Hi everyone, after my last post I said I would come back and update with some blood results for help with interpretation, I think some of it is self explanatory but mostly I’d like help understanding the thyroid results part as you are all so knowledgable! I would be extremely grateful for any thoughts on the below:
Vitamin D – 20 nmol/L (50-200) – DEFICIENT
Folate – 3.62 ug/L (3.89-19.45) – Slightly low
Vitamin B12 – 115 pmol/L (37.5-150) – Normal
Ferritin – 151 ug/L (13-150) – Slightly high
TSH – 2.86 mU/L (0.27 – 4.2) – Within range
Free T3 – 4.45 pmol/L (3.1- 6.8) – Low end of range?
Also to add to that, if I start supplementation with vitamin d spray, do I need to have vitamin K as well or would it be okay just as D in spray form as it absorbs better?
Please do not self supplement with D3 at the moment. As mentioned below, this is Vit D deficiency and your GP needs to prescribe loading doses. If he wont he is going against NICE guidelines.
The important cofactors I mention below that are needed when taking D3 are magnesium and Vit K2-MK7. The Vit K2 is nothing to do with you absorbing D3.
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.
First of all, did you do the test as we advise to get a measure of your normal circulating thyroid hormones, this is important for us to be able to interpret your results accurately:
* Test no later than 9am
* Nothing to eat or drink except water before the test so that nothing affects TSH level
* Last dose of Levo 24 hours before test so you avoid a false high or false low FT4 result
* No biotin/B Complex/any supplement containing biotin for 3-7 days before the test as this gives false results
Vitamin D – 20 nmol/L (50-200) – DEFICIENT
You should discuss this with your GP, this is Vit D deficiency and your GP should prescribe loading doses totalling 300,000iu D3 over a number of weeks. See
After the loading doses you must be retested and if GP wont do it you should do it privately, this is because your new level will determine your follow on dose of D3.
With Vit D deficiency you will be supplementing for life to maintain a good level so testing twice a year is recommended.
Please come back and tell us what your GP is going to do because there is more information about important cofactors needed when taking D3 that your GP wont know about but need to be taken.
◦Serum folate of less than 7 nanomol/L (3 micrograms/L) is used as a guide to indicate folate deficiency.
◦However, there is an indeterminate zone with folate levels of 7–10 nanomol/L (3–4.5 micrograms/L), so low folate should be interpreted as suggestive of deficiency and not diagnostic.
Vitamin B12 – 115 pmol/L (37.5-150) – Normal
This is a good level, we suggest over 100 for Active B12.
Ferritin – 151 ug/L (13-150) – Slightly high
Do you supplement or eat a lot of iron rich food, eg liver, liver pate, black pudding, red meat?
It's worth bearing in mind that it might be slightly elevated as your CRP, even though not over range, isn't as low as it could be. The lower the better with CRP as it's an inflammation marker and ferritin can rise when inflammation or infection is present.
TSH – 2.86 mU/L (0.27 – 4.2) – Within range
Free T3 – 4.45 pmol/L (3.1- 6.8) – Low end of range?
Presumably test was done when on 50mcg Levo? If so then you are undermedicated. The aim of a treated hypo patient on Levo only, generally, is for TSH to be l1 or below with FT4 and FT3 in the upper part of their reference ranges. Your TSH is too high, your FT3 is just 36.49% through range and FT4 is 49% through range, both too low.
Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L.
Also, Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (the professional publication for doctors):
"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l. In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance. But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l. This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l).*"
*He confirmed, during a talk he gave to The Thyroid Trust, that this applies to Free T3 as well as Total T3 and this is when on Levo only. You can hear this at 1 hour 19 mins to 1 hour 21 minutes in this video of that talk youtu.be/HYhYAVyKzhw
You can obtain a copy of the article which contains this quote from ThyroidUK:
tukadmin@thyroiduk.org
print it and highlight Question 6 to show your GP.
Thyroglobulin Antibodies – 267 IU/mL (should be less than 115)
Thyroid Peroxidase Antibodies – 220 IU/mL (should be less than 34)
Your raised antibodies confirm autoimmune thyroid disease, known to patients as Hashimoto's. Did you already know this?
CRP HS 2.44 mg/L (0 – 5) Normal
Within the range but not quite as low as it could be as this is an inflammation marker. GP wont be worried and it's not really a concern unless it's higher. It's a non specific inflammatory marker so can show inflammation but can't tell you where and Hashi's can cause inflammation.
Hi Suzie. Thanks for all the info. Yes I did the test exactly as you have described above. So in essence, I need to start vitamin D, K and magnesium? And also again request an increase in Levo? (Which is proving ridiculously difficult)!
Yes. See GP about loading doses of D3 for your Vit D deficiency.
You will have to provide your own magnesium and Vit K2-MK7 (GPs don't know enough about nutrients to know that these are necessary and they wont test or prescribe anyway).
Don't start all supplements at once, start with one, leave 1-2 weeks to ensure no adverse effects, then add a second supplement, again wait 1-2 weeks to see if any adverse effects, if not add the next one, etc. This means that if you do have any reaction you will know what caused it.
Also, speak to your GP about your folate level because as mentioned it is not diagnostic of but may be suggestive of folate deficiency and if GP doesn't do anything then you'd need to start taking a supplement for that.
Thank you Suzie, I really appreciate your advice and info! I will get onto the GP again. At least I now know that there are other contributing factors to my muscle problems aside from my thyroid…..
Thanks Dragon, will do! Although I only have lower folate which surprised me as I have been taking B12 for a while (not for 2 weeks prior to the test). Do you recommend a test based on the autoimmune disease rather than the vitamins?
Primarily because you have autoimmune thyroid disease
So you have high antibodies this is known by medics here in UK as autoimmune thyroid disease.
Technically it’s Hashimoto's (with goitre) or Ord’s thyroiditis (no goitre).
Both variants are autoimmune and more commonly just called Hashimoto’s
Hashimoto's frequently affects the gut and leads to low stomach acid and then low vitamin levels
Low vitamin levels affect Thyroid hormone working
Poor gut function with Hashimoto’s can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common.
According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but a further 80% find gluten free diet helps, sometimes significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)
Changing to a strictly gluten free diet may help reduce symptoms, help gut heal
Before considering trial on gluten free diet get coeliac blood test done FIRST just to rule it out
If you test positive for coeliac, will need to remain on gluten rich diet until endoscopy (officially 6 weeks wait)
If result is negative can consider trialing strictly gluten free diet for 3-6 months. Likely to see benefits. Can take many months for brain fog to lift.
If no obvious improvement, reintroduce gluten see if symptoms get worse.
The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported
In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned
Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.
Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L.
NHS England Liothyronine guidelines July 2019 clearly state on page 13 that TSH should be between 0.4-1.5 when OPTIMALLY treated with just Levothyroxine
Note that it says test should be in morning BEFORE taking levothyroxine
You can guidelines on dose levothyroxine by weight to push for next dose increase in levothyroxine
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
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.
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.
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Results in from medichecks. I'd love some input on them please.
Please help with blood test results
Medichecks results 
JUST got my results PLEASE PLEASE HELP !! ???
Thyroid function blood test results. Please help me understand these. 
