Hi, my fatigue seems to be getting worse - I have just had the following results. I have Hashimotos and am on 100mg levothyroxine (and have been for 7 years). Any advice would be greatly appreciated! Thanks🙂
TSH: 0.16 mU/l (Range 0.27 - 4.2) -2.80%
FT4: 21 pmol/l (Range 12 - 22) 90.00% (should be >75%)
FT3: 4.8 pmol/l (Range 3.1 - 6.8) 45.95%
Jasper12345
Could negative TSH result explain extreme fatigue?
Unlikely.
FT4: 21 pmol/l (Range 12 - 22) 90.00% (should be >75%)
Well, the "should be >75%" is debatable. We need it where we need it, it's not set in stone.
FT3: 4.8 pmol/l (Range 3.1 - 6.8) 45.95%
This is more likely to be your problem. Your FT3 is only 50% of your FT4 which shows poor conversion, they should be better balanced.
If they were better balanced you might find that you felt OK at around 70%, but it's something we have to find out for ourselves.
So your current results show poor conversion as was explained to you in reply to your previous post about these results here:
healthunlocked.com/thyroidu...
In answer to a question about your nutrient levels you told us that your ferritin result was 169 (13.0 - 150.0), that could possibly be a false high due to inflammation which is common with Hashi's. You could do with an inflammation marker being tested at the same time - CRP.
What about Vit D, B12 and Folate? What are these results, you didn't tell us that.
Thanks for the prompt response 😊 Vit D was 70 in March 21 - I have been on 800mg vit D since then - but has not been retested. B12 was 313 in Feb 22 (range of 130 to 800) . I don't seem to have a test result for Folate . My ferratin was retested and was 127 in Feb (from range of 13 to 150). Thanks for the link to my previous post - I couldn't find it! So.. is my next step to request a referral to an Endo in order to be prescribed T3?
Jasper12345
Vit D was 70 in March 21 - I have been on 800mg vit D since then - but has not been retested.
We should retest 3 months after starting Vit D to check level to see if it needs adjusting. Then twice a year whilst supplementing to ensure we're taking enough or not too much.
800iu (not mg 
) is barely a maintenance dose for someone who already has a decent level so your level may not have increased much, if at all, although if you make Vit D naturally from the sun then the recent good weather may have helped. It would be a good idea to test end of October which will then tell you what you need to take during the winter. Post new result for suggestions at the time.
B12 was 313 in Feb 22 (range of 130 to 800) .
This is a very poor result. Are you supplementing with B12 and B Complex?
So.. is my next step to request a referral to an Endo in order to be prescribed T3?
You can ask, whether or not an endo will agree to see you is another thing, you could be refused due to your resuts being in range, they just look at the figures and "in range" is fine as far as they are concerned, they don't seem to understand about poor conversion, etc.
I would work on optimising your B12 and Vit D. Possibly consider selenium as this is said to help conversion - 100mcg or no more than 200mcg without testing. Look for selenium l-selenomethionine or a yeast bound selenium (avoid selenite and selenate forms). Maybe consider Cytoplan, a very small tablet containing 100mcg elemental selenium, this one has no unpleasant odour unlike quite a few brands:
Ok thanks. I have not been taking B12 or B complex - I assume I can get these from a health food shop? I will also start taking Cytoplan. ...
Best not to buy any supplements from a high street health food shop or store, they tend not to have the best brands. Good brands are found on the internet. I would suggest the following
B12 sublingual:
Cytoplan sublingual B12 lozenges
cytoplan.co.uk/vitamin-b12-...
or
Nature Provides sublingual liquid
amazon.co.uk/Bioactive-METH...
Note that the Nature Provides supplement contains a much higher dose than the Cytoplan one.
B complex:
I have used Thorne Basic B for a long time and always been happy.
Ebay is cheapest at the moment: ebay.co.uk/itm/384223912852?
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).
Personally, I would suggest retesting B12 before supplementing as around 50% of those with thyroid problems go on to develop PA/B12def. and vice versa. It is very difficult to get a diagnosis once you supplement. Relentless fatigue can be one of the first major neurological symptoms. The PA Society, Tracey Witty’s and Dr J Chandy’s website give more details.
Best wishes finding answers soon 🤞
B12 was 313 in Feb 22 (range of 130 to 800) .
I don't seem to have a test result for Folate .
Did you start supplementing vitamin B complex and separate B12 after this low result
supplementing 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 improve B12 levels too
Difference between folate and folic acid
chriskresser.com/folate-vs-...
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 5-7 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 continue separate B12
Low B12 symptoms
b12deficiency.info/signs-an...
With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a B12 supplement as well as a B Complex (to balance all the B vitamins) initially for first 2-4 months.
once your serum B12 is over 500 (or Active B12 level has reached 70), stop the B12 and just carry on with the B Complex.
B12 drops
healthunlocked.com/thyroidu...
B12 sublingual lozenges
amazon.co.uk/Jarrow-Methylc...
cytoplan.co.uk/shop-by-prod...
B12 range in U.K. is too wide
Interesting that in this research B12 below 400 is considered inadequate
healthunlocked.com/thyroidu...
How other member saw how effective improving low B vitamins has been
healthunlocked.com/thyroidu...
Great - thanks for the link. Really helpful 🙂
unlikely 800iu is high enough dose vitamin D
Test twice yearly via NHS private testing service when supplementing
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...
Another member recommended this one recently
Vitamin D with k2
amazon.co.uk/Strength-Subli...
It’s trial and error what dose we need, with thyroid issues 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...
Thank you!
personal experience recently was yes. I reduced by 75 over a week and feel better fatigue wise. Alongside increased hrt. But I don’t have a conversion issue
tsh didn’t actually change from 0.2 (and I’ve since had several tests as they test every time I get an oestrogen test) but t4 dropped slightly to 19/20
Your low FT3 level is most likely the cause of your fatigue.
T3 is the active thyroid hormone and for good health needs to saturate almost every cell in the body with a constant and adequate supply
Low cellular T3 = poor health
Your T4 to T3 conversion is poor....evidenced by high FT4 with low FT3
This poor conversion would account for falling FT3 ( have you had it tested previous to this?) and consequently increasing fatigue
You must also consider that hormone levels may fluctuate slightly with Hashi's
First you need to optimise essential nutrients vit D, vit B12, folate and ferritin.....you don't mention them.
I suggest you work on those nutrients and increase levo dose by 25mcg....you may eventualy need 150mcg levo to attempt to adequately raise
Don't be persuaded to dose by TSH for the following reasons
thyroidpatients.ca/2021/07/...
Good luck
Thanks!
suggest you get vitamin D tested
Likely it may need improvement
Work on improving low B vitamins
Retest thyroid and vitamin levels in 6-8 weeks
See if Ft3 is improving
If it is ……be patient and retest again in another 6-8 weeks
TSH extremely low but low-ish free T3 and free T4
New & Confused: Could it be Hashi/Ord's or Adrenal Fatigue?
Could someone explain my blood results please?
My results? Could they cause constant fatigue? 
Thyroid Blood test results- explain please
