Results

[Hotpool23]

Hi please could anyone interpret my results, I am 60yrs and take 2.5 levo. I finally managed to get my GP to do all bloods again last wk taken at 9.20am only water to drink no levo taken for 24hrs beforehand. A few wks ago my TSH was 2.98

[Hotpool23]

This is 2nd page of blood results

Other page of blood results

[SeasideSusie Remembering]

Hotpool23

I can't read the results in the picture in the first post either on large PC monitor nor my tablet. The print looks lighter than the other one and looks a bit blurry.

Can you try again, maybe put it in a reply so we can expand it.

[Hotpool23 in reply to SeasideSusie]

The photo is clear on my phone. Is this any better

Try again

[SeasideSusie Remembering in reply to Hotpool23]

Hotpool23

Yes, thanks, I can make it out on my tablet now.

I am 60yrs and take 2.5 levo

Not sure what you mean by 2.5 Levo.

In your previous post you mentioned that you were taking 25mcg Levo. Is that the amount that you're still taking? If so you are undermedicated.

TSH: 3.55 (o.3-4.5) [previously 2.98]

So your TSH is now higher than before.

FT4: 12.9 (10-22)

This is only 24.17% through range.

The aim of a treated Hypo patient on Levo only, generally, is for TSH to be 1 or below with FT4 and FT3 in the upper part of their reference ranges, if that is where you feel well.

TSH should be no higher than 2 as an absolute maximum, but guidelines show it can be much lower, as pointed out in reply to your previous post here:

healthunlocked.com/thyroidu...

You need an increase in your dose of Levo so you should show the evidence given to you previously by SlowDragon to your GP:

From GPonline: gponline.com/endocrinology-...

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

Also 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

You need 25mcg dose increase now, retest in 6-8 weeks, aiming to achieve results which alleviate any symptoms and where you feel well.

B12: 213ng/L (191-663)

This is very low and many people with a result in the 300s have been found to need B12 injections. Do you have any signs of B12 deficiency – check here:

b12deficiency.info/signs-an...

b12d.org/submit/document?id=46

If you do then list them to discuss with your GP and ask for testing for B12 deficiency and Pernicious Anaemia. GP should prioritise symptoms over results where B12 is concerned. Do not take any B12 supplements or folic acid/folate/B Complex supplements before further testing of B12 as this will mask signs of B12 deficiency and skew results.

Folate: 4.5ug/L (3.89-26.8)

Again this is extremely low. As it is not folate deficiency then your GP may not do anything about it but do discuss with him/her. If GP doesn't prescribe anything then after you have had further testing for B12 and injections or supplements have started then it would be beneficial to supplement with a good quality B Complex such as Thorne Basic B which contains methylfolate which will help raise your level and also keep all the B vitamins balanced. Also include lots of folate rich foods in your diet.

Ferritin seems to be fine.

Vit D: 40.9nmol/L

This is marked as insufficient. GP may prescribe D3, please let us know if he does and what dose. Often too little is prescribed and we can tell you what dose you really need, plus there are important cofactors necessary when taking D3 which your GP wont know about as they're not taught much, if anything, about nutrition. I can give you details of these when you come back and let us know what dose of D3, if any, has been prescribed.

These poor nutrient levels could be the result of you having autoimmune thyroid disease (known to patients as Hashimoto's) which can cause gut and absorption problems which can lead to low levels or deficiencies. Have you had thyroid antibodies tested - Thyroid Peroxidase and Thyroglobulin antibodies?

HbA1c suggests pre-diabetes.

MCH is very slightly high as is your Gamma GT level which you might want to discuss with your GP.

Everything else seems to be in range and nothing else flagged.

[Hotpool23 in reply to SeasideSusie]

Hi yes I meant 25mcg levothyroxine and thanks so much for your help and I shall take this up with my Gp although he always tells me I'm ok and don't need futher treatment which I do disagree with him this really frustrates me and stresses me.

[SlowDragon Administrator in reply to Hotpool23]

If GP still refuses to increase dose levothyroxine, ask them to explain why they are ignoring guidelines

If they refuse you will need to go over their head and see recommended thyroid specialist endocrinologist

Email Thyroid UK for list of recommend thyroid specialist endocrinologists...NHS and Private

[e-mail]

[Hotpool23 in reply to SlowDragon]

I will do thank you.

[SlowDragon Administrator in reply to Hotpool23]

Dose levothyroxine should be increased slowly upwards in 25mcg steps until TSH is always under two

Most people when adequately treated will have TSH around or under one, Ft4 in top third or 1/4 of range

All vitamins are low BECAUSE you are under medicated

At 82kilo recommended eventual dose levothyroxine is around 1.6mcg x 82 = 125mcg levothyroxine per day

Having been left on ludicrously low dose levothyroxine for far too long you may need to increase slowly

Essential to get all four vitamins improved as well

[Hotpool23 in reply to SlowDragon]

Thanks I'm going to make appt with Gp as I've been battling on for a long time now he just thinks he can dismiss me but I shall fight my corner 💪I just need to feel well again.

[SlowDragon Administrator in reply to Hotpool23]

Email Thyroid UK for list of recommend thyroid specialist endocrinologists...NHS and Private

[e-mail]

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...

[Hotpool23 in reply to SlowDragon]

Hi been back to gp took papers which I printed off from T/UK highlighting section 6. Doc has upped my dose of levothyroxine to 50mcg bloods to be repeated in 6/8 wks. Also he's given me these B12 Tablets 2 per day and vitamin D 1x twice a week didn't give anything re Folate. No mention of me being referred to Endocrinologist but seeing him on Friday . The biggest issue was he did not know I had hypothyroidism and said I wasn't on levothyroxine although he diagnosed me and does my prescription every month. I find my GP now Dangerous. I've found an Endocrinologist based at RVI in Newcastle who specialises in Thyroid diseases so wish me luck in asking for a referral come this Friday. And thanks again for the information given.

[SeasideSusie Remembering in reply to Hotpool23]

Hotpool23

Good that you have had an increase in your Levo but diabolical that your GP said he didn't know that had hypothyroidism and are prescribed Levo. It's on your record for goodness sake 🙄.

Also he's given me these B12 Tablets 2 per day

Did you check the list of signs and symptoms for B12 deficiency?

Do you have any? If so did you tell your GP? If you have any then you should have further testing because if you have Pernicious Anaemia you need injections. If necessary bring this up at your next appointment.

vitamin D 1x twice a week

How much per dose and exactly which Vit D medication?

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.

naturalnews.com/046401_magn...

drjockers.com/best-magnesiu...

didn't give anything re Folate

I'm not surprised. Your level is not classed as deficiency so he is not obliged to prescribe. It does make one wonder why he prescribed Vit D though because you don't have Vit D deficiency, your level comes into the "insufficient" category for which they aren't obliged to prescribe but should give advice on what to buy yourself.

Once your B12 is sorted - either by further testing if you have symptoms or after starting your supplements, then you can address your folate by buying your own supplement. When taking B12 we should also take a B Complex to keep all B vitamins balanced. My suggestion would be Thorne Basic B. If you look at other brands then look for the words "bioavailable" or "bioactive" and avoid any containing Vit C because this can keep the body from using B12 contained in the B Complex. Vit C and B12 should be taken 2 hours apart.

Don't start all supplements at once. Start with one, give it a week or two and if no adverse reaction then add the next one. Again, wait a week or two and if no adverse reaction add the next one. Continue like this. If you do have any adverse reaction then you will know what caused it.

[Hotpool23 in reply to SeasideSusie]

Yes I did highlight all of my symptoms

Hi yes I did highlight all symptoms

[SeasideSusie Remembering in reply to Hotpool23]

Hotpool23

So you've been given 20,000iu D3 to take once a week, which is a pleasant surprise that your GP has prescribed anything, but it's not as much as you really need. That works out at 2,857iu per day and a more realistic amount would be 5,000iu D3 daily.

Anyway, use what has been prescribed and make sure you retest when you've finished the course, either by your GP testing or by you doing a private test if GP wont retest.

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, so that is the level you should be aiming for (regardless of what your GP may tell you).

Once you have 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:

vitamindtest.org.uk/

I have mentioned in my previous reply what important cofactors are needed when taking D3 and you will need to buy these yourself. As mentioned above, don't start all supplements at once.

As for your B12, I can only suggest that you pop over to the Pernicious Anaemia forum and post your result, reference range and list of symptoms that you are experiencing, and tell them what your GP has prescribed. See what they say, they will tell you if you need further testing and how to go about getting it if your GP is reluctant:

healthunlocked.com/pasoc

[Hotpool23 in reply to SeasideSusie]

Hi I did tell my Doctor I needed to be retested in 6/8 weeks he didn't say he wouldn't test again but because of only having 10 min appointment he said he couldn't read all I pushed his way however I do have the 20min appointment in the morning and he said he'll read everything I gave him so I'll know tomorrow if he's done so and as I've battled over 2 yrs with him he's seen I'm not going anywhere. I've had appt tonight with rheumatologist and in my estimation he's no better trying to bin me off with my fibromyalgia however because of a new symptom I've just discovered where nodules have all of a sudden appeared on my hands he's stummped he's now referring me to a hand specialist but beforehand was happily to discharge me back to my gp. I'm exhausted but I still need to sort my health problems I only want a little bit of my back

[SeasideSusie Remembering in reply to Hotpool23]

Hotpool23

Retesting in 6-8 weeks is after starting thyroid meds or a dose change.

For Vit D it's 3 months after starting (or when you've finished the prescribed course which looks like 14 weeks from your picture). Then once you've reached the recommended level it's twice a year to check level and adjust dose if necessary.

[Hotpool23 in reply to SeasideSusie]

Thank you so much for yr support ❤

[Hotpool23 in reply to SeasideSusie]

Hi the vit d is x2 tablets per week

[Hotpool23 in reply to SeasideSusie]

Sorry its B 12 x2 tablets a week and 2 vitamin a day

[SeasideSusie Remembering in reply to Hotpool23]

Hotpool23

Are you saying it's 2 x Vit D 500mcg daily, which is 40,000iu daily? That would be even more than the NICE treatment for Vit D deficiency which is 40,000iu once per week not daily.

Loading doses for Vit D deficiency is either 280,000 or 300,000iu over a number of weeks, usually 6 or 7. So 40,000iu per week for 7 weeks equals the recommended amount. I think you should recheck that because I don't think it would ever be 40,000iu daily.

[Hotpool23 in reply to SeasideSusie]

Hi this is what he has prescribed

[Hotpool23 in reply to SeasideSusie]

I'm not sure if I got mixed up trying to explain

Sorry photo didn't upload

[SeasideSusie Remembering in reply to Hotpool23]

Hotpool23

Yes, you got them the wrong way round.

The Cyanocobalamin (B12) is 1 tablet twice a day.

The Vit D is 1 twice a week for 7 weeks.

So for the Vit D he is following the NICE treatment protocol. I have given you information above about the important cofactors that you should buy yourself.

I still think it would be work asking on the Pernicious Anaemia forum whether you should be further tested for B12 deficiency or PA before taking the Cyanocobalamin, remembering to give them the results, reference ranges and symptoms.

[Hotpool23 in reply to SeasideSusie]

Oh I thought so thank you I get so confused with all my medication brain fog does me no good

[SlowDragon Administrator in reply to Hotpool23]

Great to hear you stood your ground and got dose increase in Levothyroxine

Which brand Levothyroxine are you currently taking?

[Hotpool23 in reply to SlowDragon]

Hi brand isTeva. I've been given x3 boxes containing 28 tablets but 1 box is a different brand called Mercury which I'm going to ask chemist to change is this the right thing to do. Thanks again.

[SlowDragon Administrator in reply to Hotpool23]

Have you been on Teva when on 25mcg?

Teva is the brand most likely to upset people

Though it’s one of the only 2 brands that’s lactose free so if lactose intolerant it’s often best one

[Hotpool23 in reply to SlowDragon]

Yes I have always had this brand since May 2019

[SlowDragon Administrator in reply to Hotpool23]

Ok ….well stay on same brand while you increase your dose

You only want to make one change at a time or can’t work out what’s helping or causing issues

But then after few weeks on Teva at 50mcg …..then trial Mercury Pharma brand

Ideally you would know before you get next prescription which brand to insist on having going forward

[Hotpool23 in reply to SlowDragon]

Thak you