Noobie medichecks results are in: Hi there... - Thyroid UK

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Noobie medichecks results are in

Regenallotment profile image
15 Replies

Hi there,

Medichecks results taken 8/6/22 venous draw by nurse, last dose of Levo (25mcg) taken 25 hours before, blood drawn at 7.45am.

Vit D is a surprise, I am very outdoorsy. Have been a carb dodger most of my life, have gone properly gluten free since joining the forum 2 weeks ago, eat masses of eggs and grow my own veg. Not much of a drinker, have stopped alcohol too in last fortnight.

Any recommendations would be much appreciated, especially ones that involve NHS prescriptions and not spending a fortune!

Thank you

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Regenallotment
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Regenallotment profile image
Regenallotment

the forum is only letting me upload one photo at a time sorry...

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greygoose profile image
greygoose in reply to Regenallotment

Yes, that's perfectly normal. But we can see your antibody results in the main picture. You have Hashi's. Did you know that?

Welcome to the forum, Regenallotment.

25 mcg is a very low dose - only half a normal starter dose unless over 60 or have a heart condition. So, not surprising your TSH is still much too high and your FT4 and FT3 are still low. You need an increase in dose of 25 mcg. And will probably need a further increase six weeks after.

Your vit D is very low, yes, and you should talk to your doctor about that. You need loading doses or something. Being an outdoorsy person has nothing to do with anything when you're hypo. We have hypos from Australia on here who have low vit D. Your body just doesn't absorb it.

Your ferritin is also pretty low. Your doctor should probably investigate that, too.

And your folate is too low - although your B12 is good. Don't bother your doctor with that, though. If he gives you anything it will only be folic acid, which is not well absorbed. You'd be much better off buying your own B complex. Just taking one B vit is not a good idea because they all work together and need to be kept balanced. But no way will your doctor prescribe a B complex! Thorne Basic B is a good one, which isn't very expensive. :)

Regenallotment profile image
Regenallotment in reply to greygoose

Thanks so much for the encouragement and reassurance. I just need to persist getting a doctors appointment, by 8.30 this morning the phone lines said no more calls - try the website - its a blooming nightmare. I do feel better prepared though and reading the forum has given me much needed reassurance.

greygoose profile image
greygoose in reply to Regenallotment

You're welcome. :) Good luck!

Regenallotment profile image
Regenallotment

one more

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Regenallotment profile image
Regenallotment

one more

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Regenallotment profile image
Regenallotment

last one

photo of blood test results for inflammation
SlowDragon profile image
SlowDragonAdministrator

Previous post here

healthunlocked.com/thyroidu...

So was this test done before you increased dose levothyroxine to 50mcg?

FT4: 15.1 pmol/l (Range 12 - 22) 31.00%

FT3: 4.4 pmol/l (Range 3.1 - 6.8) 35.14%

Shows good conversion but inadequate dose

Obviously you need dose increase to 50mcg and retest again in 6-8 weeks

Meanwhile working on improving low vitamin levels

Optimal vitamin levels are

Vitamin D at least around 80nmol and around 100nmol maybe better

Folate at least in double figures

Ferritin at least over 70

B12 is good at over 100

What vitamin supplements are you currently taking

Low vitamin D is strongly linked to having autoimmune thyroid disease aka Hashimoto’s

Regenallotment profile image
Regenallotment in reply to SlowDragon

Sorry, I know I've been super annoying by experimenting.

This latest test was after reducing back down again as I am running out of Levo and doctor refused to repeat my prescription as I'd been playing around with the dose, here is the timeline.

Nov 21 to end March 22 - 25mcg a day

April to end May 22 - 37.5mcg a day (50mcg alternate days with 25mcg on others)

mid May 22 - 2 weeks on 50mcg a day - felt like a new woman but terrible medical anxiety as appointments impossible to get at practice, had that previous blood test, not fasting, at 1.30pm after 50mcg at 6.15am - contacted you guys.

Start of June (jubilee bank holiday) dropped to 25mcg to preserve stocks and ordered this medichecks test as recommended.

I realise I haven't helped myself messing around with my dose so much in a short space of time, I'm actually feeling better than I was, still awful but not sofa bound. I think my anxiety and PMS had a lot to do with how I felt when I first messaged.

SlowDragon profile image
SlowDragonAdministrator in reply to Regenallotment

So TSH would have been much higher had you not increased dose

Still ….you are where you are

Make an appointment with (different?) GP …..if face to face take these results in with you

If it’s on phone email or print results and get to GP 3-4 days before phone consultation

Recommend taking printed copies of guidelines below in with you too …..or include with test results if email

If GP still won’t increase dose

Ask for referral to endocrinologist of your choice (probably at least 6 months waiting time) or book private consultation

Roughly where in U.K. are you

Email Thyroid U.K. for list of recommended thyroid specialist endocrinologist and doctors

tukadmin@thyroiduk.org

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

NICE guidelines on full replacement dose

nice.org.uk/guidance/ng145/...

1.3.6

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.

Also here

cks.nice.org.uk/topics/hypo...

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.

Your Ft4 is far too low….because you are under medicated

Regenallotment profile image
Regenallotment in reply to SlowDragon

I don't take any vitamin supplements at present.

SlowDragon profile image
SlowDragonAdministrator in reply to Regenallotment

Vitamin supplements

Low vitamin D

GP should prescribe 1600iu everyday for 6 months, but you’re probably better self supplementing

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...

Or another member recommended this one

Vitamin D with k2

amazon.co.uk/Strength-Subli...

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...

Start with vitamin D

Only add one supplement at a time, waiting at least 2 weeks before adding another to assess any changes

SlowDragon profile image
SlowDragonAdministrator

Low folate 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 (eg Jarrow brand)

SlowDragon profile image
SlowDragonAdministrator

Ferritin isn’t bad but you don’t want it to drop any further

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

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

Regenallotment profile image
Regenallotment

Thanks so much for all this info.I have the list of specialists from TUK, live in Hereford so nearest would be Birmingham/Bristol for me.

GP - yeah our practice covers the whole city, all the small practices merged and you take pot luck.At the moment it’s zero appointments. I’ll print and drop the results in addressed to the GP that initially spotted 3 years of HRT wasn’t working and use all the online forms.

Thanks again, this forum is such a help. Much appreciated.

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