Recent results can someone tell me what this means . I’m on levithyroxine 50/75mcg alternate days.. obviously under medicated as I know tsh should be under 2. But don’t know what ft3 and ft4 mean
Ft3 4 (3.1-6.8)
Ft4 17.5 (12-22)
Tsh 2.44 (0.5-4.2)
Ferritin 30 (13-150)
Haemoglobin 142 (112-155)
Vit d 53 (50-200)
Active b12 202 (25-165) (not accurate as I had been taking b12 until a week before)
Magnesium 1.2 (0.6-1)
Folate 11.1 (2.9-14.5)
Holiday12345
First of all, did you do your test as we always advise:
* No later than 9am when TSH is highest (lowers throughout the day)
* Nothing to eat or drink except water before the test (some foods/drink can affect TSH)
* Last dose of Levo 24 hours before test
* No biotin or any supplement containing biotin (eg B Complex or hair/nail supplement) for 3-7 days before the test
If you did then your results are as accurate as can be.
Ft3 4 (3.1-6.8)
Ft4 17.5 (12-22)
Tsh 2.44 (0.5-4.2)
Your TSH is higher than one might expect to see if one was optimally treated.
Your FT4 is 55% through it's range which is maybe a bit lower than optimal for some treated hypo patients.
Your FT3 is 24.32% through range which is low.
When optimally medicated most hypo patients generally have FT4 and FT3 fairly well balanced in the upper part of their reference ranges, maybe 60-70%.
[Calculator for working out percentages here: thyroid.dopiaza.org/ ]
So your results do show that you may be undermedicated or that your Levo isn't working well enough.
For any thyroid hormone to work well we need optimal nutrient levels.
Ferritin 30 (13-150)
This ferritin level is a problem. From: cks.nice.org.uk/topics/anae...
In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency.
So you really need an iron panel to test serum iron, total iron binding capacity, saturation percentage as well as ferritin. This will show if you have iron deficiency or just low ferritin.
Symptoms of low ferritin include:
◾Weakness
◾Fatigue
◾Difficulty concentrating
◾Poor work productivity
◾Cold hands and feet
◾Poor short-term memory
◾Difficulty remembering names
◾Dizziness
◾Pounding in the ears
◾Shortness of breath
◾Brittle nails
◾Headaches
◾Restless legs
Symptoms of iron deficiency include:
◾Persistent fatigue
◾Pale skin
◾Shortness of breath
◾Headaches
◾Dizziness
◾Heart palpitations
◾Dry skin
◾Brittle hair and hair loss
◾Swelling or soreness of the tongue or mouth
◾Restless legs
◾Brittle or ridged nails
Even if you don't have iron deficiency your ferritin level is far too low and will be affecting conversion of T4 to T3 and some experts say that the optimal ferritin level for thyroid function is 90-110ug/L.
Your haemoglobin level is good and doesn't suggest anaemia. You can have iron deficiency with or without anaemia.
Vit d 53 (50-200)
This is low.
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.
Are you supplementing?
Active b12 202 (25-165) (not accurate as I had been taking b12 until a week before)
B12 injections or supplements?
If supplements your result shows that you do not need to take a separate B12, you are actually wasting your money. A level maintained at the upper end of the range is enough, higher isn't better.
Are you taking a B Complex? When taking a B12 supplement we need B Complex as well to keep the B vitamins balanced. With your new high B12 level just a B Complex containing methyfolate and methycobalamin will be enough to maintain both B12 and folate levels (your folate level is good).
Magnesium 1.2 (0.6-1)
I imagine this is a serum magnesium test.
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.
A red cell magnesium test is the better indicator of magnesium status, not the standard serum magnesium test.
I would optimise your nutrients and this may improve your thyroid results.
Hi, thank you for your reply. yes I tested before 9am fasted and no levo 24 hrs before. I had just recently lost a lot of blood so was anaemic taking iron to get levels back up. My ferritin is normal quite low. B12 I was using solgar sublingual tablet til about a week before test. Magnesium I use better you sensitive magnesium spray and a tiny amount of mag356 powder but also drink quite a bit of bottled water (I wonder if high magnesium in it..?). Doctor said to stop magnesium supplementing. (I thought everyone was deficent in magnesium in U.K. and encouraged to take some supplements). Unfortunately unable to get the red cell mag test now as they only seem to do it in London now.
Is there anything I can do to increase my ft3 percentage (increase levothyroxine?)
I have been feeling very unwell recently and that prompted the blood tests
Many thanks
Holiday12345
Magnesium I use better you sensitive magnesium spray and a tiny amount of mag356 powder but also drink quite a bit of bottled water (I wonder if high magnesium in it..?). Doctor said to stop magnesium supplementing. (I thought everyone was deficent in magnesium in U.K. and encouraged to take some supplements).
My serum magnesium result is like yours, and I supplement with magnesium. As it's an unreliable test personally I don't worry about it. You can check with signs of Hypermagnesaemia if you are concerned:
Nausea
Vomiting
Neurological impairment
Hypotension
Flushing
Headache
Heart problems
Breathing difficulties
As for the B12 supplement, I would just stop it now, there is no need to continue it and waste your money. If you test nutrients once or twice a year you can keep your eye on it but just supplementing with a good B Complex such as Thorne Basic B should maintain your level, and your folate level.
I too suffer with constant low ferritin and my iron panel is good so iron tablets aren't the answer when serum iron and saturation is good because they can take those levels too high and cause toxicity. The way to try to raise ferritin only is through iron rich foods, so maybe try eating liver regularly, maximum 200g per week due to it's high Vit A content, also liver pate, black pudding, and including lots of iron rich foods in your diet
bda.uk.com/resource/iron-ri...
everydayhealth.com/pictures...
But I would get an iron panel done first to see your other levels. To give you an idea optimal levels for an iron panel are:
Serum iron: 55 to 70% of the range, higher end for men
Saturation: optimal is 35 to 45%, higher end for men
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 so mid-range would be a good place to be.
Ferritin we generally suggest half way through range so around 82 with that range although bearing in mind that a bit higher is said to be best for thyroid function.
Is there anything I can do to increase my ft3 percentage (increase levothyroxine?)
Well your current results certainly suggest an increase in Levo, so even though your FT4 is 55% through range there's plenty of room for it to go higher. The aim of a treated hypo patient on Levo only is generally TSH 1 or below with FT4 and FT3 in the upper part of their reference ranges and fairly well balanced, if that is where you feel well.
Maybe increase Levo by 25mcg. If GP wont agree then see if he will compromise on an extra 12.5mcg. Retest 8 weeks after increase to check your levels and how you feel. At the same time optimising nutrient levels may help, especially ferritin. Once all nutrients are optimal if your conversion is still poor (highi n range FT4 with low in range FT3) then consider the addition of T3.
What about Vit D. Are you supplementing for that? If you're not I can suggest what dose will be appropriate to bring your level up to the recommended level of 100-150nmol/L.
Thank you again for the reply. I’ve Been taking 1000iu Vit d3 better you spray most days for past few weeks. (On and off). Would that work if I continue at 1000 or should I increase to 2000.I had 7 weeks heavy menstral bleeding and ferritin and haemoglobin dropped down to 23 (still good for me!) and 11 but I was taking Galfer syrup iron which helped. I’ve got levels up to 30 and 142 (14.2?) in past month but my transferrin saturation is low: 18 (20-55) and haemocrit high at 0.463 (0.33-0.45) and platlets high at 430 (150-400). I’ve been taking Galfer syrup to raise ferritin levels
Holiday12345
Vit d 53 (50-200)
I’ve Been taking 1000iu Vit d3 better you spray most days for past few weeks. (On and off). Would that work if I continue at 1000 or should I increase to 2000.
With that level of Vit D, to reach the recommended level you're looking at supplementing with 4,000iu daily - regularly.
Does your spray contain Vit K2-MK7 or is it just D3? We also need K2-MK7 because 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.
So if your spray doesn't contain it you will need to take a separate K2-MK7 supplement.
Hi, I have a separate better you k2 spray which I’ve been using sparingly as I’m on clopidrogrel (antiplatlet blood thinner) and was a bit worried using it with this. Although I understand it’s the k1 that deals with clotting rather than k2 but as my stroke doctor or cardiologist couldn’t tell me it was ok to take it I was just a bit nervous. But that ms good to know that just 90-100mcg is enough for up to 10000 iu. I think I’m taking 60mcg (one spray) every now and again.
Request dose levothyroxine is increased to 75mcg every day and bloods retested 6-8 weeks later
Which brand of levothyroxine are you currently taking
Do you always get same brand
Approx how much do you weigh in kilo
Use guidelines on dose levothyroxine by weight to push for next dose increase
guidelines on dose levothyroxine by weight
Even if we frequently don’t start on full replacement dose, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose
NICE guidelines on full replacement dose
nice.org.uk/guidance/ng145/...
1.3.6
Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.
Also here
cks.nice.org.uk/topics/hypo...
gp-update.co.uk/Latest-Upda...
Traditionally we have tended to start patients on a low dose of levothyroxine and titrate it up over a period of months. RCT evidence suggests that for the majority of patients this is not necessary and may waste resources.
For patients aged >60y or with ischaemic heart disease, start levothyroxine at 25–50μg daily and titrate up every 3 to 6 weeks as tolerated.
For ALL other patients start at full replacement dose. For most this will equate to 1.6 μg/kg/day (approximately 100μg for a 60kg woman and 125μg for a 75kg man).
If you are starting treatment for subclinical hypothyroidism, this article advises starting at a dose close to the full treatment dose on the basis that it is difficult to assess symptom response unless a therapeutic dose has been trialled.
BMJ also clear on dose required
Hi thanks for your reply. I use Mercury pharma brand and make sure I get it each time. I’m about 60 kg so probably should be on about 100 mcg per day for my weight. Tbh doc or endo never really bothered with my thyroid and always say it’s fine despite my ongoing symptoms. I will ask to go up to 75 daily and see how I get on. I did have to push to get up from 50 daily after 2 or 3 years on levo. Many thanks
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