Latest results - pondering next steps

[Decant]

Hi

I've just had the results for my Medichecks Ultimate Performance Test back. I followed the protocol; fasting, blood test at 9am, no thyroid meds for 24 hours, no biotin for 3 days beforehand.

TSH 0.72 mU/L Range 0.27-4.20, 11.5%

T4 18.5 pmol/L Range 12-22, 65%

Free T3 pmol/L 4.49 Range 3.1-6.8, 37.6%

Vit B12 pmol/L >151 Range 37.5-150, >100%

Vit D 143 nmol/L Range 50-200, 62%

Folate - Serum 15.58 ug/L Range > 3.89

Ferritin 142 ug/L Range 30-400, 30%

I have a full iron panel and FBC and lots of other results if you think that would help.

I'm currently taking 112.5 mcg/day T4 and 5 mcg/day T3.

I'm also taking loads of supplements (all away from thyroid meds): Thorne Basic B, 8000 IU Vit D3 and K2 (properly separated), Magnesium, Boron, Zinc+copper. Some of those to try and address a lowish testosterone figure (no improvement).

I eat pretty well, but not gluten free (I don't have hashios - low antibodies). Recently introduced liver to improve Ferritin a bit.

I'm a 55 year old man. I'm "doing ok", managing to work about 30 hours/week without needing mid-afternoon naps any more, but I have little spare energy, sleep poorly, racing mind, low mood and motivation, etc.

Should I increase my T3 as there's room for improvement there I think? Do some other test genetic, etc?

Many many thanks,

David

EDIT: worth saying I'm also exploring Testosterone Replacement Therapy (TRT) as those levels are low and symptoms also align.

[SlowDragon Administrator]

Yes, next step is to increase T3 ….add 2nd 5mcg dose approx 10-12 hours after 1st dose

Wait 6-8 weeks and retest

cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code

thyroiduk.org/getting-a-dia...

monitormyhealth.org.uk/

[Decant in reply to SlowDragon]

Thank you - I appreciate the confirmation. I am running out of my privately sourced 5 mcg T3 pills. I bought some 25mcg pills at the same time (wasn't really thinking straigtht). Do you think it'd be ok to cut them in half and take one pill (12.5 mcg) in the morning? I could try and cut them into 4 but that sounds quite fiddly!

[SlowDragon Administrator in reply to Decant]

ideally, and certainly initially, cut into 1/4’s and take 1/4 waking and 1/4 approx 8-12 hours later

They cut easily with sharp craft scalpel

onbuy.com/gb/3-modelcraft-s...

Save the other 1/4’s for next day

Mop up any crumbs with damp finger

Many, many people end up on 3 x 5mcg T3 at approx 8 hour intervals

[SeasideSusie Remembering in reply to Decant]

I can cut a 25mcg T3 tablet into quarters, I use this pill cutter:

amazon.co.uk/Safe-Sound-Pil...?

The secret is to use a light touch when lowering the blade. Or try a sharp craft scalpel.

I do take my T3 all in one dose, tried splitting it but it made no difference to me, others find they need to split it.

[SeasideSusie Remembering]

Decant

Should I increase my T3 as there's room for improvement there I think?

That was my first thought upon seeing your thyroid results. I would increase to 10mcg daily and retest in 8 weeks.

Looking at your August results in previous post, Active B12 has increased from 70.8 to over 150 (not measurable as over the limit they measure to). That's a big increase in 2 months, are you taking a B12 supplement? If so it's no longer needed, you'd be best stopping it for now, getting B12 back into range to be able to measure it then it will probably be maintained at that level by the Thorne Basic B.

Vit D has increased from 121 to 143nmol/L, it's now just about perfect as the Vit D Society, Vit D Council and Grassroots Health all recommending a level between 100-150nmol/L with a recent blog post on Grassroots Health recommending at least 125nmol/L so forget about percentage through range where Vit D is concerned, concentrate on the actual result. If you continue with 8,000iu D3 daily I'd retest in 3 months, if your level has risen again I'd reduce to find your maintenance dose, maybe just drop off one day a week to start with and see what difference that makes.

Folate has increased nicely.

Ferritin very similar to last time, this one is always the most difficult to improve. What are the results of your iron panel?

[Decant in reply to SeasideSusie]

Hi SeasideSusie,

So many thanks for more great info. I shall go buy a pill cutter or knife and get onto increased T3.

Active B12. I have been taking Thorne Basic B every day (except 3 days before test) and also occasional B12. However I was so "desperate" for improvement that I went to a local B12 clinic about 3 days before the latest test and had a B12 shot. It made no difference to the way I feel but I realise it was foolish so close to the blood test. I shall retest in 3 months on the current protocol (I'll drop the separate B12).

Vitamin D. With winter coming I'll stick to 8000 IU and see where it is in 3 months.

Iron Panel. I'v started eating a little more liver. My results are

Iron 15.3 umol/L, Range (5.8-34.50), 33.1%

TIBC 60.2 umol/L, Range (45.00-81.00), 42.2%

UIBC 44.9 umol/L, Range (22.30-61.70), 57.4%

Transferrin Saturation 25.4 %, Range (20.00-50.00)

Ferritin 142 ug/L, Range (30.00-400.00), 30.3%

Thank you again x

[SeasideSusie Remembering in reply to Decant]

Decant

OK, so for your iron panel, whenever we discuss them we refer to optimal levels suggested here:

rt3-adrenals.org/Iron_test_...

and these are:

Serum iron: 55 to 70% of the range, higher end for men - yours is 33.1% so quite low

Saturation: optimal is 35 to 45%, higher end for men - yours is 25.4% so again it's low

Total Iron Binding Capacity (TIBC): Low in range indicates lack of capacity for additional iron, High in range indicates body's need for supplemental iron - yours is getting on for mid-range so not really a lot of help!

So your serum iron and saturation are low but you don't have iron deficiency.

Personal experience - I always had decent serum iron and saturation but low ferritin. After taking some co-codamol for a few days I noticed, from a regular iron panel, that my serum iron and saturation had plummeted (although little difference to TIBC). Looking for a cause I discovered that codeine (in co-codamol) is turned into morphine by the body and morphine can lower iron levels. So I experimented with taking iron tablets - low dose 20mg iron bisglycinate plus Vit C (in one capsule), I think I may have started with taking one capsule 3 times a week. When I retested 2.5 months later there was a marked improvement in serum iron and saturation and ferritin had increased a bit. Being mindful of not allowing serum iron/saturation to get too high I reduced to 1 capsule twice a week to see if that would maintain my new level. Retest after 3 months showed a drop but not as low as originally. At the moment I am taking one capsule alternate days and due to retest at the end of the year.

I can't advise you to do this, I'm not medically trained, but if you decide to experiment to see if you can raise your serum iron/saturation/ferritin then do so cautiously and retest the iron panel regularly.

Also, in case it's appropriate to you, keep an eye on CRP and if that's raised then your ferritin will give a false result - higher than normal as ferritin also rises with inflammation.

Iron must be taken on it's own, 4 hours away from thyroid meds and 2 hours away from any other medication and supplements as it affects their absorption. Vit C should be taken with iron as it aids absorption, I buy a combined iron/Vit C capsule. Iron bisglycinate is known as "gentle iron", least likely to cause upset stomach.



[Decant]

Hi SeasideSusie,

I wonder if I should just stick to eating liver-and-bacon every week. It's not as awful as I remember it as a kid!

I'm already taking so many supplements that I don't know when I could fit in iron.

Waking: thyroid meds

Breakfast: B-complex, D3

Dinner: K2, Magnesium glycinate, Boron

Bedtime: Magnesium, Zinc + copper. Mg here as it supposedly helps sleep

I can drop the Boron, Zinc and copper as they've made no difference to my testosterone level. I suppose I could drop the Mg at bedtime as well and take the iron then.

Because I'm taking so many I shall be trialling the increased T3 when I wake.

Thanks,

Decant

[SeasideSusie Remembering in reply to Decant]

If you want to try iron you could have it at lunchtime. Iron is best absorbed on an empty stomach but can be taken with food if taking without upsets stomach. Maybe you could work around that 2 or 3 days a week. Or just continue with liver, when I was taking liver only it helped ferritin a bit but didn't seem to change serum iron/saturation levels mjuch. But we're all different.

[Decant in reply to SeasideSusie]

 Hi again,

 I've just taken another look at the thyroid results.

 August Results

On 150mcg/day Levothyroxine

TSH 0.32 (1.3%)

FT3 4.46 (36.8%)

FT4 22.6 (106%)

October Results

On 125 mcg/day Levothyroxine, 5 mcg/day Liothyronine for more than 2 months.

TSH 0.72 (11.5%)

FT3 4.49 (37.6%)

FT4 18.5 (65%)

So, even though I've been on T3 for over 2 months my fT3 hasn't improved. My fT4 has decreased as I've reduced my T4 intake. It would seem the T3 hasn't improved my fT3 level.

I increased my T3 this morning from 5 to 10mcg/day, but I now wonder if I should increase it (in 2 weeks) to 15 mcg/day.

What do you think?

 Thank you x

[SeasideSusie Remembering in reply to Decant]

Decant

You reduced your Levo dose, this will reduce your FT4 level.

You added T3, this will reduce your FT4 level to a certain degree.

So we expect to see a lower FT4 result.

Lower FT4 means that if you have any natural conversion then you wont produce as much T3 naturally as you did before. Adding in 5mcg T3 might not have replaced the naturally converted T3 you lost plus raising your FT3 level a bit. 5mcg T3 is a small dose and not many on combination thyroid hormone replacement would find this enough.

I increased my T3 this morning from 5 to 10mcg/day, but I now wonder if I should increase it (in 2 weeks) to 15 mcg/day.

My suggestion is to stay on 10mcg T3 for 6 weeks to give your levels time to settle on the new dose then retest, see what difference it has made. Finding the right balance of doses of Levo and T3 requires patience and very gradual tweaking.

[Decant in reply to SeasideSusie]

 OK, I'll be patient and steady!

I only have a few 5mcg pills left so after that I'll be splitting my 25mcg pills in half. So in a week I'll be in 12.5mcg anyway. Splitting hairs maybe.

Interestingly I've just checked my NHS prescription history. I used to be on 50mcg T4 and 20mcg T3 from 2015 to 2016. My bloods weren't being monitored regularly back then as I "bullied" my GP into a trial, which ended when the prices went silly. I remember feeling more lively and capable, but without blood tests I can't really comment further. I sourced NDT between then and early 2021 and again was subjectively livelier.

Certainly I've gone backwards since being off combo or NDT. I managed a half marathon and 2 triathlons for example; no chance right now.

Thank you.