Been on 50mcg of levothyroxine for subclinical hypothyroidism for about 7 weeks, and had a Medichecks Advanced Thyroid blood test. It seems my thyroid levels are good, but I'm still totally exhausted (my main symptom) and having lots of other symptoms including dry eyes, weight gain, etc. The weight gain may also be to do with me not having energy to exercise.
These are my results, and you can also see my past T4 and TSH results on my profile... Would fixing my vitamin insufficiencies be enough to make me feel better? The Medichecks GP suggested I may also have a significant underlying B12 deficiency and recommends arranging a serum methylmalonic acid (MMA) blood test but it's £149 and I'm a bit broke... I might ask my GP if they could do this, or just pass this info onto them.
Thank you! <3
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melissa-b
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Your nutrient levels are very poor. We need optimal levels for thyroid hormone to work properly, plus low levels/deficiencies bring their own symptoms.
Folate: 2.19ug/L (>3.89)
This is folate deficiency so you should discuss with your GP. See
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.
Vit D: 42nmol/L
This is in the "insufficient" category and your GP may prescribe a lowish dose of D3 but to be honest you'd be better treating this yourself.
You might want to check out a recent post that I wrote about Vit D and supplementing:
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 4,900iu per day (nearest is 5,000iu)
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.
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.
As you are only 7 weeks into your thyroid treatment your levels may still be settling. Your FT4 and FT3 look to be at good levels but your TSH is on the high side. 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.
It might be worth staying on your dose for a few more weeks to see if TSH comes down but as 50mcg is only a starter dose so it might be worth considering a dose increase to see if you can get your TSH down if your GP agrees. 25mcg might make your FT4 go over range so you could trial an extra 12.5mcg and retest after 8 weeks or so. I find that my levels are still settling at 8-10 weeks after a dose change.
Thank you so much, your response is so helpful!! I will bring those points up to my GP, and just hope she retests them or accepts them (she did say she wouldn't accept Medichecks results). I do also have a lot of symptoms of B12, especially heart palpitations (I thought I was maybe going into hyperthyroidism apart from the fatigue and weight gain!!). Thank you again, I'll take my time to look through your points and take the right supplements - I'm seeing the nurse for a TSH NHS blood test on Tuesday so I'm hoping my GP might've seen these results by then and may want to retest me. Fingers crossed!!
I'll take my time to look through your points and take the right supplements
You'll be fine to address the Vit D yourself, but please don't do anything about the B12 and folate yourself, your GP should address these, you may need B12 injections.
my heart goes out to you. Those that have responded are so knowledgeable and have helped me hugely on my journey.
what is interesting about your thyroid hormone and TSH results are a similarity to my recent test. I am on 50mcg of levothyroxine also.
I had high levels of antibodies, both kinds in June 2022 way over range TSH and rock bottom T4, my folate, B12, vit D and ferritin were poor and similar to your current readings at that time.
My GP as a result of medichecks agreed to do the MMA but unfortunately refused to treat dispite my symptoms and a reading below 300. I asked about supplements but was told i was in range so everything was fine (like they know how I am feeling) The GP has refused to up my levothyroxine saying I am also in range for this, and T4 is top end of range at 21.8 pmol/L at this time... very frustrating as I felt tired, fatigued and just rubbish.
But for my good news, i followed the advice on here to address the vitamins. I increased my vit D which is now at 125 so just maintaining now, and will test every 6 months. I am taking sublingual B12 and B complex as posted on here, whilst there is room for improvement my levels are rising. I am feeling so much better with more energy, I know there is room for improvement but I am happy with what I have achieved and the continual improvements I am feeling.
If addressing my vitamins had not worked then I feel I would have had more to fight my GP with. But for now I am seeing where this takes me.
I do think the change in my diet has also help which has to remove gluten, dairy, sugar and overly processed foods. I am seeing such a difference in my antibodies TPO antibodies still over range but hugely reduced from 995 to 125 and the other has fallen below range.
I hope my journey has helped a little, there will be sunshine in your journey. Good luck
Thank you so much for your kind words, it means a lot! I'm very grateful for how knowledgable people on here are - they've helped me so much already. I hope my GP will test me again (and treat me for the vitamin deficiencies) but I have a feeling she probably won't - so it's really good to know I can try treating it on my own as you did! I also probably should remove sugar and processed foods lol
I'm so glad you're feeling better, and hope you continue to improve <3
Had a blood test (NHS for TSH) today and asked to run the blood recommended by Medichecks (the MMA, and asked if any need to be repeated) and they said they’ve never heard of MMA, if I was deficient in B12 I don’t need it I just need a B12 serum test, and she said all my vitamins from Medichecks were in range anyway, including folate. I booked in an appointment with my GP for a week and a half’s time but I’m not hopeful that they’ll help me I just feel so utterly exhausted. I’m in my third year at university and I have 6000 words to write in less than 3 weeks and I don’t know what to do
Is it okay to just self treat myself re: folate, B12, and vitamin D? I have so many deadlines coming up and I can't be this exhausted... I'm also getting sick all the time, I had COVID, then the flu a few weeks later, and now I'm sick again less than 2 weeks after the flu with a cold virus.
I mentioned above that it's fine to treat the low Vit D yourself, the suggestions I gave follow the guidance of the Vit D Council and all the information you need is in that post above.
she said all my vitamins from Medichecks were in range anyway, including folate.
Your GP is talking out of an orifice other than her mouth.
Folate: 2.19ug/L (>3.89)
This is clearly folate deficiency, backed up by information from the NHS which I have linked to above. Did you show/discuss that information with your GP?
If your GP is ignoring that then she is being negligent. See another GP and consider making a complaint about this one.
they said they’ve never heard of MMA, if I was deficient in B12 I don’t need it I just need a B12 serum test,
MMA = Methylmalonic acid - information about this test here:
These are two tests that can help establish if the cause of B12 deficiency is Pernicious Anaemia.
If you are deficient in B12 you need to know if the cause is Pernicious Anaemia (PA) which is an autoimmune condition that stops you absorbing nutrients. This has to be treated by life long B12 injections. If it is not PA then oral supplements may be sufficient to raise your B12 level.
You have symptoms of B12 deficiency and symptoms are more important that numbers where B12 deficiency is concerned.
Both SlowDragon and myself have said that it is important to get tested for B12 deficiency and PA. Sometimes we have to advocate for ourselves and perhaps be politely pushy when talking to our GP. If you can't get anywhere with this one then see another one.
For further guidance on B12 you can pop over to the Pernicious Anaemia forum here on HealthUnlocked, list your symptoms for them and see what they suggest
Thank you so much - sorry I totally forgot you said I could treat the vitamin D myself! My brain just isn't working recently. I'll start taking the vitamin D, and then try to push for the B12 and folate blood tests when I see my GP next Friday - the person I saw today was a nurse, so maybe the GP will be nicer (I doubt it)... The nurse said she wouldn't accept the readings and that's why she said I probably wasn't deficient in anything, but then she contradicted herself and said the Medichecks results said I was all completely in range, too, so... Very frustrating lol. I'll print out the information and take it with me on Friday, thank you again
Nurses at my practice don't have that sort of authority, the only one whoever did was an Advanced Nurse Practioner who was actually better than any of the doctors!
Maybe re-read my original reply because there are important cofactors to add when taking D3, also important links.
I've added a link about MMA testing in my most recent reply today.
So any update - my GP refused to run the tests - I actually left the room in tears after what she said. She said even if the Medichecks test was true, it wouldn't affect me phyiscally in anyway, and can't affect my immune system (I've been sick for 6+ weeks with repeated flu/viral illness). She said I won’t find anything clinically significant in my blood just because I feel a tiny bit unwell with a cold, or that I feel exhausted. She said basically there's nothing to find, and nothing that will help me, and she said I already had a blood test in March so she will not repeat it.
I might try changing GP surgeries as I'm not sure what else to do now
Think I'll take the vitamin D as prescribed and also look for an added supplement of daily vitamin D, and K2 and magnesium. I'll take folate and iron but book in an MMA test privately before taking B12...
Hopefully I'll stop getting sick and my energy will get better as I have fallen behind so much at uni! Thank you to the admins for your help
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 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results
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.
as your serum B12 is very nearly over 500 (or Active B12 level has reached 70), just a B Complex is necessary
B12 range in U.K. is too wide
Interesting that in this research B12 below 400 is considered inadequate
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I just feel so utterly exhausted. I’m in my third year at university and I have 6000 words to write in less than 3 weeks and I don’t know what to do 
Medichecks blood test results
Thoughts/advice on blood test results 
Medichecks Results 
Medichecks results
Does my blood test results need tweaking
