Please can someone advise been trying to get my thyroid in balance for several years since going on NDT had to come off WP as stopped making it tried NP didn't seem strong enough so now on Amour my TSH is 2.09 on 1.5 grain but I cant get my t4 up it's only 10 so have all the symptoms puffy face etc still?
My ferritin is only 25 (12-300)
Transferrin level 3.46 /binding cap 79 (37-77)
Per sat iron 25 % (25-50)
Vit D 79 (50-150)
Can someone advise what I need to do and supplement to get them optimal?
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Merlio18
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on Amour my TSH is 2.09 on 1.5 grain but I cant get my t4 up it's only 10
You don't give any reference ranges unfortunately (these vary from lab to lab) but from most ranges we see on the forum your FT4 is very likely either below range or low in range. Also your TSH is too high for a treated hypo patient, most feel best when TSH is below 1 and on NDT it's often the case that it's very low in range or suppressed (the T3 in NDT causes that effect). So straight away we can see you are undermedicated and your symptoms also suggest this.
My ferritin is only 25 (12-300)
Transferrin level 3.46 /binding cap 79 (37-77)
Per sat iron 25 % (25-50)
This all suggests iron deficiency. Ferritin below 30 suggests this according to NICE
Serum iron: 55 to 70% of the range, higher end for men - you don't have this result
Saturation: optimal is 35 to 45%, higher end for men - yours is 25%
Total Iron Binding Capacity: Low in range indicates lack of capacity for additional iron, High in range indicates body's need for supplemental iron - yours is over range suggesting that you need to supplement with iron
Ferritin: Low level virtually always indicates need for iron supplementation: as mentioned above NICE already considers this iron deficiency.
Your GP should do a full blood count to see whether you have anaemia.
You shouldn't self supplement, your GP should prescribe and monitor you regularly with an iron panel to keep an eye on your levels.
Vit D 79 (50-150)
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. So although you don't have Vit D deficiency, and it's within the "adequate" category, you might wish to consider supplementing to raise your level. If you do then 2,000-3,000iu D3 daily might be enough but if supplementing with D3 there are important cofactors needed - magnesium and Vit K2-MK7.
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.
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.
When I was on t4 only I could get my t4 to around 17 at best but now it's so low on NDT ? Even when I am taking the equivalent to what I was taking on levo I only took 50/75 mcg and now I am on 1?5 grain on Armour which has made my TSH go to 2.06 but on NP for some reason my TSH was 4.05 on 1.5grains ? So totally confused?
Do coffee affect NDT absorption the same as Levo? As I usually have a brew within the hour I take it before I go to work or not as wondering whether that would help if I cut it out? Or do I need to up my dose to 2 pills ? It doesn't seem to be as strong as levo? And I can't really afford to take 2 pills of Armour as it's expensive,
My GP won't do anything for my iron it says (!) No action required......So how can I get them to abide by Nice guidelines ?
What's the best iron supplement to start taking is fumerous fumerate ok as I was going to get some 250mg off Amazon and then ask the GP to do some bloods again in two months if they will compromise with me as it's hard enough to even good my thyroid bloods run?
Also is there a good supplement that has ViT D and K2 that anyone uses?
With magnesium is I have tried glycinate in the past what level should I be taking daily and should I take vit D at tea and then magnesium at bedtime?
Serum iron: 55 to 70% of the range, higher end for men - you don't have this result
My serum iron is 20 (10-30)
This is a photo of my blood test j asked her to check my thyroid, iron, vit d, full bloods and do tests for liver, pancreas and bile function
Coffee is said to affect absorption of Levothyroxine and because NDT contains T4 then one would assume that it affects that as well. Here is one article about it:
So it makes sense to make sure your coffee is at least an hour away from your NDT, possibly more.
I don't take NDT but I think some people have found that those brands may not be as effective as they were before, I can't say for sure. But not everyone gets on well with NDT, have you tried synthetic Levo plus T3 as that gives you the freedom to tweak the dose of each hormone to suit you rather than have the fixed ratio that's in NDT. I take Levo plus T3 and need a higher proportion of Levo than is in NDT. NDT is 4:1 T4:T3, at the moment my ratio is 9:1 T4:T3.
My GP won't do anything for my iron it says (!) No action required......So how can I get them to abide by Nice guidelines ?
This is a difficult one. Obviously your ferritin level suggests iron deficiency according to NICE but your serum iron is actually good at 20 (10-30) as it's 50% through range so doesn't suggest iron deficiency. Yet your TIBC is over range and your saturation is low which does suggest iron supplements. Iron is complicated and beyond the basics it's not something I can make suggestions for so I don't get into recommending iron tablets, etc. That would have to be your decision but if you do take them it's essential to regularly monitor your levels, say every couple of months, because if your serum iron goes too high then that can be toxic.
You can help raise your ferritin level by 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
However you try to raise it, it's not a particularly quick fix.
Also is there a good supplement that has ViT D and K2 that anyone uses?
Some members use BetterYou combined D3/K2 spray. It's not something I would personally use because it contains a lot of excipients which I try to avoid and it can work out quite expensive.
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.
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
With magnesium is I have tried glycinate in the past what level should I be taking daily and should I take vit D at tea and then magnesium at bedtime?
With magnesium the usual sort of dose is around 350-450mg daily, just see what the recommended dose is on the supplement you use.
Magnesium and Vit D both should be taken 4 hours away from thyroid meds, Vit D with a fatty meal as it needs fat to be absorbed (but if oil based should be fine to take without the dietary fat).
As magnesium is calming you don't want to be getting sleepy in the daytime so it's best taken in the evening if that fits in with your routine for your thyroid meds.
Thanks that's great info for all the supplements I will check them out. I av tried veggie and vegan but I was to exhausted so now mainly only eat fish so that's why I think I will be low end of iron so I will look into supplementing which blood test should I be monitoring my ferritin levels when I next ask the GP ? As will just trial it for a few months and then go back to see if levels increase how long should it take to notice a difference ?
With thyroid meds I am only on NDT as when lio got blacklisted in 2018 the endo wouldn't prescribe the free from brand of liothyronine I was taking from the phamarcy and I had really bad reactions to that mercury pharma brand he would only prescribe so I took my self of both and then retried levo but had bad reaction so then had to source NDT as had no option they left me unmedicated knowing I couldn't tolerate the brand and discharged me
And now that's why my t4 is so low as for some reason on NDT I can't get it higher is there anything else I could try to get my T4 in mid range what is causing it to go so low?
Whilst supplementing iron it would be best to do an iron panel to include
Serum Iron
Transferrin Saturation percentage
Total Iron Binding Capacity
Ferritin
Also, because ferritin can be raised when inflammation is present it's a good idea to get inflammation markers tested at the same time (CRP and any others, can't think of what at the moment).
As your serum iron is already 50% through range this is the one that you need to ensure doesn't go too high. We can have good serum iron but poor ferritin (this is normally my problem).
Impossible to say how long it will take for improvement, you might find serum iron improves but ferritin doesn't. It's all so complicated. I've been trying to raise my ferritin for years.
And now that's why my t4 is so low as for some reason on NDT I can't get it higher is there anything else I could try to get my T4 in mid range what is causing it to go so low?
It could just be there's not enough T4 in the NDT for your needs and the only way to increase the T4 is to add Levo.
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Bloods 
Advice on Armor (Amour?)
Got my latest bloods back......
NDT v Levothyroxine
