I'd truly appreciate help interpreting my latest blood test of 7 Sept '21. Sample taken 24 hours after last dose and haven't been taking any supplements.
Been on Levothyroine 50mg for nearly 2 years. Haven't taken supplements during this time and wondering whether I should be based on these results. Particularly worried about Ferritin (last read 2019 at 119 (13-150 range)) and struggling to understand why my hair has been falling out significantly over the last couple of months. I have been on HRT (Femoston 2/10) for 7 years and will be changing to Femoston 1/10 next week.
Feedback much appreciated.
CRP 7.3mg/l (0-5)
Ferritin 167μg/L (13-150) - Oct 2019 result was 119 (13-150 range)
Folate (sample error) - Oct 2019 result was 4.32 μg/L (>3.9)
Vitamin B12 - Active 95pmol/L (25.1-165
Vitamind D 66nmol/L (50-200)
TSH 1.66 miU/L (0.27-4.2)
Free T3 4.2pmpl/L (5.1-6.8)
Free Thyroxine 16.1 pmol/L (12-22)
Thyroglobulin Antibodies 64.4 IU/ml (0-115)
Thyroid Peroxidase Antibodies <9 IU/ml (0-34)
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Lillybet2
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Lillybet as a general guide vitamins need to be in the top third of their ranges . By that rough measure b12 is a little low as is vit d.Your thyroid hormones ft4 and ft3 are in the lower half of the ranges suggesting the need for an increase in levo dose. Note there is an error in the ft3 range which won't start at 5.1
The need for a dose increase is mirrored in the TSH of 1,66. Generally on levo we look for a TSH of around 1.
Improve the vitamins you are low on and increase levo by 12.5MCG or 25mcg would be my suggestion to improve things.
Ferritin 167μg/L (13-150) - Oct 2019 result was 119 (13-150 range)
CRP is a non-specific inflammation marker and yours, being over range, is telling you that there is inflammation somewhere.
Ferritin can be raised when inflammation (or infection) is present and it's quite likely that your ferritin is high due to the inflammation suggested by your CRP.
Folate (sample error) - Oct 2019 result was 4.32 μg/L (>3.9)
I take it this is a Medichecks test, they have many, many failures with folate for some reason. However, your October 2019 result was low and you should have started a B Complex, but that result is now too old to be of any use.
Vitamin B12 - Active 95pmol/L (25.1-165
I prefer mine to be 100 plus.
If you take a B Complex it will contain B12 as well as methylfolate so it should bump up your B12 a bit.
My preference for a B Complex is Thorne Basic B. If you look for another brand then look for the words "bioavailable" or "bioactive" and methylfolate (not folic acid) and methylcobalamin (not cyanocobalamin). Also avoid any containing Vit C as this keeps the body from using the B12 the supplement contains. Vit C and B12 should be taken 2 hours apart.
When taking a B Complex we should leave this off for 3-7 days before any blood test as it contains biotin and this gives false results when biotin is used in the testing procedjure (which most labs do).
Vitamind D 66nmol/L (50-200)
The Vit D Society and Grassroots Health recommend a level of 100-150nmol/L, with a recent blog post on Grassroots Health mentioning a study which recommends over 125nmol/L.
If you want to improve your level then to reach the recommended level from your current level, you could supplement with 3,000-4,000iu D3 daily.
Retest after 3 months.
Once you've reached the recommended level then a maintenance dose will be needed to keep it there, which may be 2000iu daily, maybe more or less, maybe less in summer than winter, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. This can be done with a private fingerprick blood spot test with an NHS lab which offers this test to the general public:
Doctors don't know, because they're not taught much about nutrients, but there are important cofactors needed when taking D3. You will have to buy these yourself.
D3 aids absorption of calcium from food and Vit K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems such as hardening of the arteries, kidney stones, etc.
D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds if taking D3 as tablets/capsules/softgels, no necessity if using an oral spray.
For D3 I like Doctor's Best D3 softgels, they are an oil based very small softgel which contains just two ingredients - D3 and extra virgin olive oil, a good quality, nice clean supplement which is budget friendly. Some people like BetterYou oral spray but this contains a lot of excipients and works out more expensive.
For Vit K2-MK7 I like Vitabay or Vegavero brands which contain the correct form of K2-MK7 - the "All Trans" form rather than the "Cis" form. The All Trans form is the bioactive form, a bit like methylfolate is the bioactive form of folic acid.
Magnesium helps D3 to work. We need magnesium so that the body utilises D3, it's required to convert Vit D into it's active form, and large doses of D3 can induce depletion of magnesium. So it's important we ensure we take magnesium when supplementing with D3.
Magnesium comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds if taking magnesium as tablets/capsules, no necessity if using topical forms of magnesium.
Free T3 4.2pmpl/L (3.1-6.8) (I have corrected the range)
Free Thyroxine 16.1 pmol/L (12-22)
The important question is how do you feel with these results? If you feel fine then there's nothing to do about your dose. However, the aim of a treated Hypo patient on Levo only, generally, is for TSH to be 1 or lower with FT4 and FT3 in the upper part of their reference ranges.
Your FT4 is 41% through range and your FT3 is 29.73% through range. Most Hypo patients would need these higher in their ranges.
If you feel you are not optimally medicated then there is plenty of room to increase your dose of Levo, 25mcg now and retest in 6-8 weeks to check your levels.
Your antibodies are below the upper limit so classed as negative, ie not suggesting autoimmune thyroid disease (Hashimoto's).
This is so comprehensive and helpful.... I don't know where to start to express my sincerest thanks. I am going to start with the supplements. I have noticed some symptoms I had pre levothyroxine are happening (especially hair loss which is what triggered my diagnosis in the first instance) so I think I will review the dose once I have my supplement regime underway.Once again, truly grateful for the reply.
Which brand of levothyroxine are you currently taking
Was test done as early as possible in morning before eating or drinking anything other than water
This gives highest TSH and lowest Ft4
Correct that last dose levothyroxine 24 hours before test
Ft3 is very low
Ft4 under half way through range
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
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.
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.
Test done at 9am prior to drinking or eating anything and brand is Accord. I seem to tolerate the tablet OK other than I can feel a little nauseous around an hour after taking it. I think I could halve one of my 50mcg tablets to increase by 25mcg in which case I wouldn't have to change brands at the same time.
I've cut out gluten and dairy which I have to say has helped enormously with my health in general.
I'd really like to get to the bottom of what's causing inflammation in my body as it always reads elevated.
If a patient reports persistent symptoms when switching between different levothyroxine tablet formulations, consider consistently prescribing a specific product known to be well tolerated by the patient.
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