Another request for blood test results help

[lutepavan]

Hello friends,

I'm back with an update and a further request for you to have a look at some blood results. As a reminder, I'm 57, male, and have been on 75 mcg Levothyroxine for many months now, diagnosed only last year. I refer frequently to SeasideSusie 's extremely helpful advice in her reply to my last one, linked to here:

healthunlocked.com/thyroidu...

The story is that I have since then spent six weeks on a very strict and fairly radical "autoimmune diet" (which cuts out the most common triggers, such as gluten, dairy, sugar, etc.). At the end of the six weeks, I had another Medichecks Thyroid test (see below), taken in exactly the same conditions at 9 AM after fasting and not taking Levo until after the test. The results have been interesting, and I thought them worth sharing, partly because it's so heartening to see what's happened to my ferritin, B12, and folate (and, to a lesser extent, my D3) levels purely as a result of dietary changes, but also because I'd be grateful for advice about the direction the Thyroid numbers are heading in.

For easy reference, I'm going to show the pre-diet and post-diet figures side by side. Here we go:

7 October CRP HS 0.8 mg/L (Range: 0 - 5) to 25 November 1.51 mg/L (Should I be worried that it's rising? It's still pretty low.)

Ferritin 38.20 ug/L (Range: 30 - 400) now up to 88.30 ug/L ! (I should add here that by 14 October my Ferritin had sunk to a low of 24 ug/L at an NHS Health Check, but that was not after fasting or leaving out my dose of Levo, because I hadn't been expecting the blood test, and I was just back from an exhausting trip.) Obviously pleased with this improvement.

Folate 5.37 ug/L (Range: > 3.89) now 10.65 ug/L

B12 90.000 pmol/L (Range: 37.5 - 188) now >150 pmol/L

Vitamin D 76.20 nmol/L now 98.60 nmol/L

TSH 2.29 mU/L (Range: 0.27 - 4.2) now dropped to 1.21 mU/L (This is very encouraging because my dose of Levo hadn't change, and this dramatic drop happened in under seven weeks. I've no intention of returning to the old diet, by the way, but am gradually reintroducing some safe foods. Now perhaps I don't need to increase the Levo dose to 100 mcg after all, do I?)

Free T3 4.33 pmol/L (Range: 3.1 - 6.8) now 3.26 pmol/L

Free Thyroxine 15.500 pmol/L (Range: 12 - 22) now 17.300 pmol/L (The FT3 and FT4 are no longer as balanced in terms of their distance through the range, and I'm particularly keen to know what this might mean.)

Thyroglobulin Antibodies >4000 IU/mL (Range: < 115) to >4000 IU/mL (Seemingly unchanged, though for all I know it's dropped from 6000 to 5000 or something.)

Thyroid Peroxidase Antibodies 315.00 IU/mL (Range: < 34) to 310.00 IU/mL

Very grateful for your thoughts on this. Best wishes to all

[lutepavan]

I completely forgot to add that I followed your advice to get an iron panel, and the results are below:

Inflammation

CRP HS

1.51 mg/L (Range: 0 - 5)

Iron Status

Iron

18.06 umol/L (Range: 5.8 - 34.5)

TIBC

53.76 umol/L (Range: 45 - 81)

UIBC

35.70 umol/L (Range: 22.3 - 61.7)

Transferrin Saturation

33.59 % (Range: 20 - 50)

Ferritin

88.30 ug/L (Range: 30 - 400)

[SlowDragon Administrator]

Looking at previous post, you weren’t eating any red meat

Have you now increased iron rich foods in your diet

Ferritin still has long way to go to get to at least around 100

Approx how much do you weigh in kilo

Guidelines on dose levothyroxine by weight is approx 1.6mcg per kilo per day, but many people need higher dose

Your results suggest you need dose increase in levothyroxine

Suggest you try 75mcg and 100mcg on alternate days initially and retest in 6-8 weeks minimum

Which brand of levothyroxine are you currently taking

Do you always get same brand each prescription

[lutepavan in reply to SlowDragon]

Thank you, SlowDragon . Yes, I introduced high-quality grass-fed beef just six weeks ago, after years of a pescatarian diet. It's felt very much like the right thing for me, and I'll keep it up. I'm now also going to take ferrous fumarate prescribed by my doctor for a while.

My weight is 63 kg, which puts me bang on 100 mcg, so I'll ask my doc if he'll agree to put the dose up for me. My brand is and always has been Teva, and I'd love to try a different brand (as the 100 mcg would be, I think) because I have a (probably unfounded) suspicion that my occasional severe headaches are caused by something in the Teva. I'll definitely try your suggestion if I can get my GP to agree. Many thanks.

[SlowDragon Administrator in reply to lutepavan]

Many people find Levothyroxine brands are not interchangeable.

And as you are aware ……Many patients do NOT get on well with Teva brand of Levothyroxine.

Teva contains mannitol as a filler, which seems to be possible cause of problems.

Teva is the only brand that makes 75mcg tablet. So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half

But for some people (usually if lactose intolerant, Teva is by far the best option)

Teva, or Aristo (100mcg only) are the only lactose free tablets

Most easily available (and often most easily tolerated) are Mercury Pharma or Accord

Mercury Pharma make 25mcg, 50mcg and 100mcg tablets

Accord only make 50mcg and 100mcg tablets

Accord is also boxed as Almus via Boots, and Northstar 50mcg and 100mcg via Lloyds ....but Accord doesn’t make 25mcg tablets

beware 25mcg Northstar is Teva

List of different brands available in U.K.

thyroiduk.org/if-you-are-hy...

Posts that mention Teva

healthunlocked.com/search/p...

Teva poll

healthunlocked.com/thyroidu...

Once you find a brand that suits you, best to make sure to only get that one at each prescription.

Watch out for brand change when dose is increased or at repeat prescription.

New guidelines for GP if you find it difficult/impossible to change brands

gov.uk/drug-safety-update/l...

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. If symptoms or poor control of thyroid function persist (despite adhering to a specific product), consider prescribing levothyroxine in an oral solution formulation.

academic.oup.com/jcem/artic...

Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).

Do you take levothyroxine waking or bedtime

Levothyroxine is an extremely fussy hormone and should always be taken on an empty stomach and then nothing apart from water for at least an hour after

Many people take Levothyroxine soon after waking, but it may be more convenient and perhaps more effective taken at bedtime

verywellhealth.com/best-tim...

No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.

Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away

(Time gap doesn't apply to Vitamin D mouth spray)

If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal

[lutepavan in reply to SlowDragon]

Thank you very much. I'll make sure to take this on board. May I ask an ignorant question? In the previous blood test (before I changed my diet), T3 and T4 were relatively evenly matched (albeit a bit low) in terms of their position within the range. Now, in the latest test, T4 is up a bit, but T3 has gone down. What might be the reason for the imbalance? Am I failing to convert T4 to T3? Will increasing the Levo dose actually help this? Thanks, and sorry to ask so many questions. Trying to learn.

[SlowDragon Administrator in reply to lutepavan]

As TSH drops conversion tends to get worse…one of the reasons so many thyroid patients eventually need small doses of T3 prescribed alongside levothyroxine

Vitamins are improving which is good

Things that might help increase TSH

Splitting levothyroxine dose into two smaller doses waking and bedtime

Trialing liquid levothyroxine (expensive so it’s a battle to get prescribed)