Fine Tuning

[Recon]

I am now coming up to my one year anniversary of figuring out what the heck was going on (and my thyroid diagnosis) and I can say that I really do feel so much better. An endo added T3 (5 mcg) to the T4 (100 mcg daily) in late December, and I could tell it was super helpful, but not quite there. When I did labs in early February, my TSH was .476 (range .45-4.5), but my T4 stayed the same at 1.1 (.82-1.77). I asked for a slight increase in T3, and now I am up to 10 mcg a day. If I was at a level "2" for energy last April, I now feel like a solid "7" (if I imagine 10 being totally optimal). I am so glad I am "getting there". Anyways, I went ahead and went private to get more details on vitamins and other blood tests, as I think I am at a good place with the T3/T4 for now. Here are the results (and I followed the suggested protocol of early morning testing, no T4 until after the draw, and 1/2 of my T3 dose at bedtime the night before):

FT4: 1.3 ng/dL (.8-1.8) 50% of range

FT3: 3.5 pg/mL (2.3-4.2) 63% of range

Iron Saturation: 33% (16-45)

Ferritin: 137 ng/mL (16-232)

Iron Binding Capacity: 271 mcg/dL (250-450)

Iron, Total: 89 mcg/dL (45-160)

Folate: 8.1 ng/mL (normal >5.4)

Vitamin B12: 356 pg/mL (200-1100)

Vitamin D: 59 ng/mL (30-100)

From my reading here, I understand that the B12 is actually low for what a hypothyroid person (or maybe any person) is. I am planning on starting a sublingual B12. I don't really know how to interpret the iron, and I don't know if I need to increase my Vit D (I take 5000 IU daily) - and it did go up since I tested it last (which was in 2017, the doctor announced I was "normal" at 31 (the range began at 30), so I started taking supplements then.

Any suggestions for me would be appreciated. Should I look at other tests? I am looking to fine tune, so I can be a 8 or 9 or even a 10 on my personal "how I feel" scale.

Thanks!

Mary

[shaws Administrator]

Before you supplement with B12 and due to it being low, I would advise that you should ask GP to confirm if you have Pernicious Anaemia or not. Once we have one autoimmune disease we can develop others.

If we do have P.A. our stomach cannot absorb B12 supplements and we have to have regular B12 injections and make appointments for surgery to do so.

[SeasideSusie Remembering]

Recon

Optimal iron panel levels according to rt3-adrenals.org/Iron_test_... are:

Serum iron: 55 to 70% of the range, higher end for men - yours is 89 mcg/dL (45-160) = 38.26% thrugh range so on the lowish side.

Saturation: optimal is 35 to 45%, higher end for men - yours is 33% (16-45) so almost there.

Total Iron Binding Capacity (TIBC) or Transferrin: Low in range indicates lack of capacity for additional iron, High in range indicates body's need for supplemental iron - yours is 271 mcg/dL (250-450) so it's low in range and doesn't suggest you need to supplement

Ferritin: Low level virtually always indicates need for iron supplementation; High level with low serum iron/low saturation indicates inflammation or infection; High level with high serum iron and low TIBC indicates excess iron; Over range with saturation above 45% suggests hemochromatosis - yours is 137 ng/mL (16-232) = 56% s pretty much spot on at the suggested "half way thrugh range".

Vitamin D: 59 ng/mL (30-100)

Vit D is recommended to be 40-60ng/ml by the Vit D Society and Grassroots Health. If you know that you can make Vit D naturally from the sun during the summer months you could lower your daily dose to a maintenance dose now, maybe 2,000iu per day. Retest in October/November to see whether you need to increase your dose during the winter months.

Folate: 8.1 ng/mL (normal >5.4)

When thre is no proper range for folate, ie no lower and upper limits, we generally suggest aiming for double figures.

Vitamin B12: 356 pg/mL (200-1100)

I understand that the B12 is actually low for what a hypothyroid person (or maybe any person) is. I am planning on starting a sublingual B12.

According to an extract from the book, "Could it be B12?" by Sally M. Pacholok:

"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".

"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."

Do you have any signs of B12 deficiency – check here:

b12deficiency.info/signs-an...

b12d.org/submit/document?id=46

If you do then list them to discuss with your doctor 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.

If you don't then you could supplement with some sublingual B12, along with a good quality B Complex to keep all the B vitamins balanced, until your level reaches 550pg/ml. Once you've reached that level then you can drop the B12 and just continue wth the B Complex which should be enough.

The B Complex should also improve your folate level.

I have used Thorne Basic B for a long time and always been happy so that's one to consider. 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 don't know what brands of sublingual B12 are avaiable in the US but make sure it's methylcobalamin rather than cyancobalamin.

[Recon in reply to SeasideSusie]

Thank you Seaside Susie (and shaws, too) - your input is very helpful!

[Digitalbluecat]

Excellent post. Congrats!