New Results

[giraFfe39]

Hi, I have new results in which my TSH has risen and need some advice of what to do next. I am not on any medication. Display many classic symptoms particularly fatigue and have many family members with thyroid disease.

[SeasideSusie Remembering]

giraFfe39

CRP is raised indicating inflammation somewhere.

Ferritin looks good but as this can also be raised due to inflammation or infection, coupled with the fact that CRP is raised then I wouldn't take this as a true reflection of your ferritin level, it may well be elevated due to inflammation.

Folate is low. Their range is 3.89-19.45 and folate is recommended to be at least half way through range, so with that range you're aiming for at least 12 plus. I'd consider a good quality, bioavailable B Complex to help raise your folate level, along with eating folate rich foods. I have used Thorne Basic B for a long time and always been happy. However, it's quite expensive so I have bought some of this one to try when I've finished the last of my Thorne. The amounts of the vitamins are very similar, it's liposomal which is said to absorb better, there are no unnecessary added ingredients and better priced:

amazon.co.uk/Liposomal-Vita...

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).

Vit D is insufficient at 42nmol/L. 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 4,000-5,000iu 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:

vitamindtest.org.uk/

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

natureprovides.com/collecti...

It may also be available on Amazon

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.

naturalnews.com/046401_magn...

drjockers.com/best-magnesiu...

Don't start all supplements at once. Start with one, give it a week or two and if no adverse reaction then add the next one. Again, wait a week or two and if no adverse reaction add the next one. Continue like this. If you do have any adverse reaction then you will know what caused it.

A normal healthy person would generally have a TSH no higher than 2, often around 1, with FT4 around mid-range-ish. This is not set in stone but because we're not tested for thyroid levels in health to give a baseline, none of us know what's normal for us.

Your TSH is over range but your FT4 is 48% through range with FT3 high in range.

Did you do your test as we always advise:

* Blood draw no later than 9am. This is because TSH is highest early morning and lowers throughout the day. If looking for a diagnosis of hypothyroidism, an increase in dose of Levo or to avoid a reduction then we need the highest possible TSH

* Nothing to eat or drink except water before the blood draw. This is because eating can lower TSH and coffee can affect TSH.

* If taking thyroid hormone replacement, last dose of Levo should be 24 hours before blood draw, if taking NDT or T3 then last dose should be 8-12 hours before blood draw. Adjust timing the day before if necessary. This avoids measuring hormone levels at their peak after ingestion of hormone replacement. Take your thyroid meds after the blood draw. Taking your dose too close to the blood draw will give false high results, leaving any longer gap will give false low results.

* If you take Biotin or a B Complex containing Biotin (B7), leave this off for 7 days before any blood test. This is because if Biotin is used in the testing procedure it can give false results (most labs use biotin).

These are patient to patient tips which we don't discuss with phlebotomists or doctors.

[giraFfe39 in reply to SeasideSusie]

Hi thank you. Yes I did do the test early 8.30am with no food, only glass of water. Didn't take any supplements for two weeks so that results would be okay. I will try to get low vitamin levels up, thanks for the tips. I do eat plenty of green leafy veg but obviously need a good B complex to ensure I get enough. Vitamin D has been low for quite a long time, I have been supplementing this and is a little better than it was before.

[giraFfe39 in reply to giraFfe39]

Do you think I need to go back to the doctor and request a trial of thyroid medication? Unsure as to why my T3 is high with rising TSH. The Thyroid is very complex and confusing.

[tattybogle in reply to giraFfe39]

to diagnose and 'consider' treating 'sub-clinical' hypothyroidism with Levo... GP's need :2x over range TSH tests (taken 3 months apart to rule out a 'one off ' )

plus symptoms of hypothyroidism.

At this point they can 'consider a trial of Levothyroxine'.

If they also test TPOab and find they are over range .. this shows them that you are more likely to eventually become 'overtly' hypothyroid (TSH over range AND fT4 under range ) ... so knowing this they are more likely to decide to treat when still 'sub-clinical' (over range TSH but fT4 still in range )

So . yes.... go back to GP for a repeat test .. 3 months after this one .

But ...NHS may not accept this one is accurate, so they may need to do their own now and then another one in 3 months .

The probable reason for your relatively good fT4 and fT3 at this point (with high TSH ) is that in an attempt to bring your T4/3levels up . the TSH rises .. which causes more ft4 /fT3 to be produced from the thyroid .. and also causes more T4 to be converted to T3 in the body... so for a while you seem to have good T4/3 levels ... but if the thyroid is being damaged by the immune system it won't manage to keep up with producing this level of T4/3 forever.. sooner or later, if thyroid is struggling, you'll see fT4 falling .

Sooner /later ? is like 'how long is a piece of string ?' .. nobody knows .. might be months .. might be years.... depends on the individual, and how fast their thyroid is being damaged.

[SeasideSusie Remembering in reply to giraFfe39]

Technically an over range TSH is subclinical hypothyroidism. If you have symptoms then list them and emphasise them and say as my TSH is over range could you have a trial of Levo. Also emphasise the familial link and how many members have hypothyroidism.

Here is ThyroidUK's article on subclinical hypothyroidism:

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

Your GP may or may not agree to a trial. If your FT4 was at the bottom of the range it might persuade them. But give it a try and here's a list of symptoms, you can download it and tick off any that apply:

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

[giraFfe39 in reply to SeasideSusie]

Thank you for the list, if I can summon up the energy I might give it a go

[giraFfe39]

Have lots of symptoms, but also at the age where doctors like to blame everything on the menopause. Thank you for the very useful information, I will give it some thought

[Animal-lover2 in reply to giraFfe39]

When i first started this journey I took vit D because mine was low. It went too high so the doc said to stop. I felt increasingly more hypo so increased my T4 and T3. Then recently I was feeling jittery so went for a blood test. Over range T3 (have reduced) but significantly my D had dropped back down. I have been supplementing again and feeling stronger by the day. Just done a yoga session and was STRONG!!!!! I'm 67. What I'm trying to emphasise is how important I've found vit D to be and I increased my thyroid meds when what I needed was D. Follow Seaside Susie's advice. I use drops or spray to avoid digestion/ timing issues. I'm in South Africa so can't advise on brands.

Good luck 🌈

[giraFfe39 in reply to Animal-lover2]

Thanks for this, I have just bought the D3 recommended by Seaside Susie and started it, so fingers crossed it helps, thank you for your support, and hope you continue to feel strong.