I would be grateful for some feed back as I think I might be a bit under medicated. as feeling really sluggish at the moment, I has my yearly bloods done on monday and could do with some help in understanding them.
I have coeliacs, Hashimotos and I'm on Hrt.
Bloods were taken at 9.30am and no meds taken in the previous 24 hrs. Ranges are in brackets.
22/11/21
Serum TSH level - 2.45 mIU/L {0.27 - 4.2}
Serum free T4 level - 17.9 pmol/L {11.0 - 21.2}
Serum free T3 level - 3.5 pmol/L {3.1 - 6.8}
Serum vitamin B12 - 385 ng/L {197 - 771}
Serum folate - 6.4 ug/L {3 - 20)
Thanks in advance guys.
Written by
debra135
To view profiles and participate in discussions please or .
Do you take your HRT well away from your thyroid meds? At least 4 hours, preferably more?
TSH level - 2.45 mIU/L {0.27 - 4.2}
free T4 level - 17.9 pmol/L {11.0 - 21.2}
free T3 level - 3.5 pmol/L {3.1 - 6.8}
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 TSH is too high, your FT4 is 67.65% through range and FT3 is jut 10.81% through range.
Low T3 causes symptoms.
Your T4 to T3 conversion appears to be poor.
I would think at this stage an increase in your Levo may be beneficial, this should bring your TSH down and increase your FT4. There should also be some improvement in your FT3 but probably not enough but once your TSH is 1 or below we can see just how well you do convert, or not.
For thyroid hormone to work properly we need optimal nutrient levels.
vitamin B12 - 385 ng/L {197 - 771} ng/L is the same as pg/ml
This is too low. 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."
As long as you don't have any signs of B12 deficiency you could supplement with a B12 sublingual lozenge along with a good quality B Complex to keep all the B vitamins balanced. Check for signs of deficiency here:
If you do then list them to discuss with your GP and ask for testing for B12 deficiency and Pernicious Anaemia. 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 - 6.4 ug/L {3 - 20)
Folate is recommended to be at least half way through range so that would be 11.5 plus with your range. Eating folate rich foods may help, as can a 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).
Did you have ferritin and Vit D tested too? These are both important, and ferritin should be half way through range, with some experts saying the optimal ferritin level for thyroid function is 90-110ug/L. Vit D is recommended to be 100-150nmol/L.
As you have Hashi's, are you gluten free? It seems to help some people but there's no guarantee. Hashi's can cause gut/absorption problems leading to poor nutrient levels, so it's important to test all key nutrients once a year.
My hrt is patches so is continuous. The tablets really upset my stomach. Whats the correlation between Hrt and thyroid meds?
I take folic acid every morning -with orange juice which I now know isn't helpful. My doctor recommended taking folic acid previously and said that I could continue take it as long as I wanted. I took this on the morning of my test opps.
I have been gluten free for years as I was diagnosed with Coeliacs disease.
For some reason my ferritin and Vit d weren't checked this year.
Nov 2020 results were - should that help at all.
25 OH Vitamin D 75 nmol/L {50 - 120} -
this has been up and down but never over 100.
I take a calcuim and d3 supp each day as I am being treated for osteoporosis due to the coeliacs,
Serum ferritin 110 ug/L (13 - 150) - this has gone up over time
I'll have a read of the b12 info you have linked.
Shame that Dr's don't know all this extra info and just say yes you're in the normal range. It would make life so much easier.
However, women with pre-existing hypothyroidism treated with thyroxine, may require an increase in their thyroxine dose after starting HRT. Therefore it is useful for thyroid function tests to be re-checked after starting HRT.
It doesn't say what form of HRT though.
I take folic acid every morning -with orange juice which I now know isn't helpful. My doctor recommended taking folic acid previously and said that I could continue take it as long as I wanted. I took this on the morning of my test opps.
How much do you take and is it prescribed?
How long have you been takingh it and has your level improved much?
I wonder if you might be better taking a methyfolate supplement rather than folic acid, not everyone can convert folic acid into folate.
Nov 2020 results were - should that help at all.
25 OH Vitamin D 75 nmol/L {50 - 120} -
this has been up and down but never over 100.
I take a calcuim and d3 supp each day as I am being treated for osteoporosis due to the coeliacs,
12 month old results aren't useful now, we should check our nutrient levels annually so maybe do your own Vit D if GP wont do it. NHS lab which offers this test to the general public:
I take folic acid every morning ----How much do you take and is it prescribed?
Its was initially prescribed but Dr suggested getting the over counter ones . When some of the fatigue came back I asked if I should start it again and she said there was no harm in being on it long term. No new bloods were done - Dose is 400ug
How long have you been takingh it and has your level improved much?
I've been on it a while on and off and my levels fluctuate - thou looks like they are dropping at moment.
I wonder if you might be better taking a methyfolate supplement rather than folic acid, not everyone can convert folic acid into folate.
I will have a look into this alternative
Is the calcium prescribed? Is your calcium level tested regularly? Do you take Vit K2, this is an important supplement for bone health.
I take a combined calcium 1500 mg and d3 400iu tablet (evacal) 2 tabs have been prescribed each day but not Vit k2. First time I've heard of this.
I do have some of the symptoms on the b12 list so I think I need to have a chat with my dr again.
Going to ask her to up my medication and help me with the b vits etc. Is there anything else you would suggest I ask whilst i'm there.
When you were prescribed folic acid, was this for folate deficiency, i.e. folate level below 3ug/L. If so the normal amount to be prescribed is 5mg folic acid for a shortish course, which should bring folate level into range. 400mcg is usually a maintenance dose, or to improve a lowish but not deficient level.
Calcium
As this is prescribed, is your GP keeping an eye on your level? These combined calcium/D3 supplements tend to have a large dose of calcium and a small dose of D3, so you are getting 3,000mg calcium and only 800iu D3. 800iu D3 is barely a maintenance dose for someone with a good level already, it's not enough to raise your level. With a D3 level of 75nmol/L, if you wanted to achieve the recommended level of 100-150nmol/L then you'd be looking at taking around 3,000iu daily. But as your results are 12 months old it would be a good idea to retest now to determine your winter dose, we generally need more in the winter than summer as we can't make Vit D naturally during the winter.
Vit K2-MK7 wont be discussed,. tested or prescribed because doctors know little to nothing about nutrition so wont know about important cofactors. This is the information always given here when a member takes D3:
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. 90-100mcg K2-MK7 is enough for up to 10,000iu D3.
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.
You might be interested to read what Dr Sarah Myhill says about osteoporosis, I'll link to a couple of her articles, you might want to have a look around her website, it's very informative in lots of ways:
The accepted conversion ratio when on T4 only is said to be :- 1 / 3.50 - 4.50 - T3/T4 with most people feeling at their best when they come in at around 4 or under :
So to find your conversion ratio you simple divide your T3 into your T4 and I'm getting yours coming in at around 5.11 showing your conversion going out from centre and you will be with a slower than average metabolism.
Your TSH is high and you'll likely feel better when this gets to 1 or under, which will happen as you increase your dose of T4 - Levothyroxine as we generally need this up in the top quadrant of the range as this in theory should convert to a higher T3 result.
T4 - Levothyroxine is a storage hormone that needs to be converted by your body into T3 the active hormone that the body runs on and it is where your T3 sits in the range that gives you your wellness.
Conversion of T4 into T3 can be compromised by low vitamins and minerals, inflammation, any physiological stress ( emotional or physical ) dieting, depression and aging, and so yes, it does get a bit like mission impossible
I see you have been diagnosed with Hashimoto's so this throws another spanner in the works as it's also important to also check for food intolerances and heal your gut to maximise your absorption f the thyroid hormone replacement and read of many people following the research of Dr Izabella Wentz who also has this thyroid AI disease.
With every attack from this auto immune thyroid disease your own thyroid production becomes more laboured, and you will likely experience erratic " hyper swings " but then when the swing swings back you'll likely feel further incapacitated and need additional medication.
Ultimately as your thyroid gland dies you'll need to consider taking full spectrum thyroid hormone replacement replace your own missing T3 and T4 thyroid hormones.
I have read that some people sensing an attack imminent stop their T4 thyroid hormone for a few days to offset the severity of this temporary rise in your thyroid hormones.
I have read that some people need to increase their thyroid hormone dose when they take HRT - I don't know myself as am way past that time in my life.
I'm with Graves post RAI thyroid ablation and now managing lingering Graves, thyroid eye disease and hypothyroidism and am self medicating taking full spectrum thyroid hormone replacement.
I hope that its ok to reply on the back of a previous post I thought it helps to see the history. If nor please let me know and I will start a new post.
7/4/22 results (only just got them as hosp / dr lost them)
Serum TSH level - 0.62 mIU/L {0.27 - 4.2}
Serum free T4 level - 20.7 pmol/L {11.0 - 21.2}
Serum free T3 level - 4.5 pmol/L {3.1 - 6.8}
Serum vitamin B12 - 562 ng/L {197 - 771}
Serum folate - 2.5 ug/L {3 - 20)
22/11/21 results
Serum TSH level - 2.45 mIU/L {0.27 - 4.2}
Serum free T4 level - 17.9 pmol/L {11.0 - 21.2}
Serum free T3 level - 3.5 pmol/L {3.1 - 6.8}
Serum vitamin B12 - 385 ng/L {197 - 771}
Serum folate - 6.4 ug/L {3 - 20)
New results are since my levothyroxine was put up slightly . I'd appreciate any thought on whether I need more or if I may need to see if I need to supplement with T3. I'm sure your laughing by now as I know that its rare to get T3 now.
I was on 100 four days and 125 the other three. I'm now on 125 all week.
I started taking b12 daily plus k3 d3 both as a spray and a broad b vit supp after advice from seaside sue when I posted the Nov results. I have hashimotos and coeliacs and still on hrt. Thanks in advance.
Content on HealthUnlocked does not replace the relationship between you and doctors or other healthcare professionals nor the advice you receive from them.
Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
Blood test result: help! 
Help with bloods please including iron levels. 
New thyroid results to add to my previous ones
help with latest blood tests
