done on the NHS. You would need an MRI scan of your head, plus many blood tests of all sorts of hormones the P and H produce.

en.wikipedia.org/wiki/List_...

Vitamin D - Optimal for this is about 100 - 150 nmol/L. Your level is very low, but is in range so your GP is unlikely to help to raise it. You can work out your ideal vitamin D3 supplement dose from this calculator :

grassrootshealth.net/projec...

Vitamin D3 supplements come in lots of different doses and types. The best kind are in gel capsules containing only oil and vitamin D3. However, some people prefer mouth sprays if they have gut problems and can't tolerate the capsules.

When taking vitamin D3 the body will extract more calcium from the diet. You want that calcium to go into your bones and teeth, and to achieve this your body needs good levels of vitamin K2 and magnesium. Both of these have been discussed frequently by @SeasideSusie so take a look at her Replies to others on her profile :

healthunlocked.com/user/sea...

Vitamin B12 - Optimal is over 500, but preferably top of range. Personally, I keep my own B12 as close to 1000 pmol/L as I can, and I never worry if it goes higher than that. The UK reference ranges for B12 are absurdly low in my opinion. Supplements are easily sourced on Amazon and other sites selling supplements. I would recommend one which contains methylcobalamin, and also adenosylcobalamin if possible, for example

cytoplan.co.uk/vitamin-b12-...

Folate - Optimal for this is in the upper half of the range i.e. 35 - top of range with the range you've supplied. I keep mine at this level and I avoid going over the range.

A very useful link on folate including possible supplements :

chriskresser.com/folate-vs-...

[SlowDragon Administrator]

Low B12 and low folate

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-...

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...

cytoplan.co.uk/shop-by-prod...

healthunlocked.com/thyroidu...