Annual bloods

[Pixie6]

Hi blood results in , disappointing i think , would you cast your eye over them for me please and give me your advice thank you . Bloods taken morning without food and meds 24 hrs earlier . Currently on 75 mcg of levy thyroxine. Appreciate it thank you .

[Lalatoot]

Pixie TSH is over 2 and ft4 is low in range at 14.5. This suggests that you need an increase in levo. When on levo we expect TSH to be around 1 and ft4 to be at least halfway through range.

[Pixie6 in reply to Lalatoot]

Yes as i thought , having a call with Dr next week requesting an increase but i know she s going to resist , if she wont up it im going to get a pill cutter and self medicate , she ll say ‘well you are within range ‘uuuggghhh

[SeasideSusie Remembering]

Pixie6

Hard to read all of them from the angle you've taken the picture and so many, you can always add another picture in a "Reply" so that they're more easily readable.

From what I can see:

B12: 547pg/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."

Folate: ?? (3-20)

No idea what it is but it should be at least half way through range so 12 plus with that range.

If you don't already take a B Complex then you may benefit from doing so, it will improve both B12 and folate levels. Consider Thorne Basic B or another one with methylcobalamin (not cyanocobalamin) and methylfolate (not folic acid) and does not include Vit C as this affects absorption of the B12.

Ferritin: 129 (13-150)

This looks a good level providing it is not raised due to inflammation or infection.

FT4: 14.5 - I can't read the range but it's low in range.

TSH: 2.2 - too high for someone on Levo.

The aim of a treated hypo patient on Levo only, generally, is for TSH to be 1 or below with Ft4 and FT3 in the upper part of their reference ranges, if that is where you feel well.

Cholesterol looks high but that's a symptom of hypothyroidism. Triglycerides are the important test so if they're in range it's OK.

HbA1C looks close to pre-diabetes.

FBC looks OK apart from platelets and I can't comment on that.

A lot of it is too hard to read so I haven't commented on everything.

[Pixie6 in reply to SeasideSusie]

Thank you i lll get some b complex, appreciate your advice, i take b12 high strength , magnesium, vit d . Platelets are always on the high side , again dr ignores and wont explore 🤷🏼‍♀️

[SeasideSusie Remembering in reply to Pixie6]

Pixie6

i take b12 high strength ,

What do you call "high strength", what is the actual supplement you are using and the dose?

If taking B12 you should already be taking a B Complex to keep all the B vitamins balanced.

magnesium, vit d

What is your Vit D level and what dose of D3 are you taking? You should test twice a year when supplementing to check that you are taking the correct dose and not going too high.

Vit K2-MK7 is another important cofactor of D3, are you also taking that?

[Pixie6 in reply to SeasideSusie]

Yes 1,000ug b12. Vit d 2.5 ug. Never heard of vit k2-mk7 but will look at too

[SeasideSusie Remembering in reply to Pixie6]

Yes 1,000ug b12.

Is that a sublingual? How long have you been taking it? Your B12 level doesn't seem conducive to taking that amount, one would expect it to be higher if you've been taking it for a while. Maybe it's not being absorbed. Do you take it with Vit C? Vit C can stop the body using B12 so they need to be taken 2 hours apart. Do you have Pernicious Anaemia?

Vit d 2.5 ug

2.5ug as in two point five - seriously? That is 100iu which is less than a child's maintenance dose? Or do you mean 25ug (twenty-five)?

What was your level when tested and who told you to take that amount?

What is your current Vit D level?

Never heard of vit k2-mk7 but will look at too

When taking D3 it 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 like calcification of arteries, kidney stones, etc.

[Pixie6 in reply to SeasideSusie]

Been taking that amount of b12 for 5 years ! Iv been amenic on and off all my life and as i started menopause 6 years ago i had intense prolonged bleeding which delpleted blood count and i dont think iv ever recovered from that , i think thats what triggered my hypothyroidism …. iv never been diagnosed with pernicious amnemia . I asked for vit d to be tested but they haven’t included it in test

[SeasideSusie Remembering in reply to Pixie6]

Pixie6

Been taking that amount of b12 for 5 years !

In that case there's something wrong. Taking that amount under the right circumstances should increase your B12 level in a matter of a few months. But you didn't answer the questions:

Is that a sublingual?

Do you take it with Vit C?

Iv been amenic on and off all my life and as i started menopause 6 years ago i had intense prolonged bleeding which delpleted blood count and i dont think iv ever recovered from that

What form of anaemia - iron deficiency anaemia, B12 anaemia, folate anaemia?

Has this ever been addressed by your GP?

Your current haemoglobin and haematocrit levels are good and don't suggest anaemia.

I asked for vit d to be tested but they haven’t included it in test

Rarely done because they think it's an expensive test. Just test it yourself, easy home fingerprick dried blood spot test from NHS lab costs £29:

vitamindtest.org.uk/

Put results on forum for comment and suggestions of what dose may be needed if level is low. What you are taking now is just wasting your money, absolutely no point in taking it but I have never, ever seen a 2.5ug dose of D3 for sale anywhere. But again you didn't answer the questions:

Vit d 2.5 ug

2.5ug as in two point five - seriously? That is 100iu which is less than a child's maintenance dose? Or do you mean 25ug (twenty-five)?

What was your level when tested and who told you to take that amount?

[Pixie6 in reply to SeasideSusie]

No tablet b12 , and i dont take vit c, my vit d is normally a high dose but picked these up as it had added calcium tbh i did nt look at the vit d levels so willgo back to my original ones, bloody hell this must be really frustrating for you , im a hopeless case 😂the last time it was tested a year ago it was a good level , nobody has ever told me me to take it , but i know we all need it . My anemia was iron deficiency and low b12 I believe but not 100% , at the time iwas in a daze did nt know my name, iv changed docs 2 times since then and records have gone awol 🤦🏼‍♀️

[SeasideSusie Remembering in reply to Pixie6]

No tablet b12

Tablets are less absorbable than sublinguals, if you are going to continue with B12 then look for a sublingual lozenge or liquid methylcobalamin as these are absorbed through the mucous membranes in the oral cavity rather than the stomach/intestine.

my vit d is normally a high dose but picked these up as it had added calcium

Why calcium? Have you tested and found to be deficient? Calcium should not be supplemented unless tested and you know your levels are low, then best prescribed and monitored by GP.

tbh i did nt look at the vit d levels

It is important to check level twice a year (April and October/November) when supplementing so that you don't go too high which can lead to toxicity.

the last time it was tested a year ago it was a good level , nobody has ever told me me to take it , but i know we all need it .

Most of us in the UK may need to supplement during the winter but not all of us need to supplement during the summer. Most people can make Vit D from the sun during the summer months, it gets stored and used up during the winter. Vit D is fat soluble so any excess gets stored, it cannot be excreted. So if you take too much D3 supplement it builds up and leads to toxicity.

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 although some studies suggest there is no benefit in having a level higher than 125nmol/L.

[Pixie6 in reply to SeasideSusie]

Great info thank you

[SlowDragon Administrator]

Approx how much do you weigh in kilo

Request/insist on 25mcg dose increase in levothyroxine

pathlabs.rlbuht.nhs.uk/tft_...

Guiding Treatment with Thyroxine:

In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months.

The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).

The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range.

……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.

The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.

This means Ft4 at bottom of range is TOO LOW because you are not on high enough dose levothyroxine

Come back with new post once you get vitamin D result

Likely to need higher dose vitamin D

[Pixie6 in reply to SlowDragon]

I weigh 60 kgs and will request an increase of 25 mcg , she cant deny that surely but we ll see 🤦🏼‍♀️Thanks for response

[SlowDragon Administrator in reply to Pixie6]

60 kilo x 1.6 = 96mcg per day

96mcg x 7 days a week = 672mcg

Perhaps suggest you will increase to 100mcg 6 days week and 75mcg one day a week

Retest thyroid levels in 6-8 weeks after any dose change or brand change in levothyroxine

Which brand of levothyroxine are you currently taking

[Pixie6 in reply to SlowDragon]

Teva , i know a lot of patients dont like teva but i prefer it , my stomach is better on teva

[SlowDragon Administrator in reply to Pixie6]

Are you lactose intolerant and on dairy free diet?

Lactose intolerance often means needing higher dose levothyroxine than guidelines if not on dairy/lactose free diet

Lactose intolerance is very common with Hashimoto's

ncbi.nlm.nih.gov/pubmed/240...

Lactose intolerance was diagnosed in 75.9 % of the patients with HT

read.qxmd.com/read/24796930...

These findings show that lactose intolerance significantly increased the need for oral T4 in hypothyroid patients.

[Pixie6 in reply to SlowDragon]

I have been lactose sensitive for a few years keep dairy minimal, i have to be very careful with my diet , meat and dairy minimal , can only eat small meals , my stomach rules how i am feeling , holiday s can make me ill , and cant really tolerate acholol now , mores the pity 🤣, thanks for the info i will read