I have been following this site for some time, and would really appreciate an opinion on my blood test results. At the time of tests I was taking 125/150g alternate days, I have ,since my partial thyroidectomy in 1999. Taken 150g, although gp advised I am over medicated, but was happy as I was feeling well. After seeing endo, i have been told to decrease dose to 125, unfortunately I now feel very lethargic and tire after doing the smallest thing.
My results are
Serum TSH 0.01. 0.35-5.50 mu/L
Serum T4 level. 18.5. 10.0020.00pmol/L
Plasma free T3. 4.8. 3.50-6-50. “
HbA1c level - IFCC standardised (MM3130)
41. mmol/mol. 26.00-41.00mmol/mol
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R7vfmbroadway
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* No biotin, B Complex or any supplement containing biotin (B7) for 3-7 days before test
If so then your results can be interpreted as follows:
Serum TSH 0.01. 0.35-5.50 mu/L
Serum T4 level. 18.5. 10.0020.00pmol/L
Plasma free T3. 4.8. 3.50-6-50. “
A hypo patient on Levo only, generally, would have TSH 1 or below with FT4 and FT3 in the upper part of their reference ranges, if that is where you feel well.
Your FT4 is 85% through range and your FT3 is only 43.33% through range, this shows poor conversion of T4 to T3. It's low T3 that causes symptoms.
How long have you been on the reduced dose of 125mcg?
Even though when taking 150mcg you felt well, maybe FT4 was over range but your conversion would still have been poor. It's better to keep FT4 in range and add T3 to bring a better balance of FT4 and FT3.
However, before adding T3 you need to know if your key nutrients are at optimal levels, they need to be for good conversion of T4. Have you had the following tested:
Vit D
B12
Folate
Ferritin
If not then I would ask for them to be done, post results/ranges on here for comment.
Your HbA1c is top of range, I'd keep an eye on it as it would be better if you don't proceed to pre-diabetic.
The Vit D Council, the Vit D Society and Grassroots Health all 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:
and you can check out the link to how to work out the dose you need to increase your current level to the recommended level.
Your current level of 86.3nmol/L = 34.52ng/ml
On the Vit D Council's website you would scroll down to the 4th table
My level is between 30-40 ng/ml
So now you look at how much is needed to reach 50ng/ml and you'll see that they suggest 2,500iu per day.
Bearing in mind that your only 20.8 you could also look at the 2nd table for current level between 10-20ng/ml and you'll see that one suggests 4,900iu D3 daily.
You should be perfectly OK to supplement with 4,000iu D3 daily.
When starting to supplement we should retest after 3 months to check our level.
Once you've reached the recommended level then a maintenance dose will be needed to keep it there, which may be 2000iu daily, maybe more or less, maybe less in summer than winter, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. This can be done with a private fingerprick blood spot test with an NHS lab which offers this test to the general public:
Doctors don't know, because they're not taught much about nutrients, but there are important cofactors needed when taking D3. You will have to buy these yourself.
D3 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 such as hardening of the arteries, kidney stones, etc. 90-100mcg K2-MK7 is enough for up to 10,000iu D3.
D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds if taking D3 as tablets/capsules/softgels, no necessity if using an oral spray.
For D3 I like Doctor's Best D3 softgels, they are an oil based very small softgel which contains just two ingredients - D3 and extra virgin olive oil, a good quality, nice clean supplement which is budget friendly. Some people like BetterYou oral spray but this contains a lot of excipients and works out more expensive.
For Vit K2-MK7 my suggestions are Vitabay, Vegavero or Vitamaze brands which all contain the correct form of K2-MK7 - the "All Trans" form rather than the "Cis" form. The All Trans form is the bioactive form, a bit like methylfolate is the bioactive form of folic acid.
Vitabay and Vegavero are either tablets or capsules.
Vitabay does do an oil based liquid.
Vitamaze is an oil based liquid.
With the oil based liquids the are xx amount of K2-MK7 per drop so you just take the appropriate amount of drops.
They are all imported German brands, you can find them on Amazon although they do go out of stock from time to time. I get what I can when I need to restock. If the tablet or capsule form is only in 200mcg dose at the time I take those on alternate days.
If looking for a combined D3/K2 supplement, this one has 3,000iu D3 and 50mcg K2-MK7. The K2-MK7 is the All-Trans form
Magnesium should be taken 4 hours away from thyroid meds and as it tends to be calming it's best taken in the evening. Vit D should also be taken 4 hours away from thyroid meds. Vit K2-MK7 should be taken 2 hours away from thyroid meds. Don't take D3 and K2 at the same time unless both are oil based supplements, they both are fat soluble vitamins which require their own fat to be absorbed otherwise they will compete for the fat.
B12. 495. 211-911
Presumably the unit of measurement is pg/ml (or ng/L, they are both the same).
This is a little low. 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."
A good quality, bioavailable B Complex will help raise your level. 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).
Folate 15. >4.00/L
Folate is recommended to be at least half way through range, but where there is no upper and lower limit to the range we always suggest aiming for double figures. Your folate level seems to be fine. The B Complex contains some methylfolate which will help maintain, maybe even increase your level a little.
Ferritin 53. 10.00-291.00ug/L
This is poor. Ferritin is recommended to be half way through range, that would be about 150 with your range.
Some experts say that the optimal ferritin level for thyroid function is 90-110ug/L.
You can help raise your level by eating liver regularly, maximum 200g per week due to it's high Vit A content, also liver pate, black pudding, and including lots of iron rich foods in your diet
Don't consider taking an iron supplement unless you do an iron panel, if you already have a decent level of serum iron and a good saturation percentage then taking iron tablets can push your iron level even higher, too much iron is as bad as too little.
Don't start all supplements at once. Start with one, give it a week or two and if no adverse reaction then add the next one. Again, wait a week or two and if no adverse reaction add the next one. Continue like this. If you do have any adverse reaction then you will know what caused it.
I have been on reduced dosage approx 6 weeks.
So you've tested at the right time, although personally I still see a difference at 8-10 weeks as my levels seem to need that length of time to settle.
Your T4 to T3 conversion is poor, optimising your ferritin level may help so I'd give that a go before doing anything else.
Am I correct in thinking , in the UK it is not normal practice to prescribe T3
Not exactly. Some endos are pro-T3, many aren't. Some CCGs allow T3 to be prescribed, some don't. So it's a case of if your area does prescribe and finding an endo to initiate a trial (GPs can't initiate a trial of T3).
Suggest you get all four vitamins improved to optimal
Do you always get same brand levothyroxine at each prescription
You could also try splitting your dose levothyroxine. Taking half dose waking and half at bedtime…..this might improve conversion rate too
Retest thyroid levels after 6-8 weeks
If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test
Similarly if normally splitting your levothyroxine, take whole daily dose 24 hours before 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
If Ft3 remains low ….may need addition of T3 prescribed alongside levothyroxine
Can I just add that a fully functioning working thyroid would be supporting you, on a daily basis, with trace elements of T1. T2 and calcitonin plus a measure of T3 at around 10 mcg plus a measure of T4 at around 100mcg.
T4 is prohormone, a storage hormone, and needs to convert in your body into T3 the active hormone which runs your body and read the average person needs to find convert/find around 50 T3 daily just to function.
The thyroid is a major gland responsible for full body synchronisation including your physical, mental, emotional, psychological and spiritual well being, your inner central heating system and your metabolism.
No thyroid hormone replacement works well until your ferritin, folate, B12 and vitamin D are up and maintained at optimal levels and conversion can also be compromised by inflammation, and physiological stress ( physical or emotional ) dieting, depression and ageing - so whilst we can't yet turn back time we do need to keep these other issues in mind.
Once on any form of thyroid hormone replacement it is essential that you are dosed and monitored on your T3 and T4 bloods and not a TSH reading looked at in isolation, which I'm afraid seems to be what this endocrinologist is doing.
In fact you likely have ' room ' for a dose increase in Levothyroxine since your T4 is at 85 % which is giving you a T3 at around 46% and we generally need our T3 at over 50% : and it is acceptable to run a T4 slightly over range if this results in a good level of T3 and resolves symptoms.
We generally feel at our best when our T3 and T4 are in balance at around a 1/4 ratio T3/T4 :
So if we divide your T4 by your T3 we can see you ratio is at around 3.85 so a good rate of conversion as the accepted ratio when on T4 only is said to be 1 - 3.50 - 4.50 T3/T4 with most people feeling at their best with a ratio at around 4 or under.
The TSH was originally introduced as a diagnostic tool to help identify a person suffering with hypothyroidism and was never intended to be used once the patient was on any form of thyroid hormone replacement, as then you must look at the T3 and T4 blood test results.
Some people can get by on T4 only :
Some people find that T4 seems to not work as well as it once did and need the addition of a little T3 alongside their T4 - and considering you have ' half ' your thyroid what is left is probably in overdrive. overstretched and over time this maybe pulling you down.
Some people can't tolerate T4 - Levothyroxine and need to take T3 - Liothyronine only :
Whilst others find their health restored better by taking Natural Desiccated Thyroid which contains all the same known hormones as that of the human gland and the original successful treatment for hypothyroidism for over 100 years.
NDT is made from pig thyroids dried and ground down into tablets referred to as grains.
You do not need a dose reduction and I'm afraid going this route will slow down your metabolism even further and put further strain on your body.
I'm with Graves Disease post RAI thyroid ablation in 2005 and became very unwell some 10 years later - details on my profile page - I have been refused both T3 and NDT by my doctor and hospital. I have been self medicating for over 4 years now, have my life back and am much improved thanks to a couple of books and Thyroid UK the charity who support this amazing forum.
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