This is my first post, may I have some help on my latest blood tests please?
All my tests (Medichecks) were done according to the recommended protocol; fasting, no Levo for 24 hours, bloods drawn at 9am. I'm not currently taking any biotin. I am currently taking 50mcg Levothyroxine.
My symptoms are: Fatigue, brain fog, uncontrollable weight gain, joint pain (arthritis), almost constantly on my period.
August 2022 Results :
TSH: 4.03 mU/L, 96% (0.27 - 4.2)
fT3: 3.87 pmol/L, 21% (3.1 - 6.8)
fT4: 15 pmol/L, 30% (12 - 22)
Thyroglobulin Antibodies: >4000 IU/mL (<115)
Thyroid Peroxidase Antibodies: 95 IU/mL (<34)
Vitamin D: 56 nmol/L, 4% (50 - 200)
Vitamin’s B12: 70.8 pmol/L, 30% (37.5 - 150)
Folate - Serum: 10.65 ug/L (>3.89)
Ferritin: 79.5 ug/L, 48% (13 - 150)
Oestradiaol (Luteal): 129 pmol/L (82 - 1251)
GGT: 38 U/L (5 - 36)
Bilirubin: 7.8 umol/L (<21)
ALP: 57 IU/L (30 - 130)
ALT: 23 U/L (<35)
July 2020 Results:
TSH: 5.6 mU/L, 122% (0.27 - 4.2)
fT3: 3.76 pmol/L, 18% (3.1 - 6.8)
fT4: 12.6 pmol/L, 6% (12 - 22)
Thyroglobulin Antibodies: >4000 IU/mL (<115)
Thyroid Peroxidase Antibodies: 89.3 IU/mL (<34)
No other vitamins, etc tested.
My husband posted my results in 2020 and with your kind advice I was prescribed 50mcg Levothyroxine. I haven't been regularly supplementing any nutrients, though sporadically taking Folic Acid prescribed by GP. I think I need a Levo dose increase and I can also see I need to start taking Vitamin D3 regularly, but may I have any other recommendations please?
Thank you.
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Hexagon74
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Which brand of levothyroxine are you currently taking
Ideally do NOT change brand when increasing….only change one thing at a time
Having been left extremely under medicated for a long time ….you might want to increase dose slowly…initially adding just 12.5mcg (so 62.5mcg daily) ….wait 6-8 weeks and then increase to 75mcg daily before retesting 6-8 weeks after being on 75mcg daily
Likely to need further increase in levothyroxine after next test
Approx how much do you weigh in kilo
Guidelines on dose levothyroxine by weight is that MOST people will end up on approx 1.6mcg levothyroxine per kilo of your weight per day
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.
High thyroid antibodies confirms autoimmune thyroid disease also called Hashimoto’s
Have you had ultrasound scan of thyroid?
Autoimmune thyroid disease with goitre is Hashimoto’s
Autoimmune thyroid disease without goitre is Ord’s thyroiditis.
Both are autoimmune and generally called Hashimoto’s.
Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)
In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)
Poor gut function with Hashimoto’s can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common.
According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps, sometimes significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)
Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies
While still eating high gluten diet ask GP for coeliac blood test first or buy test online for under £20, just to rule it out first
Assuming test is negative you can immediately go on strictly gluten free diet
(If test is positive you will need to remain on high gluten diet until endoscopy, maximum 6 weeks wait officially)
Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse
The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported
In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned
Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.
They did an ultrasound in 2020 , have loads of polyps. There’s a couple that are quite big but they said they won’t need to do another scan. I assume it’s Ord’s thyoiditis. I have had a celiac test which came back negative, but I definitely find I feel better when I decrease gluten, I’ll have to start being stricter about my diet 👍. I also decreased my intake of dairy 10yrs ago as it just causes me to feel ill, especially milk which I haven’t had since - too painful.
If a patient reports persistent symptoms when switching between different levothyroxine tablet formulations, consider consistently prescribing a specific product known to be well tolerated by the patient. If symptoms or poor control of thyroid function persist (despite adhering to a specific product), consider prescribing levothyroxine in an oral solution formulation.
Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).
Levothyroxine is an extremely fussy hormone and should always be taken on an empty stomach and then nothing apart from water for at least an hour after
Many people take Levothyroxine soon after waking, but it may be more convenient and perhaps more effective taken at bedtime
No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.
Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away
(Time gap doesn't apply to Vitamin D mouth spray)
If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test
If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal
Results the same for both tests two years apart. I think this may be an error. Are those the current results?
I haven't been regularly supplementing any nutrients, though sporadically taking Folic Acid prescribed by GP.
For Active B12 we tend to suggest aiming for 100 plus. If not supplementing I would suggest a good bioavailable B Complex and this will help raise B12 and raise/maintain your folate level. Once the folic acid had increased your folate level you shouldn't just stop and start again when it drops again, you take something to maintain the level and B Complex should do that.
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).
As for Vit D, The Vit D Society and Grassroots Health recommend a level of 100-150nmol/L, (40-60ng/ml) with a recent blog post on Grassroots Health mentioning a study which recommends over 125nmol/L (50ng//ml). You might want to check out a recent post that I wrote about Vit D and supplementing:
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