Private blood results.

[Lucky14]

So I sent of my private bloods on Tuesday and received the report back tonight. I have an Endocrinologist appointment coming up soon and would appreciate your thoughts. I am on 100 levo once a day and 2 x 20 strength T3 daily and iron tablets. Many thanks in advance.

[SlowDragon Administrator]

Was test done as recommended

Testing early morning, ideally before 9am

Last dose levothyroxine 24 hours before test

Do you always get same brand levothyroxine at each prescription

Day before test did you split T3 into 3 doses….taking last 10mcg dose approx 8-12 hours before test

Which brand of levothyroxine are you currently taking

Which brand of T3

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

Presumably you knew you have Hashimoto’s?

Have you had coeliac blood test done

Are you on absolutely strictly gluten free diet

What vitamin supplements are you currently taking

Vitamin D, B12 and ferritin all too low

Are you vegetarian or vegan

[Lucky14 in reply to SlowDragon]

Yes in regards to bloods drawn before 9am and the proper time left between medication etc. Not sure at present what brand of levo, T3 etc I would need to check. Yes I knew before I had Hashimotos, yes been checked for coeliac and negative. Tried gluten free for a few months a few years ago and felt no different. I’m not vegan or vegetarian.

I have felt very well on my medication for over a year or two but recently so tired, blood pressure, playing up more than usual. Periods all over the place but that could just be my age. I take Ferrous for ferritin even though Endo says ferritin plays no part in Thyroid ( I know laughable) I use B12 sublingual spray and this is the first I’ve seen vit D result. He checked my cortisol about 3 years ago but don’t believe it’s been checked again.

[SlowDragon Administrator in reply to Lucky14]

Ft4 is very low

Many people on levothyroxine plus T3 need BOTH FT4 and Ft3 at least 50% through range

These results suggest you may need dose increase in levothyroxine up to 125mcg and slight reduction in T3 ……down to 35mcg daily perhaps…..retest in 6-8 weeks

ALWAYS get same brand levothyroxine

You need to work on improving low vitamin levels

Do you currently take vitamin D

Aiming for vitamin D at least around 80nmol and around 100nmol maybe better

Low B12

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 and will help improve B12 levels too

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

Ferritin at least half way through range

Strictly gluten free diet may help improve low vitamin levels

[Lucky14 in reply to SlowDragon]

Was thinking a slight change in dosage might help. Not had any luck with pill cutters before but wondering what to try with pills I already have, as I know Endo will disregard everything I will say to him, he told me last time after our telephone appointment that none of the blood tests apart from TSH are important now I’m on T3. I used to be on 200 levo daily before Endo added T3 but only 10 at beginning and felt good. But then he tweaked to 100 levo and 20 x 2 daily. Thanks

[SlowDragon Administrator in reply to Lucky14]

I use a craft scalpel to cut T3 into half and 1/4’s

Easy and accurate

ynrinstruments.co.uk/produc...

Ferritin

Look at increasing iron rich foods in diet. Red meat every day, liver or liver pate once a week

Getting Ft4 levels higher will probably help too

[SeasideSusie Remembering]

Lucky14

Did you do your test as we advise:

* No later than 9am

* Water only before the test (no food or other drink)

* Last dose of Levo 24 hours before the test

* Last dose of T3 8-12 hours before the test

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

If so your results are as accurate as can be, if the timing of last dose of Levo and T3 were not as mentioned above your FT4 and FT3 results wont be accurate.

CRP is good, as an inflammation marker the lower the better.

Ferritin is low. Recommended is half way through range and some experts say that the optimal level for thyroid function is 90-110ug/L. What dose of iron tablets do you take? Are they prescribed? Was an iron panel done before taking iron tablets?

Magnesium - 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. As a red cell magnesium test is expensive and requires phlebotomy this is not included in these test bundles.

Cortisol is high, you should discuss this with your GP and further testing may be required.

TSH is low as expected when taking T3.

FT4: 12.9 (12-22)

This is low and taking T3 lowers FT4. Whether this level is right for you only you can say. Some people on combination thyroid hormone replacement are fine with low FT4 as long as FT3 is in the upper part of it's range, others need both FT4 and FT3 over half way through range to feel well. It's a very individual thing.

FT3: 6.69 (3.1-6.8)

This is high in range and may be right for you, again it's a very individual thing.

I take Levo plus T3 and your results wouldn't be right for me. FT4 that low would probably have me bed bound, my FT4 and FT3 need to be fairly well balanced around the 70% mark for me to feel well. Again only you can say whether this combination of Levo and T3 and these results are right for you.

Thyroid antibodies are raised confirming Hashimoto's and previous posts show that you already know this.

Vit D is low at 57. 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.

Are you supplementing Vit D? If so at what dose?

B12: 379pmol/L = 513pg/ml

On the lowish side.

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."

Folate: 29.2 (8.83-60.8)

Slightly low. Folate is recommended to be at least half way through range so around 35 plus with that range.

With those B12 and folate results it may be beneficial to take a good quality bioavailable B Complex to help raise levels. 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).

[Lucky14 in reply to SeasideSusie]

Test was taken as per recommendations on here. I’ve not been taking anything for vit D as this was the first test I’ve had for this. The iron tablets are a bone of contention for me, as they make going to the bathroom 10 times harder, even with taking with fresh orange etc, I’ve tried the other tips from here, regarding the iron rich foods etc. My iron goes up slightly but as soon as tablets finished it crashes back down. After getting the T3 added my stomach issues all improved 90% but recently been back to old and I’ve been taking Psyllium Husks as seen recommended here for a couple of weeks, no improvement yet. The B12 spray I got from recommendation here too, spoke to GP & Endo regarding B12 but they are both happy with ranges 🤦🏼‍♀️ It’s fitting all supplements in a daily routine, with T3, T4 & BP meds and iron etc. thanks for the help though much appreciated.

[SeasideSusie Remembering in reply to Lucky14]

Lucky14

Vit D: 57nmol/L (22.8ng/ml)

To reach the recommended level of 125nmol/L (50ng/ml) then you can follow the Vit D Council's suggestion - see their website here, go to the 3rd table here:

web.archive.org/web/2019070...

and you will see that they suggest taking 3,700iu D3 daily (nearest is 4,000iu) and 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.

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 or Vitamaze 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. All can be obtained from Amazon and they are all good German imported brands. They do go out of stock from time to time so just go for what's available and if it's the 200mcg dose size then take alternate days rather than daily.

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

natureprovides.com/products...

It may also be available on Amazon

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...

Magnesium citrate helps constipation. I use Natural Calm magnesium citrate powder, you start low and gradually build up to the dose where you produce a comfortable BM the next day, if too loose lower dose a bit. Seems expensive but works out very reasonable because it lasts such a long time:

dolphinfitness.co.uk/en/nat...?

I put powder in a glass, add some warm water, let it fizz then add some orange juice, it makes quite a pleasant little drink.

It’s fitting all supplements in a daily routine, with T3, T4 & BP meds and iron etc. thanks for the help though much appreciated.

It's just a case of working out what you can take when. I take my thyroid meds, betablocker, prophylactic antibiotic plus the supplements.

I always need the bathroom in the early hours of the morning so that's when I take my Levo and T3, keeps it away from everything else by a good few hours. I take my betablocker when I get up.

The antibiotic is taken 3 days a week and I just take that during the morning.

With breakfast I take Vit D, B Complex.

With evening meal I take Vit K2-MK7, Q10 and a mineral supplement.

Magnesium citrate is taken before bed.

If I wanted to take an iron tablet I could fit that in at lunchtime.

[Lucky14 in reply to SeasideSusie]

Thank you, and very helpful with the vitamin advice. Was never sure if you can take a load of vitamins at the same time. I usually sleep right through the night, so take my thyroid and BP meds when waking at 8am. And then any other ones after dinner, ie iron, husks etc.

[SeasideSusie Remembering in reply to Lucky14]

so take my thyroid and BP meds when waking at 8am.

Thyroid meds should be taken on their own so that nothing affects their absorption, 2 hours away from any other medication and supplements (although some do need a gap of 4 hours).

Here's an article that touches on what can't be taken at the same time:

webmd.com/vitamins-and-supp...