I posted a few weeks ago asking for advice and I was told to get some private testing and come back with the results. I've done this and received the results at the end of last week. So here goes :
Inflammation
CRP HS : 5.01 mg/l (I did have a cold come on the next day after testing)
Thyroid
TSH: 5.08 mu/L
Free T3: 3.95 pmol/L
Free thyroxine: 14.2 pmol/L
Thyroid peroxidase antibodies: 191 IU/mL
Thyroglobulin antibodies: 53.6 IU/mL
Vitamins
Folate serum: 5.85 ug/L
Vitamin B12 active: 70.7 pmol/L
Vitamin D: 29.8 nmol/L
Ferratin: 181 ugl/L
So I can see I have high thyroid antibodies suggesting my underactive thyroid is autoimmune, my tsh is too high and my vitamin d is low.
My ferratin is likely higher than the suggested range as I have iron infusions occasionally due to anemia. I had one in the summer.
One of my main issues is I had ariatric surgery and although I'm losing weight it is slow and I am hungry I think this is due to my thyroid issues not being properly treated. I'd also like to feel healthy and not as knackered.
My GP is OK and I see the same one all of the time, but I do think I'm going to have to really push for what I need. So what do I need? I currently take 150mg of levothyroxine. But obviously its not doing much! So I imagine I need a higher dose, but he always wants to up it 25mg at a time which feels like it will take forever to get anythinglike a decent level. And what should that level be?
Somone on here or on a Facebook group said they felt hungry until their t3 was addressed mine is just in the suggested range. But I know I felt rubbish before my tsh was outside of the reference range! I don't know what meds exist for t3 treatment. Any advice on what I need to do next and what I need with these results would really be appreciated. Thanks xx
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Bearfam
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We need the ranges for those results. Ranges vary from lab to lab, so we need those that came with your results.
Well, you're obviously not absorbing your levo, are you. That could be due to your surgery and the resulting reduced stomach, but one would expect better results on 150 mcg levo. Do you always take your levo on an empty stomach and wait at least one hour to eat, and at least two hours before taking any other supplements or medication?
You shouldn't increase your levo by more than 25 mcg every six weeks. I know it takes a long time, but it's the same for everybody. Increasing by more than that will stress your body and you'll have to restart the whole thing. It's shooting yourself in the foot. So, your doctor is right to do it that way.
As for what levels should be, you probably need your TSH at 1 or under, and the Frees up in the top third of the range. But, it's a very individual thing. You need the levels that make you well. How you feel is more important that a lab reading.
First of all, did you do the test as we always advise:
* Test no later than 9am
* Nothing to eat or drink except water before the test
* Last dose of Levo 24 hours before the test
* No biotin or any supplement containing biotin (typically B Complex or hair and nail supplement)
I would also factor in the fact that you started with a cold the next day so you obviously had an infection which could have skewed results. But let's look at them as if everything is in order and these are your normal results.
I currently take 150mg of levothyroxine. But obviously its not doing much!
Your results are very poor for someone on 150mcg Levo. This makes me wonder if something is stopping it being absorbed properly.
Do you take your Levo on it's own, one hour before or two hours after food, with a glass of water only, water only for one hour each side?
Do you take any other medication?
Do you take any supplements or other medication at least 2 hours away from your Levo. Some need 4 hours - iron, magnesium, calcium, Vit D, PPIs (eg Omeprazole), HRT. Antidepressants should also be taken as far away as possible I believe.
So I imagine I need a higher dose, but he always wants to up it 25mg at a time which feels like it will take forever to get anythinglike a decent level.
That is the correct way to titrate Levo, in 25mcg increments, wait 6-8 weeks, retest and see if another increase is necessary.
Somone on here or on a Facebook group said they felt hungry until their t3 was addressed mine is just in the suggested range. But I know I felt rubbish before my tsh was outside of the reference range! I don't know what meds exist for t3 treatment.
Forget T3 for now. Before considering adding T3 we need to take enough Levo to get TSH down to 1 or below to get the highest possible FT4. Once we have that we can see what our FT3 level is and how well, or not, we convert.
Good conversion needs optimal nutrient levels so if necessary these need addressing before adding T3.
Vitamins
As you have an Active B12 test I am assuming this is a private test. Please always add reference ranges when posting results, these vary from lab to lab and we need the ranges to interpret your results accurately. All popular private labs members use have the same ranges so if it's Medichecks, Blue Horizon or Thriva then they will be as follows:
Folate serum: 5.85 ug/L - the range for this can vary but it's obviously very low whether the range is >3.89, 3.89-19.45 or 8.83-60.8. Where there is a range it's recommended to be at least half way through. Your level is not folate deficiency so a good quality B Complex and eating folate rich foods can help raise your level.
Vitamin B12 active: 70.7 pmol/L - Active B12 below 70 suggests testing for B12 deficiency, you are just above this so although not suggestive of B12 deficiency it is very low and needs improving.
With levels like these it's generally suggested to take a sublingual B12 until your Active B12 level reaches 100. Alongside this take a B Complex which helps keep all the B vitamins balanced.
If you would like a suggestion for supplements then for B12 I liked Cytoplan which contains two forms of active B12, one tablet a day should be sufficient:
For B Complex 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:
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).
I would retest B12 and Folate in about 3-4 months to see how things are improving.
Vitamin D: 29.8 nmol/L
At one time a level below 30nmol/L was considered Vit D deficiency. The NHS has now moved the goal posts and it's now a level below 25nmol/L that is considered deficiency. You would be classed as in the "insufficiency" category.
It would be worth speaking to your GP about this and ask if he is willing to give you the loading doses applicable to Vit D deficiency, which is 300,000iu D3 over about 6 weeks. Here is NICE guidance for treatment of Vit D deficiency:
If rapid correction of vitamin D deficiency is needed, for example in people with symptoms or about to start treatment with a potent antiresorptive agent (zoledronate, denosumab, or teriparatide), prescribe a fixed loading dose followed by regular maintenance vitamin D therapy 1 month after loading.
The loading regimen should provide a total of approximately 300,000 international units (IU) of vitamin D, given either as separate weekly or daily doses over 6–10 weeks. See the section on Loading dose regimens in Prescribing information for more detailed information.
Maintenance therapy of vitamin D equivalent to 800–2000 IU daily (up to a maximum of 4000 IU daily for certain conditions such as malabsorption following specialist advice), given either daily or intermittently at a higher equivalent dose.....
If correction of vitamin D deficiency is less urgent and when co-prescribing vitamin D supplements with an oral antiresorptive agent, maintenance therapy (800–2000 IU daily) may be started without the use of loading doses.
Several vitamin D loading dose treatment regimens are available, including [ROS, 2018]:
50,000 IU once a week for 6 weeks (300,000 IU in total).
40,000 IU once a week for 7 weeks (280,000 IU in total).
1000 IU four times a day for 10 weeks (280,000 IU in total).
800 IU five times a day for 10 weeks (280,000 IU in total).
Note: this list is not exhaustive.
It would be prefable if your GP addresses this but if not you could follow the guidance if you wish.
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. It's likely that if your GP treats you then he will be satisfied just to get you above 50nmol/L or maybe above 75nmol/L.
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.
So first thing to do is work on improving your nutrient levels, see if anything is affecting absorption of your Levo and address it if there is, ask GP about an increase in your dose of Levo to get your TSH down and your FT4/FT3 up higher in range. The aim of a treated hypo patient on Levo only, generally, is for TSH to be 1 or below with FT4 and FT3 in the upper part of their reference ranges, if that is where you feel well.
It would be worth speaking to your GP about this and ask if he is willing to give you the loading doses applicable to B12 deficiency, which is 300,000iu D3 over about 6 weeks.
SeasideSusie …..think you meant vitamin D deficiency
Hi thanks for your very detailed reply! I've added my ranges from the test with the results in a reply. The test was from medichecks.
Yes I did as recommended for the test. I take my levi at night as I have to take a lansoprazol first think so I can eat. I'd say I'm almost always at least an hour away from having eaten when I take it.
I take the rest of my meds in the morning or after food as one is required on eating. I take:
Lansoprazol 30mg
Escitaloprám 15mg
ursodeoxycholic acid x 3 per day after eating. This is to prevent gallstones post surgery /weight loss. This will be reviewed in a month as the min term is 6 months for taking this.
Supplements wise I take what is directed by my NHS team and extra so an a to z certain brands are acceptable based on their contracts. I currently take sainsburys own brand and in addition b vitamin complex,hyaluronic acid, flaxseed, sea kep and biotin all just vitamins brand.
Sorry for the typo yes bariatric! 8 had the sleeve. I have commented above re vitamins. I had my surgery on the NHS and was given a choice of brands if vitamins to but to ensure I got the right dose.
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Ranges vary from lab to lab, so we need those that came with your results. 
please can I have some advice on my latest results?
Can I have some help with results please?
Can someone shed some light on my test results please?
