What supplements do you normally take that you left off?
The only supplements you need to leave off are
Iron for 7 days
B Complex or biotin or any supplement containing biotin for 3-7 days, this is because it can give false blood test results. High dose biotin as in a stand alone supplement or hair/nail supplement, eg 5-10mg you leave off for 7 days, the smaller amount in a B Complex, eg 400-500mcg, you leave off for 3-4 days.
Everything else you continue with up to and including the day before the test.
B12: 290ng/L
Some people with B12 in the 300s have been found to need B12 injections.
Do you have any symptoms of B12 deficiency - check here:
If you do then list them to discuss with your GP and ask for testing for B12 deficiency and Pernicious Anaemia. Do not take any B12 supplements or folic acid/folate/B Complex supplements before further testing of B12 as this will mask signs of B12 deficiency and skew results and if you have B12 deficiency is not detected and treated then this could affect your nervous system. B12 deficiency should be treated before starting folic acid because folic acid can sometimes improve your symptoms so much that is masks B12 deficiency.
Ferritin: 59ng/ml (15-300)
This is low. Ferritin is recommended to be half way through range, so with yuor range that would be 157, although some experts say the optimal level for thyroid function is 90-110ug/L (ug/L is the same as ng/ml).
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.
Iron panel consists of serum iron, transferrin saturation percentage, total iron binding capacity plus ferritin. This would show if you have iron deficiency.
Also you would need a full blood count to see if you have anaemia. You can have iron deficiency with or without anaemia.
Folate is over range and unmeasurable.
Vit D at 107nmol/L is good, recommended is 100-150nmol/L.
TSH: 0.06 (0.3-5.0)
FT4: 12.6 (7.9-16) = 58.02% through range
FT3: 5 (3.8-6.0) = 54.55% through range
How do you feel with those thyroid levels?
If you feel less than optimal there is room for an increase but personally I would just do a small increase of 12.5mcg and retest in 6-8 weeks minimum to check levels and how you feel. If you feel the need for more then another 12.5mcg max and retest again. I doubt you'd need more than that.
I was taking a multivitamin (wearefeel.com/products/esse... but recently advised on here to stop due to iodine content. I hadn't realised this was wrong!
I've not taken any vitamins for a couple of weeks now and definitely feel lacking. I just don't know which to take, I'm a bit confused! Should I take a B-complex and D3? I'm keen to get back on some vitamins ASAP - are you able to recommend a good brand / product?
I definitely have B12 deficiency symptoms - my tinnitus is horrendous atm and seems to be getting worse, weekly. I assumed it was just thyroid connected but makes sense it could be due to low B12. I'll request a full blood count test too and B12 help from my GP.
I'm vegetarian so can only get B12 through leafy greens mostly - which I eat a lot of!
I feel great (or did before stopping vitamins!) on 100mcg of levo. I had to battle to get this dose and for the first time since being diagnosed in January this year, I'm not gaining weight and even starting to lose a bit. Most other symptoms have eased off too - just the tinnitus and tiredness creeping back in, but I think that may be the lack of vits.
I'd love to stay on 100mcg but my GP says my TSH is below threshold and needs to be 0.3 min. They say the risk of irregular heart rate and osteoporosis is high if I stay below threshold? They've prescribed me 100mcg 5x week then 75mcg at weekends. Would staying on 100mcg be a risk, do you think?
Should I take a B-complex and D3? I'm keen to get back on some vitamins ASAP - are you able to recommend a good brand / product?
No, not at the moment if you have signs of B12 deficiency, this must be looked into first because as I said above
Do not take any B12 supplements or folic acid/folate/B Complex supplements before further testing of B12 as this will mask signs of B12 deficiency and skew results, if you have B12 deficiency and it's not detected and treated then this could affect your nervous system. B12 deficiency should be treated before starting folic acid because folic acid can sometimes improve your symptoms so much that is masks B12 deficiency.
So list your symptoms and discuss with your GP. Don't let your GP fob you off with the fact that your B12 is within range, symptoms should take precedence over numbers where B12 is concerned.
As for Vit D, as I said your level is within the range recommended, i.e. 100-150nmol/L. The Vit D Council, Vit D Society and Grassroots Health all recommend a level of 100-150nmol/L with a recent blog post on Grassroots Health recommending at least 125nmol/L. It might be worth you supplementing during the winter months when we can't make Vit D naturally from the sun. So maybe from now until March you might want to consider taking 2,000iu D3 as a winter dose.
There are important cofactors needed when taking D3. 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.
You could consider a combined D3/K2 supplement, this one has 3,000iu D3 and 50mcg K2-MK7. You could maybe take that 5 days a week (have weekends off). 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.
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'd love to stay on 100mcg but my GP says my TSH is below threshold and needs to be 0.3 min. They say the risk of irregular heart rate and osteoporosis is high if I stay below threshold?
Your doctor is like most, they've been brainwashed into thinking this but it's incorrect.
See replies by our advisor and thyroid researcher Diogenes, here are a couple:
Also, Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (the professional publication for doctors):
"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l. In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance. But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l. This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l).*"
*He confirmed, during a talk he gave to The Thyroid Trust in November 2018 that this applies to Free T3 as well as Total T3 and this is when on Levo only. You can hear this at 1 hour 19 mins to 1 hour 21 minutes in this video of that talk youtu.be/HYhYAVyKzhw
You can obtain a copy of the article which contains this quote from ThyroidUK
Email : tukadmin@thyroiduk.org
and ask for the Dr Toft article from Pulse magazine. Print it and highlight Question 6 to show your GP.
When your GP says you must lower your dose, your argument is tht your FT4 and FT3 are only just over half way through range so you can't be overmedicated. You can refuse to lower your dose, your GP can advise but not dictate to you. My GP is the same, she constantly tells me that because my TSH is suppressed I am overmedicated and should reduce my dose. I reply with "But TSH is not a thyroid hormone, it's a pituitary hormone. FT4 and FT3 are the thyroid hormones and both are well within range". She repeats about the TSH so I repeat about the FT4 and FT3, I do not lower my dose as long as my thyroid hormones are in range. It's actually the FT3 that is most important, that tells us if we are over medicated if that goes over range.
If you feel good on 100mcg then advocate for yourself to keep your dose.
If you want to quote the dose by weight that is stated in the NICE guidelines that might help
Consider starting LT4 at a dosage of 1.6 micrograms per kilogram of bodyweight per day (rounded to the nearest 25 micrograms) for adults under 65 years of age with primary hypothyroidism and no history of cardiovascular disease.
75.5kg x 1.6 = 119.2
so that would be 120mcg Levo but if you feel great on 100mcg then that is your optimal dose, you don't have to have as much as it works out to, it's purely a guide to be adjusted to suit the individual.
Others will be along, but is that the cut off result of a FT3 result I spy at the bottom of the results page?
Questions
You make absolutely no mention of how you are actually feeling- are you feeling well are there any symptoms?
It’s important and you need to calibrate any test to how YOU actually feel and keep doing so. Bring how you feel into the conversation with the doctor. If you do not, the GP will simply calibrate YOU to the test.
If you then become symptomatic this is usually when you will be gaslighted if the GP deems you “normal” by virtue of ‘in range’ results and you not obliging by feeling great.
Then if this frustrates you and makes you depressed they will give you antidepressants to ‘treat’ the depression which will ACTUALLY be a symptom of under medication.
So Why exactly do they want to reduce your Levothyroxine? 🤔
Do you have symptoms of over medication or are they treating the lab work? (Most likely the latter) TSH!
What is your weight? Have you calculated your guide dose from the NHS Guidelines.
If all you do is familiarise yourself with the current NHS guidelines chances are you will know more than the GP.
I was approximately 15 stone (95 Kg) when I got to my optimal dose and calculated from NHS guidelines of 1.6 ug levo per Kg body weight
95 x 1.6 =152ug I rounded down to 150ug and had to fight for every dose increase because GPs do not understand how to interpret data, are woefully out of date with latest research and use the least reliable measure to manage a patient’s condition, that being TSH.
Lag over from research that says suppressed TSH is bad for health. Not refuting that but more recent research shows being under medicated has equal if not greater risks and there is no consideration of Quality of Life. We have to introduce these topics into the conversation or they will not even be considered.
Sorry if this sounds bleak, but so many people coming onto the forum having been utterly mismanaged from the outset. The sooner people get on track the much better the outcome.
I found the forum about 6 months after my diagnosis and acted very quickly to advice forum gave me - I credit the forum with my being well. 😊👍
SeasideSusie has given great comprehensive advice and for more about Debunking TSH there is a pinned post collated by tattybogle .
Thanks so much Charlie-Farley, this is really helpful.
Yes, I managed to get my T3 tested via my GP! I'm amazed! I added pg 2 of the results in a separate photo reply - it's 5.0.
I'd love to stay on 100mcg but my GP says my TSH is below threshold and needs to be 0.3 min and I'm 0.06. They say the risk of irregular heart rate and osteoporosis is high if I stay below threshold? They've prescribed me 100mcg 5x week then 75mcg at weekends. Would staying on 100mcg be a risk, do you think?
I'm 74.5 kgs and 5'9
I feel great on 100mcg of levo - or did before I stopped taking vitamins as the ones I was taking contain Iodine and I didn't realise this was bad for thyroid! I haven't worked out which vits to take instead yet..
I had to battle to get this dose and for the first time since being diagnosed in January this year, I'm not gaining weight and even starting to lose a bit. Most other symptoms have eased off too - just the tinnitus and tiredness creeping back in, but I think that may be the lack of vits - B12 specifically.
I completely agree with what you say about this forum - it's been life changing for me too. I'm still learning the thyroid ropes! It's all very new to me still but slowly working it out, thanks to everyone here.
I have a suppressed TSH and feel great! If it is a trade of between living a half-life to keep the doctor happy or having a suppressed TSH and ME being happy it’s a no brainer. Doctors more often than not treat the lab work not the person.
Tattybogle has a pinned post on low TSH with papers and solid references that debunk the TSH myth. It is the least reliable measure and the fact so many doctors still don’t understand this is testament to their lack of training and continuing ignorance.
I’ve popped a post today about how I got to full replacement dose and I have other posts in presenting my test results and how I argued to full replacement dose - do not allow this dose reduction if you feel well. Read around on tattybogle’s references and write/ type a report with references (I’ve posted mine on here as an example). Submit to reception a few days before your appointment- it becomes part of your records and has to be addressed. Verbal discussion does not make a record when summarised by the doctor in their own words. 😉👍
Just keep reading others lived experience it adds so much context to everything. So much knowledge here.
I've never considered antibodies tested - just about getting my head around TSH, T4 and T3! Do GPs ever sign off antibody tests, or are these only available privately through medichecks etc?
I thought all hypothyroidism is autoimmune? Is Hashimoto's a different type of Autoimmune disease? Would you say my vitamin levels suggest I could be Hashimoto?
I also have vitiligo, which is an auto immune disease and often linked with thyroid issues. Although I only learnt this recently.
My Tinnitus is horrendous and getting worse - quite possibly linked to my B12. I'll speak to my GP and ask for help with this. Should oral supplements be sufficient, or are injections the best way to go?
I really need to start taking vitamins - will obviously stop for any further blood tests.
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