Blood results

[LoobyM]

Hi, like most of you on here I have been diagnosed with thyroid issues. I have been borderline underactive for some time now with no treatment. Due to many new symptoms and menopause I have been prescribed Levothyroxine and have gone from 25mg to 50mg. I've also been diagnosed with FMS. The Levo has done nothing for my symptoms so I thought I would share my last bloods to see if anybody could give me more info. My B12 was also low and I'm on Cyanocobalamin 1mg daily. TIA

[SeasideSusie Remembering]

LoobyM

Those results from when on 50mcg?

You are ready for next increase 25mcg now and retest in 6-8 weeks.

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, if that is where you feel well.

Your FT4 is very low in range, even the notes on the print out say FT4 can be slightly above range so there is plenty of leeway.

Were Vit D, Folate and Ferritin tested?

What is FMS?

[LoobyM in reply to SeasideSusie]

Thanks Susie. These results were at 25mg. My dose was increased about 8 weeks ago but due to bottle shortages my latest blood test has been postponed. Here are my Folate and Ferritin results.

Text

[LoobyM in reply to LoobyM]

FMS is fibromyalgia syndrome

[SeasideSusie Remembering in reply to LoobyM]

LoobyM

Ferritin: 47 (20-200)

This is low in range.

Am I right in thinking an iron panel and full blood count haven't been done?

Are you supplementing iron at all?

We shouldn't supplement iron unless (ideally) prescribed and know that it is needed, which an iron panel and full blood count would show.

You can help raise your level by eating liver regularly, maximum 200g per week due to it's high Vit A content, also liver pate, black pudding, and including lots of iron rich foods in your diet

bda.uk.com/resource/iron-ri...

everydayhealth.com/pictures...

According to some experts the optimal ferritin level for thyroid function is between 90-110 ng/ml (or ug/L).

Folate: 5.9

This is low although is not folate deficiency.

When there is no proper range we tend to suggest folate is in double figures.

As you are prescribed B12 for your deficiency, when taking B12 we also need to take a B Complex to keep all the B vitamins balanced (but doctors don't know this so wont advise it).

A good quality, bioavailable B Complex containing methylfolate is suggested, my preference being Thorne Basic B which contains 400mcg methylfolate which should be enough to raise your folate level and keep it maintained. I raised my bottom of range folate level to top of range in 2.5 months by taking 1 x Thorne Basic B capsule daily, and I still use this brand now after trying others and not being as satisfied with them.

If you look at other brands then avoid any that also contain Vit C as Vit C should be taken 2 hours away from B12 and a B Complex will contain some B12.

What about Vit D? If this hasn't been tested I would ask for it to be done or buy your own Vit D test with an NHS lab which offers a fingerprick test to the public for £29:

vitamindtest.org.uk/

Because of your other low levels I think it's possible Vit D may also be low or deficient.

Have you had thyroid antibodies tested? I'm wondering if you have autoimmune thyroid disease (Hashimoto's) which is shown by raised antibodies. Hashi's tends to lead to poor nutrient levels.

I see SlowDragon has replied about your thyroid results/dose of Levo so there's no point in me repeating anything.

[LoobyM in reply to SeasideSusie]

Wow you know your stuff.Firstly I dont eat meat so the liver and black pudding recommendations aren't viable. I had a full blood count around March time and the result came back as satisfactory. The Dr never discussed the full count results with me. The supplements you suggest I will order today, thank you for the advice. I was tested for thyroid antibodies and that came back ok too. My Dr has been thorough, it so I thought but the advice you and SlowDragon give is far more comprehensive and detailed.

[LoobyM]

Last results from bloods in July. Have been taking 50mg since but now awaiting retest.

[SeasideSusie Remembering in reply to LoobyM]

LoobyM

I have removed this picture because it shows your name, date of birth and your NHS number which leaves you vulnerable to identity theft. Feel free to repost image without the details or type the results into your post.

[LoobyM in reply to SeasideSusie]

Oops, try again!

.

[SlowDragon Administrator]

Likely to need further increase in levothyroxine after next blood test

Dose of levothyroxine is increased slowly upwards in 25mcg steps until TSH is ALWAYS under 2

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...

Which brand of levothyroxine are you currently taking

Many people find different brands are not interchangeable

[SlowDragon Administrator]

Suggest you retest privately yourself and give GP results

Likely ready for next 25mcg dose increase

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)

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

List of private testing options

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

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

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