Blood test results: Thank you all for responding... - Thyroid UK

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Blood test results

Mouseandcat profile image
11 Replies

Thank you all for responding so quickly and for the information already given. I didn't think about not taking medication for 24 hrs before taking a thyroid test. This might explain why I have just got a message from the doctor saying that my last blood test (last Tuesday) produced normal results. As you will see below the private test I had done (when I didn't take my medication prior to giving a sample) suggests I'm currently showing hyperthyroid symptoms indicating my thyroxine dose is high at the minute??

In response to one of the posts (sorry I can't remember who from) asking about manufacturer my pharmacist uses Almus. I think they did have a different supplier but Almus have been supplying for a couple of years at least.

As far as doses go I started off on 75/100 mcg (taking 75 one day and 100 the next) which increased to 100 then 125 but has come down to 100. I got a message back from a routine test earlier in the year suggesting my dose is too high and the private test I have just had done indicates the same, but the blood test last week says everything is alright. Generally each dose seemed to work for a few years before I needed a change.

I'm currently very low on tablets as I don't want to collect my current prescription then have to take unused tablets back that can't be reused in case the doctor changes my dose. I have been taking tablets every other day. I seem to feel worse (a slight headache, poor concentration / more anxious and a funny (start of a soar throat / throat after lots of shouting) feeling in my throat) on days when I have taken a tablet. I know this isn't good practice but I don't want to see tablets go to waste.

Anyway, after all that, private blood test results (taken on 19th July at 8:25am prior to taking my medication or eating / drinking).

Thyroid things:

TSH: 0.02 (range 0.7 - 4.2) mIU/l

Total T4: 85.3 (66 - 181) nmol/l

Free T4: 23.2 (12 - 22) pmol/l

Free T3: 4.62 (3.1 - 6.8) pmol/l

Anti - Thyroidperoxidase abs: 26 (<34) kIU/l

Anti - Thyroglobulin abs: 221 (<115) kIU/l

Other things:

CRP: <0.3 (<5) mg/l

Ferritin: 136 (30 - 400) ug/l

Magnesium: 0.99 (0.7 -1) mmol/l

Cortisol Random: 457 (113 - 456 6am - 10am) nmol/l

Vitamin D (25 OH): 52 (50 - 175) nmol/l

Vitamin B12: 213 (145 - 569) pmol/l

Serum folate: 11 (8.83 - 60.8) nmol/l.

The doctor at Blue Horizon commented on low TSH and high Free T4 (suggesting hyperthyroid symptoms). They also commented on the high Anti - Thyroglobulin (suggesting the condition is autoimmune) , slightly high Cortisol (who isn't stressed?) and B12 result. Apparently although B12 is in range it is at the low end and they suggest it should be somewhere above 400 pmol/l.

Sorry for all the information in one go but I hope it will provide some useful advice.

Thank you very much to anyone who can give some advice.

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Mouseandcat
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11 Replies
greygoose profile image
greygoose

As you will see below the private test I had done (when I didn't take my medication prior to giving a sample) suggests I'm currently showing hyperthyroid symptoms indicating my thyroxine dose is high at the minute??

Blood tests don't show symptoms. Symptoms are what you feel. But, those results do not suggest over-medication because your FT3 is not even mid-range. You are only over-medicated if your FT3 is well over-range. What those results show is that you are a poor converter of T4 to T3, so any symptoms you have are more likely to be hypo than hyper - but sometimes it's difficult to tell the difference.

If you reduce your levo, not only will your FT4 go down, but so will your FT3, making you more hypo. But, yes, I would say you do have Hashi's with those antibody results.

Vitamin D (25 OH): 52 (50 - 175) nmol/l

This is much, much too low. Show this to your doctor and ask for loading doses of vit D.

When taking vit d, you also need to take magnesium. Ignore the magnesium test result, these tests aren't reliable, and not really worth doing. And, taking vit D will reduce your magnesium, anyway. You also need to take vit K2-MK7, because taking vit D increases absorption of calcium from food. The vit K2 makes sure this extra calcium goes into the teeth and bones, and doesn't build up in the arteries and soft tissues, causing problems.

Vitamin B12: 213 (145 - 569) pmol/l

Also much too low. And, I would suggest it should be over 500. Might be worth asking your doctor to test you for Pernicious Anemia with such a low result. Your folate could be a lot higher, too.

I'm currently very low on tablets as I don't want to collect my current prescription then have to take unused tablets back that can't be reused in case the doctor changes my dose.

Don't take them back! They'd only throw them away/dispose of them, anyway. Keep them incase you ever need to give yourself an increase in the future - you can keep them for a long, long time with no problem. It's nice to have your own little stash, just in case. And, they often can be used up by cutting them into halves or quarters.

Sorry for all the information in one go but I hope it will provide some useful advice.

Please don't apologise. The more info you can give the better for our understanding of what is happening to you, and therefore the more intelligent advice we can give. :)

Mouseandcat profile image
Mouseandcat in reply to greygoose

Thank you very much

greygoose profile image
greygoose in reply to Mouseandcat

You're welcome.

SlowDragon profile image
SlowDragonAdministrator

TSH is low …but likely low because vitamin levels are very poor

Low vitamin levels tend to lower TSH, because conversion of Ft4 to Ft3 gets worse

Your Ft4 is high ….perhaps too high (poor conversion)

But Ft3 is too low

Vitamin D (25 OH): 52 (50 - 175) nmol/l

Vitamin B12: 213 (145 - 569) pmol/l

Serum folate: 11 (8.83 - 60.8) nmol/l.

Ferritin: 136 (30 - 400) ug/l

What vitamin supplements are you currently taking, if any

You need to work on improving low vitamin levels as first step

Aiming for vitamin D at least around 80nmol and around 100nmol maybe better

B12 at least over 500

Folate and ferritin at least half way through range

High Tg antibodies confirms autoimmune thyroid disease also called Hashimoto’s

Your TPO antibodies are within range, but near top of range…..possibly higher in past

Recommend you get back on taking levothyroxine EVERYDAY ASAP

Reducing dose, by skipping days will just result in collapsing vitamin levels and worse conversion

Get new prescription filled

Take 100mcg everyday without fail

Almus is Accord brand via Boots

Also available in Lloyds as Northstar

Accord don’t make 25mcg tablets

Mouseandcat profile image
Mouseandcat in reply to SlowDragon

Thank you

SlowDragon profile image
SlowDragonAdministrator

Only add one vitamin supplement at a time

Waiting at least 10-14 days to asses any changes before adding another

Suggest you start with vitamin D

GP will often only prescribe to bring vitamin D levels to 50nmol.

Some areas will prescribe to bring levels to 75nmol or even 80nmol

leedsformulary.nhs.uk/docs/...

GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)

mm.wirral.nhs.uk/document_u...

But with Hashimoto’s, improving to around 80nmol or 100nmol by self supplementing may be better

pubmed.ncbi.nlm.nih.gov/218...

vitamindsociety.org/pdf/Vit...

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

Test twice yearly via NHS private testing service when supplementing

vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function. There’s a version made that also contains vitamin K2 Mk7

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...

Government recommends everyone supplement October to April

gov.uk/government/news/phe-...

Web links about taking important cofactors - magnesium and Vit K2-MK7

Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

2 good videos on magnesium

healthunlocked.com/thyroidu...

Vitamin D and Covid

Notice how much vitamin D many of these medics are taking

vitamind4all.org/letter.pdf

Mouseandcat profile image
Mouseandcat in reply to SlowDragon

Thanks for all the information. I'll have to ask my boss if I can have a week off to go through it all.

pennyannie profile image
pennyannie in reply to Mouseandcat

Well, you did ask a question of forum members and as usual they came up trumps :

All information takes time to sink in and be understood :

It's a bit like a jigsaw puzzle and once you find and get the corner pieces in place, you will feel so much better knowing how you too can take back some control and understand the implications of optimal thyroid hormone conversion.

SlowDragon profile image
SlowDragonAdministrator

How much do you weigh in kilo

guidelines on dose levothyroxine by weight

Even if we frequently don’t start on full replacement dose, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose

NICE guidelines on full replacement dose

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

Also here

cks.nice.org.uk/topics/hypo...

gp-update.co.uk/Latest-Upda...

Traditionally we have tended to start patients on a low dose of levothyroxine and titrate it up over a period of months. RCT evidence suggests that for the majority of patients this is not necessary and may waste resources.

For patients aged >60y or with ischaemic heart disease, start levothyroxine at 25–50μg daily and titrate up every 3 to 6 weeks as tolerated.

For ALL other patients start at full replacement dose. For most this will equate to 1.6 μg/kg/day (approximately 100μg for a 60kg woman and 125μg for a 75kg man).

If you are starting treatment for subclinical hypothyroidism, this article advises starting at a dose close to the full treatment dose on the basis that it is difficult to assess symptom response unless a therapeutic dose has been trialled.

BMJ also clear on dose required

bmj.com/content/368/bmj.m41

bestpractice.bmj.com/topics...

Guidelines are just that ....guidelines.

Some people need more ….lsome less

healthunlocked.com/thyroidu...

SlowDragon profile image
SlowDragonAdministrator

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 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 a good 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...

WhyAmISoTired profile image
WhyAmISoTired

I would like to echo SlowDragon's and Greygoose's concerns about your B12 vitamin level!

Mine also showed as somewhat low but in range, but then it turned out I had a long term deficiency and it can be dangerous if left untreated. I didn't have any specific symptoms, just general fatigue and some rare mood swings which I always attributed to hypothyroidism.

A multi-vitamin won't fix a B12 deficiency even if it contains B12. One can either take jabs, or high dose B12 tablets, or other forms like sublingual. Tablets and sublingual may not work if you have Pernicious Anemia. If you take oral supplements and start developing strange symptoms like tingling in hands and feet, you should go see a doctor as sometimes symptoms of a B12 deficiency get worse when you start to address it.

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