Results help

[Emuflea]

Please tell me what you think of these results. I take 100mcg levo and 2x10mcg T3. Have recently started T3. I need to supplement iron. What time of day should I do that I’d take T3/4 AM and T3 an hour after lunch?

[SlowDragon Administrator]

Was test done as we recommend, early morning, ideally before 9am and last dose levothyroxine 24 hours before test

Day before test was last 5mcg of T3 approx 8-12 hours before test?

Your GP needs to do full iron panel test for anaemia. Ferritin is extremely low

Any obvious reason for low iron/ferritin

Eg Are you vegetarian or vegan, or heavy periods

Are you on strictly gluten free diet

If not GP should do coeliac blood test

[Emuflea in reply to SlowDragon]

Hi yes did it first thing before meds. Had taken no vits for 3 weeks. Periods aren’t especially heavy. Yes am strictly gluten free. Have recently introduced 50g of sourdough with breakfast but my ferritin has been rubbish for ages.

[Emuflea in reply to Emuflea]

T3 was taken day before after lunch.

[SeasideSusie Remembering in reply to Emuflea]

Emuflea

T3 was taken day before after lunch.

The time gap was too long to give you an accurate FT3 result. T3 should be split the day before the test into 2 or 3 smaller doses and the last dose taken 8-12 hours before the test. So if, say, you did the test at 8am then the last dose of T3 should be between 8pm and midnight.

So you have a false low FT3 result and as this is measuring over range with the longer time gap then your normal circulating level would be higher and suggests that you are taking too much T3.

How do you feel?

With a below range FT4 and over range FT3 it suggests that you should take more Levo with less T3. Some people on combination thyroid hormone replacement are fine with a low FT4 but most need it in range and some of us need it fairly well balanced with FT3 over half way through range. I take Levo plus T3 and your FT4 level would have me bedbound.

Your raised TPO antibodies confirm autoimmune thyroid disease (Hashimoto's) which is the most common cause of hypothyroidism. Did you already know you have Hashi's?

Had taken no vits for 3 weeks.

There is no need to leave vitamins off for this length of time. You carry on and just don't take them the day before the test, this then shows what level your supplements are achieving and whether you need to adjust your dose. The only exceptions are:

Iron - leave off for one week

Biotin/B Complex or any supplement containing biotin - leave off for 3-7 days before the test, the higher the dose the longer time to leave off, eg B Complex containing biotin at 400mcg should be fine to leave off for 3 days, high dose hair/nail/biotin supplement leave off for one week.

CRP is raised, this is an inflammation marker and it's possible that it's raised due to Hashi's.

Ferritin : 16.8 (13-150)

This is absolutely dire. Ferritin can be raised when inflammation is present so it may be showing higher than your actual normal level. It is essential that you discuss this result with your GP because it strongly suggests iron deficiency - see:

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.

Your GP should do an iron panel to include serum iron, total iron binding capacity, transferritin saturation percentage and ferritin. This will show if you have iron deficiency. He should also do a full blood count to see if you have anaemia, you can have iron deficiency with or without anaemia.

Folate is OK.

Active B12 is too high for the machine to measure. Do you supplement to have B12 injections?

Vit D is good.

[Emuflea]

Hi. Lots of questions to answer. I know I have hashis. No o dont have b12 injections. Ove asked the gp for an iron panel. Have been anaemic all my adult life. CRP could be due to lyme too. Leaving off the vits for 3 weeks was because of test ordering issues. Will cease the b vits. Not sure when to take iron so haven't. Only been on t3 a month. Levo has helped me to not need a 2hr nap every morning after the kids go to school but was still exhausted. The t3 has made napping even rarer. Still tired. Still fat.

[Emuflea in reply to Emuflea]

Ps antibodies are lower than they were.

[SlowDragon Administrator in reply to Emuflea]

Suspect you will see antibodies rise if eating gluten again

You can get good gluten free sourdough

[SlowDragon Administrator in reply to Emuflea]

GP must do full iron panel test

If they still refuse, write to Practice manager

Or test privately

Never supplement iron without doing full iron panel test for anaemia first and retest 3-4 times a year if self supplementing.

It’s possible to have low ferritin but high iron

Medichecks iron panel test

medichecks.com/products/iro...

Do you eat red meat and offal…if not need to start

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

Look at increasing iron rich foods in diet

Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption

List of iron rich foods

dailyiron.net

Links about iron and ferritin

An article that explains why Low ferritin and low thyroid levels are often linked

preventmiscarriage.com/iron...

irondisorders.org/too-littl...

davidg170.sg-host.com/wp-co...

Great in-depth article on low ferritin

oatext.com/iron-deficiency-...

drhedberg.com/ferritin-hypo...

This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.

Thyroid disease is as much about optimising vitamins as thyroid hormones

healthunlocked.com/thyroidu...

restartmed.com/hypothyroidi...

Post discussing just how long it can take to raise low ferritin

healthunlocked.com/thyroidu...

Iron and thyroid link

healthunlocked.com/thyroidu...

Posts discussing why important to do full iron panel test

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Chicken livers if iron is good, but ferritin low

healthunlocked.com/thyroidu...

Good explanations of iron

theironclinic.com/iron-defi...

theironclinic.com/ironc/wp/...

[SlowDragon Administrator]

Suggest you reduce T3 by 5mcg and increase levothyroxine by 12.5mcg

Perhaps split T3 as 5mcg waking, 5mcg mid afternoon and 5mcg at bedtime

Many people find small 5mcg dose T3 at bedtime improves sleep

If T3 at bedtime keeps you awake….try 6am, noon and 6pm

[Emuflea in reply to SlowDragon]

Thanks. Iron sat, he and ferritin been awful for ages. Tried iron rich foods and/or spatone but no improvement. Need to attack it a bit more. Interesting about chicken livers - less gristly. Will see what my GP says about iron tests but prepared to do medichecks if have to. Re thyroid meds, my Lyme doc in Poland prescribes it. Never had Lyme or thyroid taken seriously in this country. Will be interesting to see if his advice is similar, but what you say sounds sensible.

[SlowDragon Administrator in reply to Emuflea]

I am continually impressed with how much more up to date thyroid doctors are in Poland, Moldavia etc

[Emuflea in reply to SlowDragon]

He was treating me for Lyme then stopped and said ‘I think your problems are metabolic’. Total lightbulb moment.

[SlowDragon Administrator in reply to Emuflea]

Lyme and thyroid frequently linked

healthcentral.com/article/l...

theinvisiblehypothyroidism....

[Emuflea in reply to SlowDragon]

Indeed. My Polish doc left the Lyme clinic because they only looked at Lyme and weren’t holistic enough. I feel v lucky to have found him. I’m much better but things just need tweaking to be a bit closer to optimal. How far away from T3 does iron supplementation need to be?

[SlowDragon Administrator in reply to Emuflea]

Ideally 4 hours if possible

Though T3 is not as fussy as levothyroxine

[Emuflea in reply to SlowDragon]

Great. Thanks