Blood test results

[mazza999]

I would very much appreciate thoughts on my latest blood test results from the hospital requested after my first endocrinologist appointment. Thanks in advance.

[Simplyred57]

Hi Mazza that’s an impressive list of bloods have you got a follow up appointment? I’m sure all the amazing people on here will will be able to advise🤞

[mazza999 in reply to Simplyred57]

No appointment he just said he may get back in touch ??

[Simplyred57 in reply to mazza999]

That’s shocking bear in mind that particular consultant said to me that T4 &T3 should be in the high end of range - was it his junior ? I would be cheeky and ring his secretary and ask if you will be getting an increase in thyroid medication ????

[Partner20 in reply to Simplyred57]

Not sure why this is shocking. Many of our consultants work like this, testing then contacting by phone if there are any concerns. My rheumy has just sent me blood forms which will be dealt with in this way when she receives the results.

[Simplyred57 in reply to Partner20]

I think it’s shocking that people are left in limbo for months when they’re clearly under medication!

[mazza999]

Hope the photo is clear?

[SlowDragon Administrator]

Previous Medichecks results show poor conversion of levothyroxine to Ft3

healthunlocked.com/thyroidu...

These results

Low MCHC suggests anaemia

healthline.com/health/low-mchc

B12 still low

Folate deficient

Vitamin D better at least around 80nmol and around 100nmol maybe better

FT4 is only 35% through range

Ft3 is only 30% through range

Helpful calculator for working out percentage through range

chorobytarczycy.eu/kalkulator

Results show you are under medicated

Request 25mcg dose increase in levothyroxine

Meanwhile

Work on improving low vitamin levels

Endocrinologist/GP should prescribe folic acid supplements for folate deficiency

Guidelines on dose levothyroxine by weight is approx 1.6mcg levothyroxine per kilo of your weight per day

[mazza999 in reply to SlowDragon]

Thank you for making it clear for me 👍🏻

[SlowDragon Administrator in reply to mazza999]

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

[SlowDragon Administrator]

After you finish folic acid prescription from GP

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...

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...

[Partner20]

If you have not already been given a diagnosis, your endo/ GP will want to monitor you as your hba1c points to concerns with diabetes, and your glucose level in this occasion is high, too. Hopefully you will be contacted soon regarding both this and your thyroid levels, which still need to improve. If you don't hear anything within a couple of weeks, ring the secretary. The wheels of the NHS often grind slow, unfortunately.

[Hidden]

Your cortisol result is slightly on the low side too, this chart shows what normal cortisol levels should be.

cortisol levels

[JAmanda]

I imagine you’re taking a small amount of levo and this really stops your thyroid working (don’t know the science but it seems to be the case). You need a dose increase and should have had that after six weeks not three months!

[mazza999]

When posting I should have said this is not my first post and that I was diagnosed with hypothyroidism over 15 years ago and currently on a 150mg daily dose, recently dropping from 175mg.

[Charlie-Farley]

Hi mazza999,

Quick question……were you feeling unwell on 175 µg of levothyroxine? What is the rationale of dropping your levo? Was it to introduce T3? Reading slowdragon’s response it would appear you have poor conversion was this the reasoning behind your endo dropping dose? I just wonder if sometimes we let people muck about with our health without actually asking why they’re doing it? I fell foul of that at the start of been diagnosed and was left grossly under medicated for six months (was very ill). So I am less trusting now and want to know why for everything.

[mazza999 in reply to Charlie-Farley]

After 15 years of diagnosis I have never felt well. Dosages altered by GP simply by TSH results (that swing from very low to high, 12) and last time she asked me!

I’ve only just been referred to an endo and he wasn’t concerned about thyroid. T3 will never be an option in my area

[Charlie-Farley in reply to mazza999]

Oh dear 😢

I’m so sorry for the situation, but one thing I would say is there was an article in the guardian- it comes up if you Google.

T3 never went off the table of treatment options for clinical reasons, anyone who says otherwise has either been lied to or is full in knowledge and lying 🤥.

amp.theguardian.com/busines...

In the light of this prices may comeback down and return to wider use. Some on this site self source a few even get T3 through the NHS and more recently , some have entered into combination trials - though whether dosing is based on delivering a therapeutic outcome or merely what is considered affordable is debatable.

As for TSH

TSH is not a thyroid hormone. It is made by the pituitary - there is a feedback loop that the pituitary responds to. I’m still getting my head round this and others understand it in more detail - but! When Thyroid hormone levels in the blood are too low TSH is produced - a sort of a chemical kick up the ass for the thyroid to get working. If the thyroid can’t produce any, or produce enough thyroid hormone TSH keeps rising.

Good analogy is if you take the oil dipstick in your car engine out, give it a wipe clean then dip it in again and when you pull it out there is oil at the full mark on the dip stick you wouldn’t add any more. So in that sense pituitary won’t add more TSH. Once we introduce synthetic thyroid hormones (or NDT) we interrupt the feedback loop anyway so to treat it should be (order of importance) T3, T4 , vitamin levels then least of importance TSH.

Many doctors are dosing by TSH range - a completely wrong strategy when you read around the subject and ONLY baffling if you don’t take into consideration most of these arse policies are born out of a general lack of understanding and a drive to over simplify and the BIGGY - save money 😱

Question everything and I sincerely hope you improve 😘👍 I’m quite well today thanks to the knowledge and advice imparted by this forum. I hope the same for you .😊👍

[Charlie-Farley]

Added a bit more above 😬 hope it helps

[mazza999 in reply to Charlie-Farley]

Thank you very much for your time. I’m going to do some research before I go back to the endocrinologist and hope to find some improvement.

[Charlie-Farley in reply to mazza999]

I’m rooting for you!