Help with blood test results

[Saintrockz]

Hello everyone I just had my bloods redone and follow up appointment I'm on 75mmg of levo my endo says even though my sptoms coldness, lethargy, depression, dry skin, water retention, carpel tunnel have not gone because my weight is 105 kg I must go on a 800 calorie diet then he will look at medication. He also said my thyroid is normal.please can you very clever and knowledgeable people givee your view. Should I ask for a levo brand change? I'm on mercury pharma?

[Llantnerb]

My t4 was 15 at my last test (same reference range as you) so my endocrinologist increased my t4 again by 25mg. I'm now on 150mg levothyroxine and 5mg liothyronine and I think I weigh about 70kg. I think you should get an increase to 100mg initially then be retested. My endocrinologist likes my t4 to be around 18. I should say I have gone private as my GP would have left me on 25mg levothyroxine last year if he had his way. I am starting to feel like a normal person lately and no longer cold and tired all the time.

I would insist on an increase of 25mg and a retest in 8 weeks.

[Lalatoot]

You need calories to convert t4 to t3. As your ft4 is low we can expect your ft3 to also be low. If a restrictive diet of 800 calories affects conversion then ft3 which is what the cells in the body use will go lower and you will feel worse.Time to find a new endo.

[SlowDragon Administrator]

Is that ferritin result that’s 25 (13-150)

Ferritin under 30 requires full iron panel test for anaemia

And you need to work on improving low ferritin levels by increasing iron rich foods in diet. Likely to need iron supplements too

Aiming for ferritin at least around 70 minimum

What’s the bottom result on left page?

Folate?

No vitamin D result?

What vitamin supplements are you currently taking

Assuming test was done as early as possible in morning before eating or drinking anything other than water and last dose levothyroxine 24 hours before test

Looking at previous post your on Levothyroxine plus T3

how much T3

Do you normally split your T3 into 2 or 3 doses

Day before test split dose of T3 into 3 smaller doses, taking at approx 8 hour intervals, with last dose 8-12 hours before test

[Saintrockz in reply to SlowDragon]

Here are my results a little bigger

Results

[SlowDragon Administrator in reply to Saintrockz]

So vitamin D is far too low

How much vitamin D are you currently taking

Looking to increase vitamin D to at least around 80nmol and around 100nmol maybe better

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, 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,

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...

[SlowDragon Administrator in reply to Saintrockz]

Ferritin is clearly far, far too low

Endocrinologist should be doing full iron panel test for anaemia

Are you vegetarian or vegan?

cks.nice.org.uk/topics/anae...

In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency.

Are you currently taking any iron supplements

See GP or endocrinologist

Aiming for ferritin at least around 70

[Saintrockz in reply to SlowDragon]

Details

Results

[Saintrockz in reply to SlowDragon]

I take 15mcg T3 I take some in the morning around 630 with my levo n wait 2hours minimum to eat anything. And then take half the T3 at night

Results

[SlowDragon Administrator]

Suggest you push for increase in levothyroxine to 75mcg and 100mcg alternate days

Retest in 6-8 weeks

Meanwhile working on improving low vitamin levels

humanbean or SeasideSusie might pop along re extremely low ferritin

Are you vegetarian or vegan?

[Saintrockz in reply to SlowDragon]

Cont

Results

[Saintrockz in reply to SlowDragon]

Cont

Results

[Saintrockz in reply to SlowDragon]

Cont

Results

[humanbean]

In the bottom left piece of paper I'm assuming the result that is 53 nmol/L is a Vitamin D result.

If so, you really need to raise that to roughly 100 - 150 nmol/L, although there has been a recent suggestion that optimal for vitamin D is 125 nmol/L.

You can calculate your own dose of vitamin D supplement using this calculator :

grassrootshealth.net/projec...

1) Always use vitamin D3 supplements, never vitamin D2.

2) The best form of vitamin D supplements to take are small capsules containing nothing but oil and vitamin D3. An alternative preferred by some is a mouth spray.

3) Vitamin D raises absorption of calcium from the diet. You want that calcium to go into bones and teeth, not end up lining your arteries. To achieve this you need magnesium and vitamin K2. If you search the forum for info on these you'll find they have been mentioned hundreds of times and you can find out how to choose a supplement and at what dose.

...

I agree with Lalatoot . Restricting calories to 800 a day will make you sicker because such a low intake of food will decrease conversion of T4 to T3 and could possibly end up making you gain weight. In fact, by insisting on keeping your dose too low your endo has already sabotaged any chance you have of losing weight because thyroid hormones are required to control the metabolism.

You definitely need to see a new endo in future. The alternative is that you raise your dose yourself which would require you to buy it yourself online. I couldn't see a Free T3 result (but then I really struggled to read your results - they are too small for my eyesight) and that should be the first thing you do - get a finger-prick test to see TSH, Free T4, and Free T3 all tested from the same blood sample. If Free T3 is in your results you should type it in along with the T4 and the TSH, and please include the reference ranges.

...

I'm guessing because I can't see the test name, but I think your ferritin is 25ng/mL (13 - 150),

and your iron is 7.3 umol/L (6.6 - 26) ???

You are suffering from iron deficiency.

Go to this link :

cks.nice.org.uk/topics/anae...

and read it. Note particularly in the section "Interpreting ferritin levels" that it says :

In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency.

Being iron deficient will make it much harder to lose weight than it needs to be.

See this thread and watch the video:

healthunlocked.com/thyroidu...

Unlike starving yourself on 800 calories a day, you will most likely have more success in losing weight if you improve your iron levels.

Theoretically, your GP should prescribe iron supplements for you, and should monitor the success of that treatment by giving you a regular iron panel. However, if you can't get any help from your GP then you can treat your own iron deficiency but doing so is risky if you treat inappropriately or for too long because iron is poisonous in overdose. Having said that, some people take a long, long time to raise their iron levels and then have to find a way of maintaining their levels. It took me nearly two years to raise my ferritin to mid-range, and even then my iron was still low.

The following links should help.

Why you need to be careful about supplementing :

healthunlocked.com/thyroidu...

How to supplement, at what dose, and what with :

healthunlocked.com/thyroidu...

Testing iron and ferritin levels :

medichecks.com/products/iro...

Discounts available for some private testing companies :

thyroiduk.org/help-and-supp...

Optimal levels for iron and iron-related tests :

rt3-adrenals.org/Iron_test_...

On this forum it is usually suggested that ferritin should be mid-range or a little bit higher. So with a reference range of 13 - 150 you are likely to feel best with a ferritin (iron stores) level of about 80 or 90 up to 120.

If you do get any iron-related test results post them on the forum and ask for feedback. SeasideSusie and I often respond to people who post iron results on the forum and you can read our posts by looking through iron-related replies here :

healthunlocked.com/user/sea...

healthunlocked.com/user/hum...

This is one reply I wrote recently for a member :

healthunlocked.com/thyroidu...

[Saintrockz in reply to humanbean]

I did not take my medication 16 hours before the test, the test was at 830 in the morning. I asked to increase my levo but the Dr said I have to loose weight. I explained that I was most upset about my water retention n my carpel tunnel and cubital tunnel that my shins and ankles alsoseem to be trapped by fluid

[Saintrockz in reply to Saintrockz]

How would I buy levo? The thing is I am seeing the endo through my private healthcare I can not afford to pay for another private endo. I am going to change my vitamins I actually stopped taking them too for two days before the test. I'm really down

[humanbean]

Is this the result of a folate test?

16.9 (2.9 - 20) ?

If it is folate then it is at a good level. Optimal for folate is upper half of the range and yours is already there.

Vitamin B12 pg/mL 568 (197 - 771)

Your Vitamin B12 result is not really bad, but it could be a lot better.

There are various opinions on Vitamin B12 levels...

1) Minimum should be 500.

2) Optimal is 500 - top of range.

3) Optimal is top of range.

4) Optimal is 1000.

Vitamin B12 is the only nutrient I know of that doesn't cause problems at levels which are over the range. I keep my own at levels of about 1000+.

stichtingb12tekort.nl/engli...

There are several forms of B12 supplement :

1) cyanocoblamin - an artificial type which does not occur in nature. Cheap supplements and multivitamins usually use this. And in the US it is used to treat Pernicious Anaemia sufferers who need injections. This needs to be converted in the body to one of the active forms for the body to make use of it. Some people can't do the conversion very well, so may appear to have good levels of B12 in testing but can't actually make use of it.

2) hydroxocobalamin - found in food, and used to treat Pernicious Anaemia sufferers who need injections in the UK. Rarely found in supplements. This needs to be converted in the body to one of the active forms for the body to make use of it.

3) methylcobalamin - an active form that requires no conversion for the body to start using it. It is very popular on the forum, and is easily found for sale on the web.

4) adenosylcobalamin - an active form that requires no conversion for the body to start using it. It can be found as a supplement under the name adenosylcobalamin and dibencozide, but is less common than methylcobalamin. I think (but am not sure) that methylcobalamin has more uses in the body than adenosylcobalamin.

If you start supplementing vitamin B12 it is possible in the early days to suffer from symptoms caused by low potassium, but this is temporary. There are plenty of foods available that are sources of potassium and they should be eaten if symptoms occur.

webmd.com/diet/foods-rich-i...

Another possible side effect of supplementing vitamin B12 is that some people get spots. But this is also temporary and wears off.

[SlowDragon Administrator]

Guidelines on dose levothyroxine by weight when on just levothyroxine is 1.6mcg levothyroxine per kilo of your weight

Approx how much do you weigh in kilo

75mcg levothyroxine is only one step up from starter dose

Ft4 is too low

When T3 is added usually levothyroxine is only reduced 25mcg

Vitamin levels are likely low because you are under medicated

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...

[SlowDragon Administrator]

Low iron and/or low ferritin frequently linked to hair loss

Heavy periods are classic sign of being hypothyroid and will lead to low iron and ferritin ask for full iron panel testing for Anaemia

Look at increasing iron rich foods in diet

Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption

List of iron rich foods

dailyiron.net

Links about iron and ferritin

irondisorders.org/too-littl...

davidg170.sg-host.com/wp-co...

Great in-depth article on low ferritin

oatext.com/iron-deficiency-...

drhedberg.com/ferritin-hypo...

This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.

Thyroid disease is as much about optimising vitamins as thyroid hormones

healthunlocked.com/thyroidu...

restartmed.com/hypothyroidi...

Post discussing just how long it can take to raise low ferritin

healthunlocked.com/thyroidu...

Never supplement iron without doing full iron panel test for anaemia first

Posts discussing why important to do full iron panel test

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Why low ferritin needs improving

healthunlocked.com/thyroidu...

Iron/ferritin and restless legs

healthunlocked.com/thyroidu...

Helpful post about iron supplements and testing

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Read the many posts and replies by humanbean on iron and ferritin

SeasideSusie also helpful on low ferritin