These are my latest results which are comprehensive, however, I would like advice as to whether I need T3 medication as well as levo. I have started taking HRT 3 weeks ago and feel better mentally, but since my last test in 2020 my TSH has increased from 2.6 to the current one below…..
This test was taken at 9.30 am
CRP 0.66 <5.0
Ferritin 80.5 13-150
Magnesium 0.90 0.7-1.0
Cortisol 316.0 166-507. 6 am-10am
TSH. 3.07. 0.27-4.20
T4 total. 81.4- 66-181
FreeT4 15.0. 12.0-22.0
FreeT3 3.90. 3.1-6.8
Antithyroidperoxidase 354
Thyroglobulin 415 <115
Vit D 51
B12 341 145-569
Folate 18.20 8.83-60.8
I’m not sure what CRP is and realise that my antibodies are also high. I’m currently on 50mg of levo.
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Sewingbee24
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With a TSH over 1 and an ft 4 well within range you need an increase in levo. Until you are on a reasonable dose that brings TSH to around 1 and or ft4 into the top third of its range there is no need to consider adding T3 liothyronine. 50mcg is a low dose of levo, usually a starter dose.Vit d looks low. Have you got a range for it?
Thank you for replying I’ve been on 50mg for about a year and it was a battle to get that, but I have an endo appointment on the 26th May so I’ll ask for an increase then. The ranges for Vit D are optimal 75-200Adequate 50-75
Insufficient 25-50
It looks like I’m on the border line, my last results showed 81
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
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.
Thanks for replying I’ve been on 50mg for about a year and once again it was a battle. I have an endo appointment on the 26th May and will request an increase. I’m taking B12 supplements do you think my B12 and Ferritin is adequate and cortisol? I’m concerned about renal fatigue. I do not have gluten in my diet but have not had a test for coeliac as yet.
No point testing for coeliac if already on strictly gluten free diet
About 5% of Hashimoto’s patients are coeliac, but a further 80% find strictly gluten free diet helps or is essential
What B12 supplement have you been taking
Has level improved at all on supplement
Ferritin is good
You mean….adrenal fatigue
Obviously at moment adrenals are working hard to try to compensate for being left on only started dose levothyroxine. As dose levothyroxine is increased SLOWLY upwards…..this should improve
Which brand of levothyroxine do you normally prefer
Teva is only brand that makes 75mcg tablets……best avoided as Teva upsets many people….unless you have tried them and know they are ok
I’m not taking any supplements apart from B12. I do take a bile salt supplement which helps with constipation . Which magnesium supplement do you recommend?
Thorne Basic B or Jarrow B Right are recommended options that contains folate, but both are large capsules. (You can tip powder out if can’t swallow capsule)
IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results
If serum B12 result below 500, (Or active B12 below 70) recommended to be taking a B12 supplement as well as a B Complex (to balance all the B vitamins) initially for first 2-4 months, then once your serum B12 is over 500 (or Active B12 level has reached 70), stop the B12 and just carry on with the B Complex.
This is an inflammation marker so the lower the better, yours is fine.
**
Ferritin 80.5 13-150
Ferritin is good (presumably without taking iron tablets?), ferritin is recommended to be half way through range which is about 82 with that range.
**
Magnesium 0.90 0.7-1.0
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, this test is expensive and not included in these sort of test bundles.
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Cortisol 316.0 166-507. 6 am-10am
This seems to be OK but I'm not an expert on serum cortisol tests.
**
I have started taking HRT 3 weeks ago
What form does this HRT take - patches, oral?
Oral HRT can affect absorption of thyroid meds and can necessitate an increase in dose.
TSH. 3.07. 0.27-4.20
T4 total. 81.4- 66-181
FreeT4 15.0. 12.0-22.0
FreeT3 3.90. 3.1-6.8
As others have mentioned, you need an increase in your dose of Levo. Most hypo patients tend to feel best when TSH is 1 or below with FT4 and FT3 are in the upper part of their reference ranges, this is not set in stone, it's down to the individual, but most would not be well with your levels.
**
Antithyroidperoxidase 354
Thyroglobulin 415 <115
Your raised antibodies suggest that you are positive for autoimmune thyroid disease aka Hashimoto's which is where the immune system attacks the thyroid and gradually destroys it.
Fluctuations in symptoms and test results are common with Hashi's.
Most doctors dismiss antibodies as being of no importance and know little or nothing about Hashi's and how it affects the patient, test results and symptoms. You need to read, learn, understand and help yourself where Hashi's is concerned.
Some members have found that adopting a strict gluten free diet can help, although there is no guarantee.
Gluten contains gliadin (a protein) which is thought to trigger autoimmune attacks so eliminating gluten can help reduce these attacks.
You don't need to be gluten sensitive or have Coeliac disease for a gluten free diet to help.
Supplementing with selenium l-selenomethionine 200mcg daily is said to help reduce the antibodies, as can keeping TSH suppressed.
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Vit D 51nmol/L
This is low, it has just crept into the "adequate" category which is >50 but 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.
To reach the recommended level from your current level, you could supplement with 4,000-5,000iu D3 daily.
Retest after 3 months.
Once you've reached the recommended level then a maintenance dose will be needed to keep it there, which may be 2000iu daily, maybe more or less, maybe less in summer than winter, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. This can be done with a private fingerprick blood spot test with an NHS lab which offers this test to the general public:
Doctors don't know, because they're not taught much about nutrients, but there are important cofactors needed when taking D3. You will have to buy these yourself.
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.
D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds if taking D3 as tablets/capsules/softgels, no necessity if using an oral spray.
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. Some people like BetterYou oral spray but this contains a lot of excipients and works out more expensive.
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
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.
As this is a Blue Horizon test the unit of measurement will be pmol/L.
341pmol/L equates to 462pg/ml.
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."
so improvement is recommended.
**
Folate 18.20 8.83-60.8
This is rather low. Folate is recommended to be at least half way through range so about 35 plus with that range. Eating folate rich foods may help raise your level, also supplementing with a good quality B Complex will.
I have used Thorne Basic B for a long time and always been happy.
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).
Thanks for your very comprehensive reply. I’m taking Everol HRT patches and progesterone tablets. The B12 supplement is Igennus B complex but I’ll be changing this as slow dragon advised against taking this as it contains vit c! With the other supplements, when is best to take the B12, and K2? Is it 4 hours after levo? I also take 10mg of Escitalopram. My B12 result being 341, are you saying that this is adequate?
Sorry, I looked at the B12 range and typed 569 instead of 341. I will edit my previous post to avoid confusion. But no, I said 770 (which I mistakenly put) was a decent level.
So 341pmol/L equates to 462pg/ml which is too low. To convert pmol/L to pg/ml you multiply by 1.355.
You could use 1 bottle of B12 sublingual along with the B Complex. When the B12 is finished then just continue with the B Complex.
With the supplements:
B12 and B Complex can be taken together, 2 hours away Levo, no later than lunchtime because B vits can be stimulating and you don't want to disturb your sleep by taking them later in the day.
D3 should be 4 hours away from Levo, take with dietary fat if not an oil based supplement.
Magnesium should be 4 hours away from Levo and as it is calming it's best taken in the evening as you don't want to get sleepy in the daytime.
K2-MK7 should be 2 hours away from Levo, take with dietary fat. If your D3 isn't oil based don't take D3 and K2-MK7 together as they will compete for the fat for absorption.
Don't start all supplements at once. Start with one, give it a week or two and if no adverse reaction then add the next one. Again, wait a week or two and if no adverse reaction add the next one. Continue like this. If you do have any adverse reaction then you will know what caused it.
Hi Sewingbee I am female your age and have just been prescribed Evorel conti patches like you. Pardon my ignorance! But patches I have, contain eostrogen and progesterone, yet you say you take progestogen tablets as well? Dr put me on HRT about 8 years ago...Tablets, had to stop taking them as ballooned!! Filled up with fluid retention especially legs. Now got patches and haven't used yet! But someone who has replied to your post said it's tablets that affect absorption of levothyroxine. I take 125mcg levo every day, maybe as female now on HRT, you need to increase your dose of levo. GP wanted to reduce my dose, purely because my TSH was under 1. I refused find if I lower dose I become constipated and depressed!! Good luck going forward, hypothyroid & menopause together nightmare!
Hi there, my Evorel 25 patch is the estradiol one which I don’t think contains progesterone. I wanted a coil but there is a waiting list so opted for the tablets which I have to say help with sleep a bit. I’m hoping once I take magnesium supplement this will improve again. HRT has changed my mood considerably . I will ask for a levo increase later in the month though. I was a massive sceptic of HRT, but now wouldn’t be without it!
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