Bloods back - please can you take a look? Can’t see the T3 though

[Pow1977]

Any thoughts? :0)

[pennyannie]

Hello Pow ;

Well yes, you are correct as without a T3 result and range we can't really know how well you are converting the T4 into T3 as it is T3 that your body runs on, and not T4.

However I think you need to start working on building up your core strength vitamins and minerals as no thyroid hormone works effectively until your ferritin, folate, B12 and vitamin D are maintained at optimal levels.

These may well be in the NHS ranges but we need them at optimal levels to assist in the conversion of T4 into T3.

I self supplement and aim to keep my ferritin at around 100 : folate at around 20 : serum B12 at around 500 + and vitamin D which I can't see as having been tested, at around 100 :

[Pow1977 in reply to pennyannie]

No they wouldn’t test the vitamin D for some reason - does t3 result take longer than the others? Wondered if that’s why not on there as was tested at same time :0( I will phone and check

[Pow1977]

Thyroid removed sept 23rd this year 125mg levoBloods done after fasting @ 8.50am

Hair falling out, knackered, feeling low …

[SeasideSusie Remembering in reply to Pow1977]

Pow1977

FT3 test doesn't take any longer. Mine is always done as my TSH is always suppressed so it triggers it at the hospital lab which processes my GP tests, it always comes back at the same time as TSH and FT4.

Vit D is often refused as they consider it an expensive test. It is something you can do for yourself for £26.10 with an NHS lab which offers this test to the general public:

vitamindtest.org.uk/

Thyroid removed sept 23rd this year 125mg levoBloods done after fasting @ 8.50am

Hair falling out, knackered, feeling low …

In that case, as your TSH is suppressed and FT4 is close to the top of the range, GP may want to reduce your dose of Levo. However, you really need FT3 testing at the same time as TSh and FT4 as low T3 can cause your symptoms of fatigue and feeling low, the hair falling out may be due to iron deficiency. You really need to know how well you convert T4 to T3 with those results.

[pennyannie in reply to Pow1977]

Since you have had a thyroidectomy it is essential and imperative that you are dosed and monitored on your T3 and T4 blood test results as your feedback loop is broken.

We generally feel at our best when our T4 is in the top quadrant of the range as this should in theory convert to a high enough T3 - to keep you well and without symptoms of hypothyroidism.

Your Hypothalamus - Pituitary - Thyroid, ( the HPT axis ) is not complete any longer, as the T in Thyroid has been removed - by the surgeon - meaning the TSH test is a very unreliable measure of anything.

The thyroid is a major gland responsible for full body synchronisation including your physical, mental, emotional, psychological , and spiritual well being, your inner central heating system and your metabolism.

A fully functioning working thyroid would be supporting you daily with trace elements of T1, T2 and calcitonin plus a measure of T3 at around 10 mcg plus a measure of T4 at around 100 mcg. and read T3 is around 4 times more powerful than T4 with the average person needing to convert around 50 T3 daily, just to function.

Some people can get by on T4 only : some people find T4 seems, at some point in time to stop working as well it once did and need the addition of a little T3 with their T4 : some people can't tolerate T4 and take T3 only and some other people prefer to medicate with Natural Desiccated Thyroid.

Personally I just think that if there has been a medical intervention and the thyroid surgically removed or ablated with RAI that both T3 and T4 should be on the patients prescription for if and when they both may well be needed to be prescribed to restore balance in T3 and T4 hormones at around a 1 / 4 ratio T3 / T4 - and at a high enough level to give the patient back their " you " .

Currently in primary care doctors seem to be over reliant on monitoring on just a TSH / T4 blood test, and are only able to offer treatment of monotherapy with T4 thyroid hormone replacement.

It is early days for you, and as answered previously, you do need to build up your core strength vitamins and minerals and you do need to be dosed and monitored on T3 and T4 blood test results with the aim to be for both T3 and t4 to be high enough in the ranges, and balanced, to restore you back to better health.

Presumably you are still under endocrinology ?

[Pow1977 in reply to pennyannie]

Yes first check up tomorrow - I wanted to get the insight of you guys first as you are a wealth of information :0)

[pennyannie in reply to Pow1977]

OK - ask away on anything else you are not sure about ;

Don't direct it to me, I've not had a thyroidectomy - I've Graves Disease post RAI thyroid ablation.

You need everyone's input, as there is a wealth of information, experience, and knowledge on this forum.

[Pow1977 in reply to pennyannie]

Thank you - phoned hospital to query lack of t3 result and she (clinical scientist) said I didn’t need the t3 tested- will talk to the endo tomorrow … I just want to feel well :0(

[pennyannie in reply to Pow1977]

Well, I'm sorry, she is incorrect in her thinking :

T4 is a storage hormone and needs to be converted by your body into T3 :

The body runs on T3 not T4 and most people on T3 only tend to take round 50 T3 daily to feel well :

Your thyroid is your body's engine and to run smoothly you do not need kangaroo petrol but a smooth dip feed of T3 from T4 throughout 24 hours.

[SeasideSusie Remembering]

Pow1977

Ferritin is too low at 38ug/L (13-300) although your GP will say it's fine because it's within range.

Ferritin is recommended to be half way through range, although some experts say that the optimal level for thyroid function is 90-110ug/L

A level below 30ug/L is confirmation of iron deficiency according to NICE. Your level is close to that. I would ask your GP to do an iron panel to see if you have iron deficiency.

Raised Red Cell Distribution Width can be indicative of nutrient deficiency, eg iron, folate or B12. This is another reason to do an iron panel in my opinion.

Folate is rather low but not deficient. Deficiency is less than 3ug/L. Your GP will think it's fine so this is something you might want to try and improve yourself. Eating lots of folate rich food may help, as can a good quality B Complex. My preference is Thorne Basic B. If you look at different brands then look for the words "bioavailable" or "bioactive" and ensure they contain methylcobalamin (not cyanocobalamin) and methylfolate (not folic acid). Avoid any that contain Vit C as this stops the body from using the B12. Vit C and B12 need to be taken 2 hours apart.

When taking a B Complex we should leave this off for 3-7 days before any blood test because it contains biotin and this gives false results when biotin is used in the testing procedure (which most labs do).

B12 is on the low side at 360ng/L.

According to an extract from the book, "Could it be B12?" by Sally M. Pacholok:

"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".

"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."

It would be worth considering supplementing with sublingual B12 lozenges, just the one bottle to boost your level to over 550. Take this alongside the B Complex. When your B12 has reached 550 you can stop the B12 and just continue with the B Complex.

My preference for B12 is Cytoplan as it contains two active forms - methylcobalamin and adenosylcobalamin

cytoplan.co.uk/vitamin-b12-...

As these are rather poor, it would be a good idea to also test Vit D. All nutrient levels need to be optimal for thyroid hormone to work properly.

It's difficult to comment on your thyroid results without knowing your dose of Levo and did you do test as we advise:

* Test no later than 9am

* Nothing to eat or drink except water before the test

* No Biotin or B Complex or any supplement containing biotin in the 3-7 days before the test

* Last dose of Levo 24 hours before test

[Pow1977 in reply to SeasideSusie]

Hi yes test at 8.50 no levo for 24 hours I take no other supplements apart from iron tablets - normal levo dose 125 - thank you for your advice

[SeasideSusie Remembering in reply to Pow1977]

Replied about this above where you posted it previously.

[Pow1977]

Sorry I read them in the wrong order 🤦‍♀️

[SlowDragon Administrator]

Just testing TSH and Ft4 is completely inadequate

Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine

Which brand of levothyroxine are you currently taking

Is 100mcg and 25mcg tablets same brand

Do you take levothyroxine waking or bedtime

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

Very important to test vitamin D

Ferritin, B12 and folate all on low side

Likely to benefit from supplementing daily vitamin B complex (and B12 supplement for month or so)

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 and last dose levothyroxine 24 hours before test

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

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

[SlowDragon Administrator]

Low folate and low B12

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 or Jarrow B Right are recommended options that contains folate, but both are large capsules. (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...

Perhaps consider taking separate folate (eg Jarrow methyl folate) during week before testing

Low B12 symptoms

b12deficiency.info/signs-an...

With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a B12 supplement as well as a B Complex (to balance all the B vitamins) initially for first 2-4 months, then once your serum B12 is over 500 (or Active B12 level has reached 70), stop the B12 and just carry on with the B Complex.

B12 sublingual lozenges

amazon.co.uk/Jarrow-Methylc...

cytoplan.co.uk/shop-by-prod...

healthunlocked.com/thyroidu...

Low ferritin needs ongoing improvement

Aiming for ferritin at least around half way through range

If not already on strictly gluten free …..Have you had coeliac blood test done

Always worth trying strictly gluten free diet