Help with results please.

[Sandiij]

on levo 100mcg since March

TSH 4.6 (0.27-4.2)

T4 14. 2 (12-22pmol/l)

T3 4 .0 (3.1-6.8pmol/l)

[SeasideSusie Remembering]

Sandiij

Did you do the test as we always advise:

* No later than 9am

* Water only before the test

* Last dose of Levo before test

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

If so then you are undermedicated, need an increase in your dose of Levo and retest in 6-8 weeks. 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.

[Sandiij in reply to SeasideSusie]

Thank you. Yes I followed the advice Will send results to my Gp as this was a private test though in an nhs lab.

[SlowDragon Administrator]

Looking at other post ..you’re having B12 injections

You also need vitamin D and ferritin levels tested

Low vitamins are EXTREMELY common when hypothyroid and frequently need improving

Which brand of levothyroxine are you currently taking

Ideally stick on same brand when dose is increased to 125mcg daily

Bloods should be retested 6-8 weeks time

Have you had thyroid antibodies tested for autoimmune thyroid disease

Approx 90% of primary hypothyroidism is autoimmune thyroid disease

[Sandiij in reply to SlowDragon]

The brand is Teva. Not had the antibodies test ad gp won't and gets expensive privately. Will check vit d. Ferritin has always been in the highest part of the range although not had it done recently.

[SlowDragon Administrator in reply to Sandiij]

Excellent reply by nellie237

Print this out and request GP test thyroid antibodies

They should ALWAYS test thyroid antibodies at diagnosis

Significant minority of Hashimoto’s patients only have high TG antibodies…..so can’t get diagnosed by NHS testing

20% of Hashimoto’s patients never have high thyroid antibodies

If both TPO and TG antibodies are negative, you need ultrasound scan of thyroid

[nellie237]

Hi Sandiij

"Not had the antibodies test ad gp won't" If you have Primary or Subclinical Hypothyroidism your GP should have checked your TPO antibodies at diagnosis. You should not have to pay privately.

Tests for people with confirmed primary hypothyroidism (This recommendation is exactly the same for subclinical)

Adults

1.3.1Consider measuring thyroid peroxidase antibodies (TPOAbs) for adults with TSH levels above the reference range, but do not repeat TPOAbs testing.

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

Autoimmune Thyroid problems can be accompanied by other autoimmune problems such as pernicious anaemia/coeliac amongst others. I see that you have had B12 loading doses and are struggling to raise folate and would strongly recommend that you ask your GP to test for coeliac. Per NICE

"Suspect a diagnosis of coeliac disease in a person with:

Autoimmune thyroid disease (at diagnosis), such as Hashimoto's thyroiditis. See the CKS topic on Hypothyroidism for more information."

cks.nice.org.uk/topics/coel...

Also:

The main cause of folate malabsorption is gluten-induced enteropathy.

cks.nice.org.uk/topics/anae...

NB I doubt very much that you were subclinical at diagnosis, and mention it here in case it fits somebody else's circumstanes.

[Sandiij in reply to nellie237]

Thank you. I will run this by him when I discuss latest results with him.

[SlowDragon Administrator]

As you have B12 injections it’s recommended also to supplement a good quality daily vitamin B complex, one with folate in (not folic acid)This can help keep all B vitamins in balance and will help maintain B12 levels between injections 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 recommended vitamin B complex that contains folate, but they 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

Metaformin lowers B12 and TSH

Metaformin lowers TSH

cureus.com/articles/50564-e...

gov.uk/drug-safety-update/m...