Medicheck results now in (see attached) i have my private endocrinologist appointment tomorrow. Any advice greatly appreciated. I have included my background below.
(Background)
I have been trying to conceive for 8 months. I was concerned something was wrong and requested blood tests from GP. I received my results which indicate my TSH Is 5.5 and T4 is 13.2.
My GP advised my TSH is slightly elevated and spoke to a consultant who advised they wouldn't treat and that it shouldn't stop me getting pregnant.
After doing some reading the British Thyroid Association and other websites they state TSH should be 2.5 or lower when trying to conceive and when pregnant to avoid complications.
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Vitamin D deficiency is frequent in Hashimoto's thyroiditis and treatment of patients with this condition with Vitamin D may slow down the course of development of hypothyroidism and also decrease cardiovascular risks in these patients. Vitamin D measurement and replacement may be critical in these patients.
Vitamin D insufficiency was associated with AITD and HT, especially overt hypothyroidism. Low serum vitamin D levels were independently associated with high serum TSH levels.
The thyroid hormone status would play a role in the maintenance of vitamin D sufficiency, and its immunomodulatory role would influence the presence of autoimmune thyroid disease. The positive correlation between free T4 and vitamin D concentrations suggests that adequate levothyroxine replacement in HT would be an essential factor in maintaining vitamin D at sufficient levels.
Your High thyroid antibodies confirms autoimmune thyroid disease
U.K. medics only ever call it autoimmune thyroid disease ….they never call it Hashimoto’s
Technically
Autoimmune thyroid disease with goitre is Hashimoto’s
Autoimmune thyroid disease without goitre is Ord’s thyroiditis.
Both are autoimmune and generally called Hashimoto’s.
In U.K. medics never call it Hashimoto’s, just autoimmune thyroid disease (and they usually ignore the autoimmune aspect)
About 90% of all primary hypothyroidism in Uk is due to Hashimoto’s. Low vitamin levels are particularly common with Hashimoto’s.
Gluten intolerance is often a hidden issue too. Request coeliac blood test BEFORE considering trial on strictly gluten free diet
Poor gut function with Hashimoto’s can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common.
According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but a further 80% find gluten free diet helps, sometimes significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)
Changing to a strictly gluten free diet may help reduce symptoms, help gut heal
Before considering trial on gluten free diet get coeliac blood test done…ideally via GP …. FIRST just to rule it out
If you test positive for coeliac, will need to remain on gluten rich diet until endoscopy (officially 6 weeks wait)
If result is negative can consider trialing strictly gluten free diet for 3-6 months. Likely to see benefits. Can take many months for brain fog to lift.
If no obvious improvement, reintroduce gluten see if symptoms get worse.
The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported
In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned
Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.
The amount of selenium generally suggested as safe (without testing) is 100-200mcg.
For the nuts contain selenium and they have to have been grown in selenium rich soi. Then it depends in which area the nuts were grown in because the amount of selenium in soil varies. Eastern Amazon and Central Brazil have the highest amounts:
One member has said that M&S Natural Brazil Nuts say "harvested by hand in the Amazon forest and naturally high in selenium".
Also, check out Aldi's "The Foodie Market" Brazil nuts, the packaging is said to show selenium content as 79mcg per 30g serving.
Another one is 'My Garden of Eden' Brazil nuts from Home Bargains.. They say "High in Selenium and high in vitamin E" on the front of the packet and the Nutritional Information says "one serving (25g) gives 63ug of Selenium".
CRP- This is a measure of inflammation in the body, although it won't tell you where the inflammation is. Your result is in range which suggests that you don't have high levels of inflammation, but it is not optimal. Optimal is < 1. You can't influence this directly, you would have to improve as many other things as possible in the hope of reducing it.
Ferritin - (iron stores) Obviously too high, but without other information about your iron it is hard to say how you could reduce this. If you could get an iron panel (also known as iron studies) done by your doctor or privately it might give more information. An iron panel consists of ferritin, serum iron, transferrin saturation, and transferrin or Total Iron Binding Capacity (TIBC). High ferritin can occur with low iron, iron in range, or high iron, and the different combinations tell you different things about your health. Ferritin can also be raised by inflammation.
A finger-prick test from Medichecks would be helpful.
Thriva also do an iron panel (the Advanced Iron Profile) as well, but I've only recently discovered it and haven't tried it yet. They also subscribe people to repeated testing which I don't like. Remember to unsubscribe if you don't want to keep doing the test every three months.
Folate - Are you supplementing? If yes, what with? High folate like yours suggests you are taking folic acid and it might not be getting converted to the active/usable form. Please read this :
If you switch from taking folic acid to a folate supplement your level of folate may drop dramatically, because your body will start actually using it. In fact some people struggle to raise it with "real" folate, but at least it is getting used and doing its job rather than just building up.
Vitamin B12 - Your B12 is too low. It needs to be at least 70, and optimal is 100+. The best B12 supplement for most of us is methylcobalamin, which is easily sourced on Amazon and other supplement websites. You would need to take 1000mcg per day for a couple of months then re-test. If your result is optimal then drop the B12. For the body to metabolise B12 it needs good levels of folate.
Anyone taking folate and/or B12 needs to take a B Complex too. Once folate and B12 levels are optimal the folate and B12 doses may be reduced or dropped and just continue taking a good quality B Complex. But experimentation and repeat testing will be required.
SeasideSusie has more info than me on Vitamin B12 and good quality B Complex products.
Vitamin D - Your result is deficient. You can work out your ideal dose of Vitamin D3 with this link :
b) The best form of D3 is in a capsule with olive oil in it and nothing else. Doctor's Best is one product, but there are others.
c) Vitamin D raises absorption of calcium in the diet. You want that to go to bones and teeth, not end up lining your arteries. To achieve that you need co-factors, magnesium and vitamin K2. SeasideSusie has mentioned these in replies to others loads of times, so it is worth searching for that info on the forum.
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On the subject of conceiving with subclinical hypothyroidism, low thyroid hormone levels, and some low nutrient levels, sadly these issues will make it much harder to conceive and will increase your risk of miscarriage. Doctors did have guidelines for a while saying that TSH should be below 2.5 but the ******** have removed it again, probably to save money.
If you really can't budge your doctor, and you can't get pregnant, and if your age is against you then I would suggest you could start treating yourself. You could wait for ever for thyroid hormones otherwise. But concentrate on diet, gut health, general health and nutrients to improve your chances of pregnancy.
I had my consultation today - consultant has prescribed 25mcg of levothyroxine for 2 weeks followed by 50mcg there onwards.
He has asked me to speak to my gp about further blood tests retest for vit D then gp should per scribe high dose vit d to bring levels to optimol then reduce to vit d from shop etc.
I will look into b12 supplements you suggested - how much b complex do you recommend?
I am taking 400 folic acid - how much folate do you recommend?
I would suggest taking a good quality B Complex with active B vitamins i.e. in the form that the body can metabolise easily. SeasideSusie usually suggests Thorne Basic B :
Women planning on becoming pregnant should consume between 800 and 1200 mcg of folate per day for several months before the start of pregnancy. Unless you’re consuming chicken or calf’s liver and substantial amounts of leafy greens on a regular basis, it’s difficult to obtain this amount from diet alone. If you’re pregnant or trying to get pregnant, I recommend supplementing with 600-800 mcg of folate per day, depending on your dietary intake. . Solgar is a good brand, but there are several others that typically use 5-MTHF including Designs for Health, Thorne, Metabolic Maintenance and Pure Encapsulations.
I would suggest taking one bottle of whatever you buy then re-testing B12 and folate to see what is happening to your B12 and folate. Bear in mind that if you have been taking cyanocobalamin and folic acid your levels could drop, possibly dramatically, because your body could actually be very short of real folate, despite your high folic acid. If this happens you will need to take methylfolate and methylcobalamin in addition to the B Complex until your levels are optimised.
The problem that people with thyroid disease have is that they are not good at doing the conversion, where necessary, from one form of a nutrient to another. So, for example, a lot of multivitamins (which are not recommended anyway) will contain beta-carotene as a substitute for vitamin A. If you can convert from beta carotene to vitamin A it isn't a problem. But if you can't do it very well you could end up short of vitamin A.
I bought a bottle of (real) vitamin A supplements and after just one bottle I got rid of my orange palms and soles (I'm guessing from unmetabolised beta-carotene) which I've had all my life. It's never returned, thankfully.
Please note you should research on the forum and online generally to check whether or not you are convinced by the info you're getting. I'm not a doctor and you follow any suggestions on this forum at your own risk, not just from me but everyone else as well.
To be honest its all very overwhelming i am new to the thyroid world and just want to get things sorted asap to increase my chance of conceiving . I appreciate you are not a dr but your advice would be good if you think ghis looks about right:
Replace folic acid (400) with folate (600-800 a day)
B12 - methylcobalamin
1000mcg per day
B complex - the one you recommended contains b12/folate - do you take the one tablet or in addition the above?
Vit d - must be d3- best form of D3 is in a capsule with olive oil.
Take magnesium and vitamin K2
The vit d calculater suggests:
10,000 iui a day for 3 months
or
25,000 loading dose for 12 days followed by daily maintaince of 10,000iui - does that daily dose seem high to you?
I am contacting my dr tomorrow to sort thyroxine prescription as i only have a private one st the moment till consultant writes to my gp. I am also asking for vit d loading dose and a few other tests consultant asked for.
25,000 loading dose for 12 days followed by daily maintaince of 10,000iui - does that daily dose seem high to you?
I don't use that calculator because I don't know what anyone's weight is so I go by the information I saved from the old Vit D Council's website (no longer there).
First of all, your Vit D level is not deficient, it is in the "insufficient" category. It it was deficient you would need loading doses, when in the insufficient category you don't.
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.
To reach the recommended level from your current level, you could supplement with 5,000iu D3 daily. Retest after 3 months.
Once you've 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:
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. 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.
If looking for a combined D3/K2 supplement, this one has 3,000iu D3 and 50mcg K2-MK7. The company has told me the K2-MK7 is the Trans form
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.
Replace folic acid (400) with folate (600-800 a day)
Folic acid has to be converted to folate so with folate being the converted, bioavailable form I don't understand your reasoning to increase the dose here. 400mcg methylfolate should be sufficient. My suggestion is Thorne Basic B not a separate folate supplement, you need a B Complex to balance all the B vitamins. Your folate level is already high so you're certainly not looking to increase it.
Active B12: 56.9
Active B12 below 70 suggests testing for B12 deficiency according to Viapath at St Thomas' Hospital:
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.
SlowDragon has mentioned testing this in her reply above.
Once testing has been done and you've started on B12 injections or B12 supplements only then you add in the B Complex.
I am not medically trained so you must satisfy yourself that these suggestions are appropriate for you and that any supplements you take are appropriate if you get pregnant.
I will ask for b12 test first before taking any supplements.
With regards to the folate/folic acid you state
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.
So i should not yet swap my folic acid for folate until results come back? I am taking folic acid which is in my pre natal? (I am thinking of stopping this all together and just taking folate.
The reason i mentioned taking more folate was based on slow dragons suggestion
Women planning on becoming pregnant should consume between 800 and 1200 mcg of folate per day for several months before the start of pregnancy. Unless you’re consuming chicken or calf’s liver and substantial amounts of leafy greens on a regular basis, it’s difficult to obtain this amount from diet alone. If you’re pregnant or trying to get pregnant
I can't comment really on folate and pregnancy because it wasn't even a thing when I was pregnant 50 years ago and it's not something that I look into currently.
As for not taking any before testing B12, that's general advice because it will skew results, so I don't know what you should do in your position. You need to weigh up whether you think getting all your ducks in a row is a good idea before attempting to conceive.
So i should not yet swap my folic acid for folate until results come back? I am taking folic acid which is in my pre natal? (I am thinking of stopping this all together and just taking folate.
I would be nervous about the idea of someone who wants to conceive giving up folic acid or folate completely for any length of time, or giving up everything in their prenatal vitamins and minerals. But I'm not sure what to suggest.
I don't know what chance you have of getting tested for Pernicious Anaemia (PA) - a lot of people have trouble getting doctors to agree. It could end up dragging on for a long time, which obviously isn't ideal when you are hoping to conceive.
If there was no suspicion of PA, it is often suggested that people who are below optimal in B12 and/or have been taking folic acid should take a bottle of one of the folates recommended by Chris Kresser AND a bottle of methylcobalamin AND a B Complex, then retest after two months. If the B12 and folate are optimal then drop those and continue taking just the B Complex. If they aren't optimal then continue taking the separate B12 and/or folate along with the B Complex as necessary until they are optimal.
First of all, your Vit D level is not deficient, it is in the "insufficient" category. It it was deficient you would need loading doses, when in the insufficient category you don't.
Oops!
That's one of the advantages of forums over doctors that doctors would never acknowledge.
When doctors make mistakes they get written on the patient's records and they stay there for ever. The patient might not realise they've been given duff information or been treated wrongly, and any healthcare staff coming along later and reading the notes probably won't realise the doctor made a mistake - but they will always believe the doctor over the patient.
On forums if a member makes a mistake there is usually someone else around to point it out, often only minutes later.
One would always hope that people would do regular retesting during the process of raising vitamin D. But with doctors refusing to test vitamin D and few people having mountains of money to dive into like Scrooge McDuck it is difficult to even suggest it.
It's not possible without knowing which form of magnesium you need. I use magnesium citrate and magnesium taurate and have brands I like but these may not be the correct forms of magnesium for you.
I am still confused about my B12 - gp tested serum b12 which came back at 386ng/l
My active b12 via medicheck was 56nmol.
Gp said b12 normal is this correct?
The are two different tests. GP has done Total B12 test which measures both inactive and active B12. Active B12 is approx 10-30% of Total B12 and it's only Active B12 that the body can use.
As mentioned above when Active B12 I below 70 this suggests further investigation and I gave you links to check if you had any signs and symptoms of B12 deficiency.
Total B12 below 550ng/L is too low according to "Could it be B12" who recommend 1000ng/L. Because your result is within range your GP is going to say it's fine but just being in range doesn't mean it's at an optimal level. Some people with Total B12 in the 300s have been found to need B12 injections. So again it's signs and symptoms that are important and if you have any your GP should be doing further testing. If you do have any signs and symptoms of B12 deficiency then stop supplementing both B12 and B Complex as this will skew results.
Fine tuning of the dose could be necessary in some patients
* aim of levothyroxine treatment is to make the patient feel better, and the dose should be adjusted to maintain the level of thyroid stimulating hormone within the lower half of the reference range, around 0.4 to 2.5 mU/l. If the patient feels perfectly well with a level in the upper half of the reference range, then adjustment is unnecessary
Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L.
Also, Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (the professional publication for doctors):
"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l. In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance. But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l. This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l).*"
*He confirmed, during a talk he gave to The Thyroid Trust, that this applies to Free T3 as well as Total T3 and this is when on Levo only. You can hear this at 1 hour 19 mins to 1 hour 21 minutes in this video of that talk youtu.be/HYhYAVyKzhw
You can obtain a copy of this article from ThyroidUK:
tukadmin@thyroiduk.org
print it and highlight Question 6 to show your GP.
Also point him in the direction of the pregnancy guidelines:
Hi, GP agreed to up my dose to 75 so been on that a week now. Just wanted to ask your thoughts for the last 2/3 weeks i feel like i have something in my throat, i didnt have this before starting levo and i worried its something related to my thyroid?
You have Hashi's. Do you have a goitre? I have no experience of Hashi's, goitres, nodules, etc., so it might be worth starting a new post and anyone with any experience of something similar may be able to help.
So your increased dose is working but there's still room for much more improvement, so it's time to add another 25mcg Levo.
CRP dropped from 3.87 to 3.7 - still cant get it lower?
You have Hashi's and this can cause inflammation, so you might not be able to get it very low.
Ferrin 257 it was 230 in january which was concerning however ferritin blood test from gp was 147ug/l in January so dont no what to think
As ferritin can be raised when inflammation is present, and your CRP is still not very low (although within range), this may still be high due to inflammation.
There has always been disparity between Medichecks and GP results for ferritin, there have been quite a few posts on the forum about this. I don't think any of us know what the answer is but I wouldn't compare them, just stick to the one for monitoring.
Vit D increased from 41 - 148 (good news)
That excellent!
Active B12 only increased from 57 to 65
Mmm.... slowly increasing.
Folate dropped from 19 to 10 could this be because i switched to folate?
Exactly what are you taking for B12 and Folate?
Still not pregnant
To be honest, I wouldn't be in any hurry to get pregnant until your thyroid levels are a lot better. We know that TSH should be below 2.5 for conception and pregnancy but baby needs T4 as well so will be taking that from you initially.
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Subclinical Hypothyroidism 
Subclinical hypothyroidism 
Subclinical hypothyroidism
Subclinical hypothyroidism 
Subclinical hypothyroidism 
