Advice Blood results

[annestev20]

Would I be able to send you photos of my blood results for advice?

[SlowDragon Administrator]

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Include the test results and ranges

[annestev20 in reply to SlowDragon]

Thank you

Typed letter

[SlowDragon Administrator in reply to annestev20]

So looking at this

You are currently taking 75mcg levothyroxine is that correct

How long on this dose

Which brand of levothyroxine?

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

TSH shows you need dose increase in levothyroxine

On levothyroxine TSH should always be under 2

High Ft4, suggests you probably took levothyroxine shortly before test

What vitamin supplements are you currently taking

When were folate, ferritin and B12 last tested

[annestev20 in reply to SlowDragon]

Thanks so muchMy blood test was taken at 11am and I took my 75mg Thyroxine at 8pm night before which is my normal time I have been on 75mg for about a year now I think and was doing well but for many months now not well Brand is Accord. The only vitamin I am on is vit d brand strivit d3 800 iu from my GP

[SlowDragon Administrator]

TSH should be under 2 as an absolute maximum when on levothyroxine

gponline.com/endocrinology-...

Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L.

NHS England Liothyronine guidelines July 2019 clearly state on page 13 that TSH should be between 0.4-1.5 when OPTIMALLY treated with just Levothyroxine

Note that it says test should be in morning BEFORE taking levothyroxine

Also to test vitamin D, folate, B12 and ferritin

sps.nhs.uk/wp-content/uploa...

[annestev20 in reply to SlowDragon]

Thank you I'm feeling so frustrated as I have been feeling poorly for several months have had GP test bloods several times and he recommended lower dosage of levothyroxine to 50mg then raise it to 75 and now he is saying go up to 100 I'm having all the usual symptoms Fatigue terrible upset tummy daily awful migraines almost every other day aches in some of my joints I either sleep too much or cannot sleep well I really am confused as to how I'm feeling so low and yet GP is basically dismissing my symptoms. My vit d level ths time is showing as code 44LA value 84 nmol/L My vit B12 is code 42T 449 pg/ml and serum foliate 6.15ng/ml Serum Ferritin code 42R4 value 31.2ng/ml

[SlowDragon Administrator in reply to annestev20]

My vit d level 84 nmol/L

My vit B12 is code 449 pg/ml

foliate 6.15ng/ml

What vitamin supplements are you currently taking

So vitamin D is ok - but might be better at least around 100nmol

B12 and folate ok, but not brilliant, especially 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 a recommended option that contains folate, but is large capsule. You can tip powder out if can’t swallow capsule

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...

[SlowDragon Administrator in reply to annestev20]

Serum Ferritin value 31.2ng/ml

Ferritin remains far too low

Are you vegetarian or vegan

Do you eat red meat

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...

NICE guidelines

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.

[SlowDragon Administrator in reply to annestev20]

Fatigue terrible upset tummy daily awful migraines almost every other day aches in some of my joints

Migraine common hypothyroid symptom

Gut issues often improve on absolutely strictly gluten free diet

Request coeliac Blood Test BEFORE considering trial on strictly gluten free diet

[annestev20 in reply to SlowDragon]

Thank youI have recently had the coeliac test and was all fine. So as my TSH level is 6.62mU/L and my Free T4 is 24.2pmol/L do you think increasing my Levothyroxine to 100mg would be good or?

[SlowDragon Administrator in reply to annestev20]

So now that you have had negative coeliac blood test you can consider trialing strictly gluten free diet

Only 5% of Hashimoto’s patients are coeliac

But a further 80% of Hashimoto’s patients find strictly gluten free diet helps, often significantly or is absolutely essential

[SlowDragon Administrator in reply to annestev20]

TSH level is 6.62mU/L

Free T4 is 24.2pmol/L

What time of day was test done

How long before test did you take your levothyroxine

[annestev20 in reply to SlowDragon]

Blood test done 11am Took my meds 8pm night before

[SlowDragon Administrator in reply to annestev20]

So Ft4 is surprisingly high considering it was 15 hours before test

But last dose levothyroxine should be 24 hours before test

What time do you normally take levothyroxine

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 or in middle of night

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

[annestev20 in reply to SlowDragon]

Thank you so much so grateful. Do you think increasing my Thyroxine is good idea then? Also just to also let you know I do suffer hair loss too for many years actually I have just ordered vitamin b complex How much mor vit d should I take?

[SlowDragon Administrator in reply to annestev20]

TSH is far too high

So yes you need dose increase in levothyroxine

Wether you can tolerate high Ft4 is an individual thing

You could split levothyroxine into 2 smaller doses, taking 1/2 waking and half at bedtime…..if have trouble tolerating

Which brand of levothyroxine are you currently taking?

Getting all four vitamins OPTIMAL helps improve how you tolerate levothyroxine and may improve how well you convert Ft4 (levothyroxine) into Ft3 (active hormone )

How much vitamin D are you currently taking

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 (One spray = 1000iu)

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...

Remember to stop taking vitamin B complex a week before ALL BLOOD TESTS

Meanwhile getting GP to do full iron panel test for anaemia

Come back with new post once you get iron panel results

If GP refuses to do full Iron panel test, can get test done via Medichecks

All iron tests should be done fasting early morning. If taking any iron supplements stop week before test

Look at increasing iron rich foods in diet. Liver once week. Red meat regularly etc etc

[annestev20 in reply to SlowDragon]

I take levo Accord brand Also I take strivit D3 800 vit D one daily I have now ordered vit B What are the other 2 i should take? you mentioned 4. My Ferritin level value is 31.2ng/ml

[SlowDragon Administrator]

Two years ago you posted this

healthunlocked.com/thyroidu...

You never replied

SeasideSusie gave detailed info on you very poor vitamin levels

vitamin levels must be retested at least annually

[SlowDragon Administrator]

So you will need to retest thyroid levels 6-8 weeks after any dose change or brand change in levothyroxine

Which brand of levothyroxine are you currently taking

Always stick to same brand levothyroxine at each prescription …once you work out which suits you best

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested.

Also EXTREMELY important to test vitamin D, folate, ferritin and B12

Low vitamin levels are extremely common, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .

Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Is this how you do your tests?

Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins

List of private testing options

thyroiduk.org/getting-a-dia...

If you can get GP to test vitamins and antibodies then cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code

thyroiduk.org/getting-a-dia...

monitormyhealth.org.uk/

NHS easy postal kit vitamin D test £29 via

vitamindtest.org.uk

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins by DIY fingerprick test

bluehorizonbloodtests.co.uk...

Thriva Thyroid plus antibodies and vitamins By DIY fingerpick test

thriva.co/tests/thyroid-test

[Gingernut44]

You may want to try a different brand. I couldn’t tolerate Northstar (Accord now, was Actavis) I suffered from stomachache, headaches, bloating and constipation on this brand. Mercury Pharma gave me headaches. Those symptoms were alleviated once I changed to Wockhardt.

[annestev20 in reply to Gingernut44]

Thanks so much will try that!