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Need help with test results

51105Scot profile image
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New here but would be grateful for help interpreting blood tests and advice on supplements. Been diagnosed autoimmune hypothyroid for over 30 years on 75mcg levothyroxine.. lead healthy active life (two nutty dogs to keep up with). Eat lots of fruit and veg and pulses. Non smoker, very low alcohol consumption. Only supplement I take is Vit D with calcium on prescription by GP because family history of osteoporosis. Stopped in March as MRI showed some build up in heart arteries and GP had seen a study that oral calcium no use for bone strength and could cause build up in arteries. GP feels that my healthy lifestyle and exercise regime is sufficient without supplements. I feel that there are too many borderline results and a few too high or too low which show an overall picture of below optimal when looked at overall. But I am no medic and don’t know if my GP takes too much notice of the laboratory remarks. I specifically asked for T3 to be tested as I’ve noticed that mentioned on this site, but it wasn’t done. That was why I went for the medichecks test when it was on such a good offer. It will add the three tests, Thriva, NHS GP and medichecks, I am having difficulty getting the original NHS GP test results but the nurse did say there were some OK but borderline results and she thought ferritin was a bit low but not needing treatment but they would test every six months to keep an eye on it.

Sorry this is so long but wanted to give as full a picture as possible. Still losing muscle volume but not skinny.

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51105Scot
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51105Scot profile image
51105Scot

Just realised only the NHS GP test uploaded on original post so below are the other two

Thriva test 7/3/22Thyroid function test

Thyroid Stim Hormone Low 0.09 range 0.270-4.2

Free T3 4.2 range 3.1-6.8

Free thyroxine (FT4) 19.5 range 12-22

Thyroglobulin antibodies 95.3 range 0-115 method Roche Cobas

Thyroid peroxidase antibodies High 81.3 range 0-34 method Roche Cobas

Total thyroxine T4 145 range 59-154

Medichecks 7/6/22

Inflammation CRP HS <0.3 range 0-5

Iron status

Ferritin 24.5 range 13-150

Vitamins

Folate serum 3.37 range >3.89

B12 active 75.2 range 37.5-150

Vit D 67

(,25 deficient, 25 - <50 insufficient, 50-75 adequate, >75-200 optimal

Thyroid hormones

TSH 3.19 RANGE 0.27-4.2

FREE T3 4.30 range 3.1-6.8

FREE THYROXINE 15.8 range 12-22

Autoimmunity

Thyroglobulin antibodies 84 range <115

Thyroid peroxidase antibodies x 97 range <34

SlowDragon profile image
SlowDragonAdministrator

Approx how much do you weigh in kilo

Guidelines on dose levothyroxine by weight is approx 1.6mcg levothyroxine per kilo per day

Your current results generally suggest you are under medicated

Medichecks results

TSH 3.19 RANGE 0.27-4.2

FREE T3 4.30 range 3.1-6.8

FREE THYROXINE 15.8 range 12-22

FT4: 15.8 pmol/l (Range 12 - 22)

Ft4 only 38.00% through range

FT3: 4.3 pmol/l (Range 3.1 - 6.8)

Ft3 only 32.43% through range

NHS test

Ft4 12.6 (9-21)

FT4: 12.6 pmol/l (Range 9 - 21)

Ft4 only 30.00% Through range

Helpful calculator for working out percentage through range

thyroid.dopiaza.org

Generally on levothyroxine we need dose increase in levothyroxine to bring TSH below 2 and Ft4 at least 60-70% through range

High thyroid antibodies confirms autoimmune thyroid disease also called Hashimoto’s

Thriva test is interesting seems to have caught a Hashimoto’s flare ……as results are very different

Thriva test 7/3/22

Thyroid Stim Hormone Low 0.09 range 0.270-4.2

Free T3 4.2 range 3.1-6.8

Free thyroxine (FT4) 19.5 range 12-22

Thyroglobulin antibodies 95.3 range 0-115

Thyroid peroxidase antibodies High 81.3 range 0-34

As you have Hashimoto’s have you had coeliac blood test done

Are you on strictly gluten free diet

Which brand of levothyroxine are you currently taking

Do you always get same brand levothyroxine

51105Scot profile image
51105Scot in reply toSlowDragon

Weight 53.1 kg Pre March a different brand every month but GP has put me on TEVA as it doesn’t contain lactose which I have had problems with in the past. Symptoms creeping up on TEVA though. Thank you for all this information. Working through it slowly and then I’ll be on to Amazon. Feeling better just to understand what’s going on. So grateful

SlowDragon profile image
SlowDragonAdministrator in reply to51105Scot

So you may just need to improve vitamin levels and work out which is most suitable levothyroxine

There’s new lactose free options to consider trying now

Teva brand contains mannitol instead of lactose. Mannitol changes gut biome and upsets lots of people

Glenmark and Aristo are lactose free and mannitol free

Aristo only make 100mcg tablets

If none of these give improved results GP could prescribe liquid levothyroxine

Liquid levothyroxine can give better results

Liquid levothyroxine is often split into 2 smaller doses waking and bedtime.

SlowDragon profile image
SlowDragonAdministrator in reply to51105Scot

So your weight and results suggests you might need small dose increase in levothyroxine

Currently taking 75mcg per day = 525mcg per week

Dose by weight is approx 85mcg per day = 595mcg per week

So you might need an extra 50mcg or 75mcg per week

Or you might find once vitamins are better and brand levothyroxine is sorted current dose is fine

Only want to change one thing at a time…..or add one supplement at a time

Wait at least 10-14 days before adding another supplement

Suggest starting with vitamin D

51105Scot profile image
51105Scot in reply toSlowDragon

Noted thank you. Will start with that. Maybe a wee chat with our brilliant pharmacist to see what brands are available. I live over the water in beautiful Argyll but supplies and deliveries can be more of a challenge.

SlowDragon profile image
SlowDragonAdministrator

Ferritin 24.5 range 13-150

Vitamins

Folate serum 3.37 range >3.89

B12 active 75.2 range 37.5-150

Vit D 67 - 50-75 adequate, >75-200 optimal

Ferritin is deficient

Folate is deficient

Vitamin D is not optimal

Low vitamin levels are extremely common with Hashimoto’s, especially when slightly under medicated

Many/most Hashimoto’s patients need to supplement continuously to maintain optimal vitamin levels

SlowDragon profile image
SlowDragonAdministrator

Vitamin D

NHS Guidelines on dose vitamin D required

ouh.nhs.uk/osteoporosis/use...

GP will often only prescribe to bring vitamin D levels to 50nmol. Some CCG areas will prescribe to bring levels to 75nmol or even 80nmol

leedsformulary.nhs.uk/docs/...

GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)

mm.wirral.nhs.uk/document_u...

But with Hashimoto’s, improving to around 80nmol or 100nmol by self supplementing may be better

pubmed.ncbi.nlm.nih.gov/218...

vitamindsociety.org/pdf/Vit...

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

Test twice yearly via NHS private testing service when supplementing

vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function.

There’s a version made that also contains vitamin K2 Mk7. One spray = 1000iu

amazon.co.uk/BetterYou-Dlux...

It’s trial and error what dose we need, with hashimoto’s we frequently need higher dose than average

Vitamin D and thyroid disease

grassrootshealth.net/blog/t...

Vitamin D may prevent Autoimmune disease

newscientist.com/article/23...

Web links about taking important cofactors - magnesium and Vit K2-MK7

Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Great article by Dr Malcolm Kendrick on magnesium

drmalcolmkendrick.org/categ...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

SlowDragon profile image
SlowDragonAdministrator

Folate deficient

supplementing a good quality daily vitamin B complex, one with folate in (not folic acid) may be beneficial.This can help keep all B vitamins in balance

Difference between folate and folic acid

chriskresser.com/folate-vs-...

Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid.

thyroidpharmacist.com/artic...

B vitamins best taken after breakfast

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

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate methyl folate supplement and separate B12

pauluk60 profile image
pauluk60 in reply toSlowDragon

sorry if butting in you guys are the bees knees with the help you give and understanding just read all this lucky that i dont have to with this can i ask what are your views on vitamin supplements are these blood tests special to complaint again sos if being a pest

SlowDragon profile image
SlowDragonAdministrator

Ferritin under 30

GP should do full iron panel test for anaemia

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...

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...

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...

SeasideSusie profile image
SeasideSusieRemembering

51105Scot

Did you do these tests as we advise:

* No later than 9am

* No food or drink other than water before the tests

* Last dose of Levo 24 hours before the test

* No biotin, B Complex or any other supplement containg biotin for 3-7 days before the test

If so then your results are comparable and give the normal circulating hormone levels, if not some of your results may be inaccurate.

Medichecks 7/6/22

Inflammation CRP HS <0.3 range 0-5

Nice and low, the lower the better.

**

Ferritin 24.5 range 13-150

Very poor. You need to speak to your doctor about this.

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.

Your GP should do an iron panel consisting of Serum Iron, Total Iron Binding Capacity, Transferrin Saturation Percentage plus Ferritin. This will show if you have iron deficiency and if so your GP should treat accordingly and regularly monitor your levels.

Your full blood count does not show anaemia.

You can have iron deficiency with or without anaemia.

**

Folate serum 3.37 range >3.89 - I am assuming unit of measurement is ug/L (mcg/L)

This is below range and suggestive of folate deficiency. Again, speak to your GP.

cks.nice.org.uk/anaemia-b12...

Folate level

◦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.

Your GP may consider prescribing a course of folic acid.

**

B12 active 75.2 range 37.5-150

This is above the level where testing for B12 deficiency is suggested (that level being 70) but we always suggest a level of over 100 for Active B12. It's not dire but could be better. A B Complex containing methylcobalamin will help raise your level, consider Thorne Basic B. It also contains methylfolate which will help raise your folate level.

**

Vit D 67nmol/L

Only supplement I take is Vit D with calcium on prescription by GP because family history of osteoporosis. Stopped in March as MRI showed some build up in heart arteries and GP had seen a study that oral calcium no use for bone strength and could cause build up in arteries.

It's encouraging that your GP has the sense to realise that calcium is not the answer for osteoporosis and the reason it has built up in your arteries is, I expect, because you were not taking Vit K2-MK7 which is an important cofactor when taking a Vit D supplement. D3 aids absorption of calcium from food and Vit K2-MK7 is needed as this 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 calcification of arteries, kidney stones, etc.

Have you stopped taking D3 altogether?

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.

Take a look at my recent post about supplementing with Vit D:

healthunlocked.com/thyroidu...

To reach the recommended level from your current level, go to the 3rd table here:

vitamindcouncil.org/i-teste...

My level is between 20-30 ng/ml

67nmol/L = 26.8ng/ml

You will see that to reach 50ng/ml, which is 125nmol/L the recommended daily dose of D3 is 3,700iu. It's not possible to buy D3 in that dose so the closest is 4,000iu.

Retest after 3 months to check your level.

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:

vitamindtest.org.uk/

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.

As mentioned above 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.

Both of these are German brands which sometimes goes out of stock. They are usually found on Amazon or Ebay although can be bought direct. If the 100mcg dose size isn't available it's OK to take the 200mcg dose alternate days.

Another option is Vitamaze K2-MK7 liquid which is available on Amazon, again the All-Trans form, and it's a clean supplement with no excipients.

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.

naturalnews.com/046401_magn...

drjockers.com/best-magnesiu...

**

TSH 3.19 RANGE 0.27-4.2

Up from

Up from 0.09 with Thriva in March.

A big difference which I can't explain

FREE T3 4.30 range 3.1-6.8 = 32.43% through range

Comparable with Thriva in March at 4.2.

Low in range.

FREE THYROXINE 15.8 range 12-22 = 38% through range

Close to NHS test in May of 12.6 (9-21) which is 30% through range

Much lower than Thriva in March at 19.5 (75% through range)

Can this be explained by taking Levo before this test and not before the Medichecks test?

Leaving 24 hours between last dose of Levo and test gives a more accurate result, taking Levo before the test gives a false high FT4 level, leaving longer than 24 hours gives a false low FT4 level.

The only other explanation is that Hashi's causes fluctuations in results and you could have had a swing in March which caused the very low TSH and high in range FT4 compared to the much higher TSH and lower FT4 in June.

Your current results suggest that an increase in your dose of Levo is needed to lower your TSH and raise your FT4 which, in turn, should raise your FT3. An increase of 25mcg now, retest in 8 weeks.

Raised antibodies just confirm your Hashi's and Total T4 is not a particularly useful test.

51105Scot profile image
51105Scot in reply toSeasideSusie

All three tests done before 0900 and 24 hours from Levothyroxine. Not taking any supplements anyway but will certainly start now. Thank you so much for your help. My GP reduced my dose of Levothyroxine from 75 to 50 in March as thought test results then showed over dosing. Hence next test to check. Also put me on Teva as it is lactose free and I’m not great with lactose but my symptoms are creeping back. Apparently Teva are now the go to brand for people who don’t respond well to those with lactose fillers but I don’t think it is working as well for me.

SeasideSusie profile image
SeasideSusieRemembering in reply to51105Scot

Did your GP reduce dose after seeing the Thriva test results? It's unusual for many doctors to accept private tests.

The Thriva results did not show overmedication, your FT4 was 75% through range and FT3 only around 32% through range. It's over range FT3 that shows overmedication not low TSH.

Teva brand isn't well tolerated by quite a few members here. Instead of lactose they use Mannitol and it appears to be this that causes adverse reaction in some members. Other lactose free brands are Glenmark and Aristo.

Low ferritin causes symptoms similar to symptoms of hypo. No thyroid hormone replacement can work properly with su h a ow ferritin level, it's recommended to be half way through range and some experts say that the optimal ferritin level for thyroid function is 90-110ug /L.

51105Scot profile image
51105Scot in reply toSeasideSusie

I had an NHS blood test in March as I had lost over a stone in weight in a couple of months with no obvious cause. I was told there were no problems showing from the blood test with only a couple of iffy results but not relevant. I didn’t get to see those results. I had internal camera up and down and MRI scans of chest and abdomen all clear. I got the impression that my Levo dose was reduced in case that had caused the unexplained weight loss? I went for follow up appointment and told all OK. Managed to get a printout of the test result as I left and it didn’t look that optimal to me hence this post. So frustrating when you have symptoms but told everything’s fine. Can’t put it all down to getting old and need to work a bit harder at supporting my functions. Not good at telling doctors their jobs when they are so busy.

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