She already takes a D supplement, which I guess will need increasing.
She stopped all biotin supplements 4 days before we did the test.
She took no thyroid meds the morning of the test.
This is the first time the test has come back showing low cortisol, any insight as to why that would be? She was using an inhaler a lot, having had a chest infection, could this be it?
For some reason her folate test always comes back haemolysed, which is annoying. Is there an average dosage/brand of folate supplement I can just give her?
CRP is always high but has decreased since the last test.
She was prescribed T3 several months ago, after 10 years of NHS refusing it. She has shown some improvement in terms of brain fog and energy levels, but the changes are pretty modest in comparison to what we'd hoped, unfortunately.
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CRP is raised which tells us there is some inflammation somewhere. As she has raised antibodies (Hashi's) then this could be the cause of the inflammation.
Ferritin can also be raised when inflammation is present so although her ferritin level looks good I would doubt it's accuracy and I would expect her normal level to be lower.
Cortisol is very, very low and I would suggest she discusses this with her GP as further testing may be necessary. I will tag Hidden and hopefully she is around to comment, she is very knowledgeable about blood cortisol levels.
Vit D is insufficient. What dose of D3 is she taking (with that level she'd probably need about 4,000iu daily to reach the level recommended by the Vit D Society and Grassroots Health which is 100-150nmol/L).
Does she also take D3's important cofactors - Vit K2-MK7 and magnesium?
What form of D3 does she take? This needs too be taken up to 4 hours away from thyroid meds depending on what form it is (eg oral spray, softgels/capsules).
B12 at 499pmol/L - 676pg/ml which is a decent result.
She stopped all biotin supplements 4 days before we did the test.
What supplements are these? Does she take a stand alone biotin supplement (eg for hair and nails) or is it a B Complex?
What is the amount of biotin in total?
For some reason her folate test always comes back haemolysed, which is annoying. Is there an average dosage/brand of folate supplement I can just give her?
You wouldn't take a stand alone folate supplement unless you were deficient so you'd need a result to know that. A standard B Complex supplement would generally contain approx 400mcg methylfolate and that would usually be enough to improve a lowish level or to maintain a reasonable level.
Thyroid function tests
she's on 175 Levo and 15 T3.
TSH is suppressed due to the T3 she is taking.
Her FT4 is 72% through range but her FT3 is only 35.95% through range
When on combination hormone replacement most people would feel best with FT3 in the upper part of it's range and the FT4 possibly lower in range.
HOWEVER, when did she take last dose of Levo and T3 before the test - this may have some bearing on the results. Last dose of Levo should be 24 hours before test, last dose of T3 should be 8-12 hours before, splitting the 15mcg T3 dose into 3 the day before and taking the last part of the dose 8-12 hours before testing.
If she did her test this way then in my opinion your mum's FT3 is on the low side and she may benefit from an increase in her T3. If she left longer than 12 hours for her last dose of T3 then the FT3 result is showing a false low.
RE Cortisol - she had been using her steroid inhaler more that usual around the time of the test. Could this effect the cortisol result?
What form of D3 does she take? This needs too be taken up to 4 hours away from thyroid meds depending on what form it is (eg oral spray, softgels/capsules).
I had her on a spray recommended on this forum, her D was normal during the last teat we did, so she reverted to generic pills, but I'll buy another spray for her to use to get her D back up. (I'm still learning about all this, I wasn't totally cognisant of the difference between D and D3, I'm still not really!)
What supplements are these? Does she take a stand alone biotin supplement (eg for hair and nails) or is it a B Complex?
I've just looked and the current supplement she's on is Holland and Barrett 1000ug B12.
Does she also take D3's important cofactors - Vit K2-MK7 and magnesium?
No, I hadn't heard of these. Her magnesium is normal, does she still need the supplement. How does the K2-MK7 work?
When on combination hormone replacement most people would feel best with FT3 in the upper part of it's range and the FT4 possibly lower in range.
HOWEVER, when did she take last dose of Levo and T3 before the test - this may have some bearing on the results. Last dose of Levo should be 24 hours before test, last dose of T3 should be 8-12 hours before, splitting the 15mcg T3 dose into 3 the day before and taking the last part of the dose 8-12 hours before testing.
She isn't on an HRT, and the T4-24 hr, T3, 8-12 hr rule was observed when performing the test. I will look at increasing her T3 level, I did try increasing previously but she complained of severe anxiety and said it felt wrong, so we went back down. I will try increasing again though.
RE Cortisol - she had been using her steroid inhaler more that usual around the time of the test. Could this effect the cortisol result?
It looks like our member who is experienced in blood cortisol results has left the forum (hence her tag now showing as "Hidden" rather than her user name) and I cannot help here other than to tell you that her level is extremely low, she should make an urgent appointment to discuss this with her GP with a view to testing for Addison's disease. I'm not diagnosing this but Addison's is where the body can't produce enough cortisol and as hers is so very very low then I think it should be looked into urgently.
She stopped all biotin supplements 4 days before we did the test.
What supplement contains biotin?
I've just looked and the current supplement she's on is Holland and Barrett 1000ug B12.
When taking B12 we also need to take a B Complex to balance all the B vitamins. A B Complex contains biotin (B12 does not). So I would suggest she takes a good quality, bioavailable 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).
No, I hadn't heard of these. Her magnesium is normal, does she still need the supplement. How does the K2-MK7 work?
Testing magnesium is unreliable. About 99% of magnesium is stored in bone, muscles and soft tissues, leaving about 1% in the blood. So testing what's in the blood isn't giving an accurate picture of our magnesium status.
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.
Is D included in D3 or are they separate vitamins to be taken separately.
The supplement we take to raise Vit D level is D3 (which is cholecalciferol).
Should I take her of B12 and just put her on a complex as b12 is included in the complex?
As mentioned above, she has a decent B12 level so she doesn't need a separate B12 supplement, the B Complex will contain enough to at least maintain it and may even raise it some more.
T3 isn't an instant fix for many. It has taken me 2 years to adjust levo and lio doses and it will take many more years for the body and brain to adapt and heal.You indicate that your mum has been needing T3 for 10 years and I know from your posts that she has had problem symptoms for a long time.
I have been and am in a similar position. Over the time when our medication was insufficient or in other ways not right for us, our body adapted to survive - it possibly stopped or reduced things we could survive without. I had no earwax for 6 years for example and my skin was very dry.
I believe (but cannot say scientifically) that lacking hormones, the brain adapts by rewiring so we can functions there might be neurological changes.
Once we add in sufficient hormones or correct hormones, the body and brain have to adapt again to having a supply of what they need. This doesn't necessarily happen quickly particularly if we have been ill for many years. And indeed the re-adaptation of our body and brain may not bring us back to how we were when 'normal'
Does she always split the T3 into 3 x 5mcg doses spread through the day?
all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water and last dose levothyroxine 24 hours before test
Even if don’t normally split dose T3
On T3 - day before test split daily dose into 3 smaller doses, spread through the day at approx 8 hour intervals, taking last 1/3rd of daily dose 8-12 hours before test
Is this how she did this test?
Does she always get same brand levothyroxine at each prescription
I’d still query it with the doctor though. If she’s using her inhaler a lot then it’ll be reducing her cortisol levels often which may be causing some of the symptoms she’s still experiencing.
Edited to add, I’ve been hunting for something which explained things more clearly - this might be a bit easier to digest!
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