I'm looking for some advice on my recent thyroid panel tests from Medichecks.
I am 40 years old, recently diagnosed with Hashimoto's Disease, and trying to get pregnant. I am currently taking 50mcg levothyroxine (not taken the morning of the blood test), fertility vitamins (impryl) which includes folate, as well as vitamin D3, and B6. Here are my results:
CRP inflammation: <0.3 mg/L
Ferritin: 41.2ug/L
Folate (serum): 9.46 ug/L
Vitamin B12 active: 78 pmol/L
Vitamin D: 84 nmol/L
TSH - 4.1mU/L
FREE T3: 4.66 pmol/L
Free thyroxine: 14.7 pmol/L
Thyroglobin Antibodies: 258 IU/mL
Thyroid Peroxidase: 475 IU/mL
I'd be very grateful for any advice. Particularly on the thyroid antibodies. Does this confirm a diagnosis of Hashimoto's? They look really high to me! What can I do to reduce them? And are the other markers (TSH esp) optimal for getting pregnant or is there more I could be doing?
Thanks so much,
Rebecca
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For future reference, when posting test results we always need the reference ranges that come with them, this is because ranges vary from lab to lab. However, I do know Medichecks' ranges (if Eurofins County Pathology carried out the tests) so I can comment as follows:
CRP inflammation: <0.3 mg/L (<5)
This is a good result. As an inflammation marker the lower the result the better.
Ferritin: 41.2ug/L (13-150)
This is too low. Ferritin is recommended to be half way through range so that would be around 82 with that range.
We do not suggest self supplementing with iron. Iron is complicated and to know if you are iron deficient you would have to have an iron panel done, this would include serum iron, transferrin saturation percentage, total iron binding capacity plus ferritin. Low ferritin on it's own does not necessarily mean that your iron level is low.
Normally we would suggest that to raise ferritin (without iron deficiency) then one should eat iron rich foods such as liver, pate, etc. Obviously this is not possible when pregnant but could possibly be OK at the moment.
Folate (serum): 9.46 ug/L (3.89-19.45)
Folate is recommended to be at least half way through range which would be around 12 plus with that range. So yours is on the lowish side but not dire.
Vitamin B12 active: 78 pmol/L (37.5-188)
Active B12 below 70 suggests testing for B12 deficiency. We always suggest Active B12 is best over 100.
To improve B12 you could supplement with sublingual B12 methylcobalamin, along with a good quality, bioavailable B Complex to keep all B vitamins balanced. Just use one bottle of B12 and that should raise your level enough to then just continue with the B Complex.
Suggestions for B12 supplements which include two forms of bioactive B12 - methylcobalamin and adenosylcobalamin which you might want to check out:
Note that the Nature Provides supplement contains a much higher dose than the Cytoplan one.
For B Complex 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).
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 will continue in a new post below as there is a character limit.
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).
So now you look at how much is needed to reach 50ng/ml and you'll see that they suggest 2,500iu per day.
Retest after 3 months.
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.
Again, 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.
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.
Your TSH is too high, your FT4 is a mere 27% through range and your FT3 is 42.16% through range.
You are still on a starter dose of Levo (50mcg) and you need an increase, 25mcg now, retest in 6-8 weeks.
For successful conception and pregnancy it's recommended that TSH be below 2.5
There are some links to information about hypothyroidism and pregnancy on ThyroidUK's main website here which you may wish to check out:
These elevated antibody levels confirm autoimmune thyroid disease (Hashimoto's). Hashi's isn't treated, it's the resulting hypothyroidism that is.
Fluctuations in symptoms and test results are common with Hashi's.
Most doctors dismiss antibodies as being of no importance and know little or nothing about Hashi's and how it affects the patient, test results and symptoms. It would be best to read, learn, understand and help yourself where Hashi's is concerned.
Some members have found that adopting a strict gluten free diet can help, although there is no guarantee.
Gluten contains gliadin (a protein) which is thought to trigger autoimmune attacks so eliminating gluten can help reduce these attacks.
You don't need to be gluten sensitive or have Coeliac disease for a gluten free diet to help.
Thank you so much for all this, so very helpful and detailed. I have recently started a gluten/dairy/soya free elimination diet, and I think will stay off gluten whether or not my symptoms change while I'm off it (although I don't have much by way of gut related symptoms anyway) so we'll see if that makes a difference. I will look into all those vitamins and supplements you recommended.
This is the results after about 5 1/2 months of taking 50mcg levo. At the moment I can't find my results from before, or the ones from (I think) 6 weeks after - will get another print out from the doctors on Tuesday.
The brand I'm on at the moment is Accord but usually it is Mercury. I assume because of supply issues it changes sometimes, but the pharmacist said it wouldn't make a difference. Does it? I haven't noticed any differences, but then I never really had the classic hypothryoid symptoms.
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.
when adequately treated on levothyroxine Ft3 is almost always at least 50-60% through range and usually Ft4 will need to be higher at 70-80% through range, unless extremely good conversion rate
Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption
Obviously guidelines these days say …..no liver if pregnant
This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.
Thyroid disease is as much about optimising vitamins as thyroid hormones
Never supplement iron without doing full iron panel test for anaemia first and retest 3-4 times a year if self supplementing. It’s possible to have low ferritin but high iron
Thank you everyone for all this information. And apologies for not responding sooner - I had some internet issues.
I will push the GP about increasing my levo dose (and thank you for the ammunition). She has said that the endocrinologist advised that the target TSH for getting pregnant was 0.3-3. The last blood tests I had done in May after starting levo (in Feb) had the TSH at 2.5, so they didn't increase it. But I didn't know not to take the levo dose the morning of the test so would that explain the increase to 4.5 in the most recent test? Which result would be most reliable?
In terms of iron/ferritin, at the same time as the recent medichecks test my GP also tested serum ferritin which was 36 ug/l (13.00-150.00ug.l). They say that needs no action. Can you tell with that if I'm low in iron? I was taking ferrous sulphate (2x 200mg per day) but my GP said I could stop taking that. I've heard that it's better to take iron as a patch or liquid so that it bypasses the gut and doesn't cause any constipation or digestive issues. Does anyone have any advice on this? I do wonder if I have some kind of absorption issue as I eat so much iron-rich food (although not liver as I hate the taste!) - red meat regularly, green leafy veg all the time, lentils, chick peas, beans etc. Hopefully the elimination diet will help to identify/address this.
I'm also eating about 4 brazil nuts a day - would this mean I don't need the selenium supplement?
And with the B12, I'm currently taking a supplement with 400mcg folate and 2.5mcg vitamin B12. Do I need to worry about adding to this with the recommended amounts of B12/B complex?
One more question - does having low inflammation results mean that my gut is healthy? (I've read that gut inflammation can cause hashi's/poor nutrient absorption).
Thank you so much for all your help - despite doing a fair amount of research I'm finding it all very confusing!
The last blood tests I had done in May after starting levo (in Feb)…TSH at 2.5, so they didn't increase it. But I didn't know not to take the levo dose the morning of the test so would that explain the increase to 4.5 in the most recent test?
When we start (or increase dose) levothyroxine initially TSH drops ….as the body gets use to increased dose and metabolism improves …..TSH slowly increases ….then you’re ready for next dose increase in levothyroxine
When dose of levothyroxine is increased to 75mcg …..initially TSH will drop…..but retest after 6-8;weeks……and retest again in a further 6-8 weeks if not ready for next increase in dose
At the moment it's Accord but usually it is Mercury. I assume because of supply issues it changes sometimes, but the pharmacist said it wouldn't make a difference. Does it? I haven't noticed any differences, but then I never really had the classic hypothryoid symptoms.
Many people find Levothyroxine brands are not interchangeable.
Many patients do NOT get on well with Teva brand of Levothyroxine.
Teva contains mannitol as a filler, which seems to be possible cause of problems. Teva is the only brand that makes 75mcg tablet. So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half
But for some people (usually if lactose intolerant, Teva is by far the best option)
Glenmark or Aristo (100mcg only) are lactose free and mannitol free. May be difficult to track down Glenmark, not been available very long
Most easily available (and often most easily tolerated) are Mercury Pharma or Accord
Mercury Pharma make 25mcg, 50mcg and 100mcg tablets
Accord only make 50mcg and 100mcg tablets
Accord is also boxed as Almus via Boots, and Northstar 50mcg and 100mcg via Lloyds ....but Accord doesn’t make 25mcg tablets
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.
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
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
REMEMBER.....very important....stop taking any supplements that contain biotin a week before ALL BLOOD TESTS as biotin can falsely affect test results - eg vitamin B complex
Thanks for this. I take my levo first thing in the morning (usually when my partner wakes up for work) so there's always a few hours gap between when I take it and when I eat/drink coffee etc.
In terms of B vitamins to take - is it ok to take a vitamin B complex alongside a fertility supplement I'm taking which contains : 1.4mg B6, 400mcg Folic acid (5MTHF - glucosamine) and 2.5 mcg B12 (methylocobalamin)?
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
In week before blood test, when you stop vitamin B complex, you might want to consider just taking a separate methyl folate supplement and a separate B12
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