Blood Results

[Cat-222]

Please see below my latest blood results. They are in the normal range. I don’t feel well, feel weak and lightheaded when I get up, have acid reflux and suffer with frequent headaches. Any suggestions on making me in the optimal range.

Many thanks

[SlowDragon Administrator]

Did you also test vitamin D, folate, ferritin and B12

If not, you need these tested

Request GP test them ….or retest via Medichecks

We always recommend getting FULL thyroid and vitamin testing done at least once a year

Low Ft3 suggests poor conversion of Ft4 to Ft3

We need GOOD vitamin levels for good conversion of Ft4 to Ft3

Low Ft3 leads to low vitamin levels

Low vitamins levels tend to lower TSH and increase Ft4 due to poor conversion…..vicious circle

What’s your diet like

Are you vegetarian or vegan

What vitamin supplements are you currently taking

How long since vitamins last tested and what were your results

[Cat-222 in reply to SlowDragon]

Thank you for your reply. I had my Vitamin D, folate, ferritin and B12 they were all in the optimum range. I eat meat but have problems digesting red meat. I eat nuts, seeds, vegetables, fruit and chicken. Avoid gluten and have low carbs.

I take vitamin C, zinc, probiotics and omega 3 and CBD oil to help with anxiety and depression. What vitamins do I need to help? I am desperate and fed up not feeling well. I am having acupuncture but it doesn’t seem to be doing anything.

I am 61 and post menopausal came off HRT 2 months ago after being on it for 7 months.

I take 75mg thyroxine 50mg MercuryPharma and 25mg Wockhardt.

I had the blood test done in the morning and did not take thyroxine for 24 hours before. I weigh 12 stones.

[SlowDragon Administrator in reply to Cat-222]

Vitamin D, folate, ferritin and B12 they were all in the optimum range

Please add actual results

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

12 stone = 76 kilo

76kg x 1.6mcg = 121.6mcg as the likely daily dose levothyroxine required

Some people need less….some more

Request 25mcg dose increase in levothyroxine

Having been long time on only 75mcg….

Initially perhaps increase to 87.5mcg for few weeks before increasing to 100mcg

You may find it better to split the dose levothyroxine, taking 50mcg at bedtime and 50mcg waking …..can help tolerate higher 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.

[Cat-222 in reply to SlowDragon]

My vitamin D is 98Ferritin 110 - range 13 - 150

Folate 9.28 - range 3.89

B12 150 - range 37.5 - 150

Thyroglobulin Antibodies 16 IU/ml - range 115

Thyroid Peroxidase Antibodies 9 IU/ml - range 34

[SlowDragon Administrator in reply to Cat-222]

So yes these are good

Do you supplement any of these ….or are they naturally good

[Cat-222 in reply to Cat-222]

Yes I was taking folate, B12 injections which I haven’t had since April and I was taking D but stopped at he folate and D a while ago.I just don’t understand why I feel so bad I dubs doctors don’t want to know if your results are in the normal range. They just keep offering me antidepressants which I don’t want because of the horrible side effects. There must be a way of feeling better. Do you think B complex, selenium and magnesium would help?

[SlowDragon Administrator in reply to Cat-222]

You need to click reply….or other poster doesn’t get notifications

Yes, highly likely to need to take a good quality vitamin B complex daily indefinitely

Difference between folate and folic acid

chriskresser.com/folate-vs-...

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

How other member saw how effective improving low B vitamins has been

healthunlocked.com/thyroidu...

Also a maintenance dose of vitamin D

Trial and error what dose that is

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

Plus magnesium supplement in afternoon or evening (minimum 4 hours away from levothyroxine)

Personally I never noticed any difference taking selenium. I took it daily on advice of gastroenterologist, after endoscopy confirmed gluten intolerance. After year or two, I tested selenium level, it was high so I reduced it to just once a week

[SlowDragon Administrator in reply to Cat-222]

You probably want to try being strictly gluten free

Have you had high thyroid antibodies in the past?

20% of Hashimoto's patients never have raised antibodies

healthunlocked.com/thyroidu...

Paul Robson on atrophied thyroid - especially if no TPO antibodies

paulrobinsonthyroid.com/cou...

Probably time to consider getting T3 prescribed

Email Thyroid U.K. for list of recommended thyroid specialist endocrinologist and doctors who will prescribe T3

[e-mail]

Roughly where in U.K. are you

Some CCG areas are worse than others

In in England here’s the numbers prescribed in last year

Searchable by CCG area

58,000 prescriptions, typically that’s 6 prescriptions per person per year

openprescribing.net/analyse...

It is getting easier to get T3 prescribed on NHS , now that price is down to £50-60 per pack (was £268 when only one exploitative supplier)

Private prescription enables access to Thybon Henning 20mcg tablets via specialist U.K. pharmacies

Cost is 50-60p per tablet. Typical daily dose is 2 or 3 x 5mcg …cutting 20mcg tablets into 1/4’s

[Cat-222 in reply to SlowDragon]

Thank you for the all the I formation I really appreciate it. I live in Chichester West Sussex.

[Cat-222 in reply to SlowDragon]

I try to be 100% gluten free and never had high thyroid antibodies before. My mood is so low and I have no energy. Really strange as my main vitamin levels are fine.

[SlowDragon Administrator in reply to Cat-222]

But your Ft3 is far too low

Hardly surprising you feel dreadful

[Cat-222 in reply to SlowDragon]

I will try and get help from my doctor but I am not holding out much hope as they don’t want to know if your blood results are in range.

[SlowDragon Administrator in reply to Cat-222]

You will have to see an endocrinologist to get T3 prescribed

GP is not allowed to initiate prescribing T3

3-6 months Trial has to be via endocrinologist

Private consultation is most realistic option

Several endocrinologist on list fairly near you

[Cat-222 in reply to SlowDragon]

Thank you I will have a look. Would a doctor refer me?I am just worried because I can’t really afford to go private. I have spent a fortune on private treatments in the last year which haven’t helped. Also a lot of people have seen an endocrinologist and have had no joy.

My blood pressure was high today, do you know if my low T3 would contribute to this? Many thanks

[SlowDragon Administrator in reply to Cat-222]

Well you can ask GP

Get the list from Thyroid U.K. see if any NHS or list near you

Vast majority of endocrinologists are diabetes specialists and useless for thyroid

NHS extremely long waiting list

Private consultation approx £250

You might consider getting Dio2 test done

£80

thyroiduk.org/deiodinase-2-...

If you test positive it’s may help get T3 prescribed on NHS

[SlowDragon Administrator]

Assuming these are Medichecks results?

FT4: 19 pmol/l (Range 12 - 22)

Ft4 is currently 70.00% through range

FT3: 3.92 pmol/l (Range 3.1 - 6.8)

Ft3 only 22.16% through range

Helpful calculator for working out percentage through range

thyroid.dopiaza.org

Most people when adequately treated will have Ft3 at least 50-60% through range

Was test done early morning, ideally before 9am and last dose levothyroxine 24 hours before test

Which brand of levothyroxine are you currently taking

Approx how much do you weigh in kilo

75mcg is only one step up from starter dose levothyroxine

Likely to need to improve low vitamin levels

Then retest thyroid levels again after 2-4 months improving vitamins

Frequently improving low vitamin levels improves conversion

So Ft3 rises and Ft4 drops….then you can get next dose increase in levothyroxine….perhaps to 87.5mcg daily

If Ft4 is still high and Ft3 is still low (below 5) will need to see thyroid specialist endocrinologist for small dose of T3 prescribed alongside levothyroxine

Very common for conversion to get worse as we get older

[pennyannie]

Hello Cat :

Can i just add that the accepted conversion ratio when on T4 only Levothyroxine medication is said to be 1 / 3.50 - 4.50 T3/T4 with most of us feeling at our best when your ratio comes in at around 4 or under.

So find your ratio you simply divide your t3 into your T4 and I'm getting yours coming in at around 4.85 so wide of centre and showing poor conversion of the T4 medication.

No thyroid hormone replacement works well until your core strength is strong and solid and ferritin, folate, B12 and vitamin D need to be up and maintained at optimal levels.

Conversion can also be compromised by any physiological stress- physical or emotional, dieting, inflammation and ageing so it ca become a vicious circle but at least we can take back some control of some things.

We generally feel at our best when our T4 is up in, towards the top quadrant of its range as this should in turn convert to a good level of T3 at around a 1/4 ratio T3/T4 :

However whilst your T4 is at around 70% through your T3 is only at around 22% :

There is room for an increase in T4 - this may just be enough to jump start your T3 reading to a better, higher level and start alleviating symptoms.

You need to know if you have high or low stomach acid, and if low this is a very common hypothyroid issue as our whole digestive system is slowed and our ability to break down nutrients from our food more labour intensive,

There is a bicarb of soda test - several youtube sites offer this easy home test visual :

I waited 15 minutes for a burp and now take a teaspoon of raw apple cider vinegar in a glass of water 1/2 an hour before my main lunch time meal.

[Cat-222 in reply to pennyannie]

Hi Penny, not sure if you received my reply. I did the bicarbonate of soda test and I burned after 9 minutes.

Would that mean I have low acid?

[pennyannie in reply to Cat-222]

Oh, no, I didn't see that reply, sorry I'll look back :

Ok well i hope you meant to write burp and not burn and if yes that's low stomach acid which is very common when hypothyroid.

[Cat-222 in reply to pennyannie]

I think I forgot to click on reply. Sorry I am having one of those days and yes I was meant to put burp.What can I do for low acid because I am getting a lot of indigestion and acid reflux at night, when I wake up I get burning sensation in the middle of my chest and throat. I am unable to digest my food properly and have soft stools in the mornings. Many thanks 😊

[pennyannie in reply to Cat-222]

So I don't have your symptoms and as detailed above I take raw apple cider vinegar -

other people take digestive enzymes -

but I think first you need to know for sure what is the cause of your discomfort - do you take anything now, has it been investigated and anything prescribed ?

[Cat-222 in reply to pennyannie]

I have tried digestive enzymes but they didn’t agree with me. I have tried Gaviscon and am now trying Silicolgel. The doctor prescribed Famotidine 20mg but when I read the side effects it put me off and they are to decrease the acid. I had a camera down many years ago and they just said it was gastritis and a camera up and just said it was IBS. Doctors do not recognise low acid.

[pennyannie]

I can't really say anything as I've never experienced these problems -

maybe start a new post just asking forum members for feedback on Silicolgel and or other recommendations.

[Cat-222 in reply to pennyannie]

Thank you. I am going to stop the Silicolgel haven’t felt well today and my blood pressure went up, pretty scary. I am very sensitive to a lot of supplements and medication. The Silicolgel is meant to be natural. I will carry on with Aloe Vera and herbal teas and see how I go.

[pennyannie in reply to Cat-222]

There does seem to be something going on stomach wise, and do wonder if there is an absorption issue and would suggest asking for a trial of liquid T4.

If liquid Levothyroxine works better for you, this will improve your conversion of the T4 into T3 and this in turn means your metabolism will start working better which includes an improved digestive system and bowel movements - all of which you mention in your post above as symptoms being suffered.

Just another thought ?

[Sofie007 in reply to Cat-222]

Hello Cat, how are feeling now? Your situation looks like mine so I was wondering if you added more levothyroxine or maybe T3 since your last post?