I have now got an appointment with the Endo Clinic on 27th Oct. and need to put my ducks in a row. I attach the results of my latest blood test on 17th Oct. and would be grateful if you could interpret what is going on with my thyroid so that I will be better informed when I see the Endo.
Ferritin 27.9 ug/L 10.0 to 291.0 ug/L10.0 - 291.0 ug/L
A normal ferritin may not exclude iron deficiency if levels are at the lower end of the normal range or in the presence of inflammation.
I recently read a post that said the four symptoms I have continually could be as a result of B12 deficiency, which seems to fit with my result, I am now taking liquid Bioactive B12, by Nature Provides, and Thorne Basic B Complex. Also take Vit D3 4,000IU . I need to get some Vit K to take with the D. My vit D levels look ok, I think.
Diet – not on gluten free, or dairy free, don’t eat meat, do eat fish, pulses, grains, veg, fruit. Use Oat Milk, because I like it and its more sustainable. Make my own bread but not gluten free flour. Make my own meals, no ready meals.
The blood test was taken at 8.30 am . All vitamins were stopped 7 days previously. I take my Levo at night, in bed, just before sleep. I stopped Levo 24 hrs before the appointment.
I think my ferritin is low? Folate looks ok? I’m not sure how to interpret the thyroid results.
I joined the forum several weeks ago but haven’t posted anything yet, just been reading other peoples posts and feeling my feet. I can see you all have a wealth of knowledge and appreciate what I have learnt since reading all the other posts. I’ve bought several books and googled stuff to get my head around this complicated health issue.
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The blood test was taken at 8.30 am . All vitamins were stopped 7 days previously. I take my Levo at night, in bed, just before sleep. I stopped Levo 24 hrs before the appointment.
Did you adjust the timing of your dose of Levo for the couple of days before your test so that your last dose was 8.30am on the day before the test and not the night before so that the last dose was 24 hours before the test?
Serum TSH level 3.81 mU/L [0.35 - 5.5]
Serum free T4 level 14.1 pmol/L [10.5 - 21.0]
Free T3 4.9 pmol/L 3.5 to 6.5 pmol/L3.5 - 6.5 pmol/L
These results show that you are undermedicated. What is your current dose of Levo?
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 endo may not agree, he may just want to see your results somewhere within range. If this is what happens and you feel you want to increase your dose then you can use the following information:
Fine tuning of the dose could be necessary in some patients
* aim of levothyroxine treatment is to make the patient feel better, and the dose should be adjusted to maintain the level of thyroid stimulating hormone within the lower half of the reference range, around 0.4 to 2.5 mU/l. If the patient feels perfectly well with a level in the upper half of the reference range, then adjustment is unnecessary
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
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 doctor.
Your raised antibodies confirm the cause of your hypothyroidism is autoimmune (known to patients as Hashimoto's).
Vitamin B12 394.0 ng/L 211.0 to 911.0 ng/L
I recently read a post that said the four symptoms I have continually could be as a result of B12 deficiency, which seems to fit with my result, I am now taking liquid Bioactive B12, by Nature Provides, and Thorne Basic B Complex.
If you think you have symptoms of B12 deficiency you shouldn't have started the B12 and the B Complex, it would have been better to list your symptoms to discuss with your GP and get tested, based on symptoms, for B12 deficiency and pernicious anaemia. Symptom checkers here:
If you don't think it's B12 deficiency then you could continue as you are but I'd retest in 3 months to see what difference it's making. If B12 is improving then that means you're absorbing it.
According to an extract from the book, "Could it be B12?" by Sally M. Pacholok:
"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".
"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."
In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency.
However, this would need to be confirmed by an iron panel (serum iron, total iron binding capacity, transferrin saturation, ferritin) to determine iron deficiency and a full blood count to determine anaemia. You can have iron deficiency with or without anaemia, and you can have low ferritin without iron deficiency. You should ask GP for these further tests.
Vit D is currently good. What was your level before you started supplementing? You could continue with your current dose of D3 during the winter months and retest in April to see if it needs adjusting or stopping during the summer months.
The Vit D Council, Vit D Society and Grassroots Health all recommend a level between 100-150nmol/L with Grassroots Health's recent blog post recommending at least 125nmol/L.
You need to add D3's important cofactors.
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 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.
Another important cofactor is Magnesium which helps the body convert D3 into it's usable form.
There are many types of magnesium so we have to check to see which one is most suitable for our own needs:
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.
Thank you Seasidesusie. Before my blood tests on Monday 17th I took the last tab on Sat night, (now realise I should have taken it on the Sunday morning) Sunday's tab was taken on Monday am after bloodtest , then normal dose Monday night.
My current dose is 50/75 alternate days. This was prescribed by letter to my GP 11th May 2022, because the endo didn't want to see me, due to my GP not sending the full facts on my symptoms(despite me having sent her an email outlining them all) endo had very little to go on. She recommended that if symptoms don't get better to increase the Levo to 50/75 alternate days, and to aim at getting TSH to 1-2.5. My previous dose was 50 which I have been taking since May 2020, with a break of four months from Aug 21 to December 21 because I felt they were making my symptoms worse. Blood test showed my TSH was 10 in Oct. 2020 so I went back onto 50mcg Levo in December 2021.
B12 - On the 23rd June 22 I mentioned to the GP that booked my second attempt to get an Endo appointment that I felt my B12 to be low and that I might be anaemic, she judged it by looking at my previous bloodtest which would have been 26/4/22, and said that my levels look alright and didn't think I was anaemic, on this test there was no Vit B12 test, no T3 test, no ferritin test, no folate or vit D. She said might be an idea to take a B complex tab. I started Thorne B complex and Liquid B12 about the 9th Sept. (thats when i bought them off Amazon) had a week off before my blood test so have been taking them for four weeks. My test on 8th July 22 had B12 of 256.0 (211.0 - 911.0). My test on 17th Oct 2022 had B12 394.0(211.0 - 911.0). The GP also ordered a neck scan. See result on my Profile.
I will stop the liquid B12 until I have spoken to the Endo.
Will get vit K2-MK7 and magnesium to aid vit D. and check levels.
Will ask for iron panel test re low ferritin.
And will arm myself with all the useful info you have attached.
Thank you so much, your help is a godsend, I thought I was going crazy.
Further to post of yesterday. My vitamin D was 103.7 on the blood test done 8.7.22. I never felt I was deficient in D because of my time spent in Kenya. I started the supplements in 2020 but took them spasmodically, because i haven't been able to to to Kenya since end of 2019 because of lockdowns and ill health.
I don't know what my weight is, if I get weighed with my caliper on it will not be my true weight because the caliper is quite heavy, can't stand up without it, so will weigh myself with it on, then weigh the caliper, and take that amount off the total.
I am still on 50/75 Levo on alternate days. The 50 is Northstar and the 75 is Teva.
I started Thorne B complex and Liquid B12 about the 9th Sept. (thats when i bought them off Amazon) had a week off before my blood test so have been taking them for four weeks. My test on 8th July 22 had B12 of 256.0 (211.0 - 911.0). My test on 17th Oct 2022 had B12 394.0(211.0 - 911.0).
Should I take vit D alternate days to reduce the dose?
Celiac blood test done 26th April 2022
tTG IgA Antibody A tissue transglutaminase (tTG) IgA and/or IgG test is used as part of an evaluation for certain autoimmune conditions, most notably celiac disease.
Tissue transglutaminase IgA antibody 0.3 u/ml
0.0 – 6.9 u/ml
I have no idea what this result means?
This is my full blood test done on 17th Oct 2022 - some of the levels look to be at the lower end of the range, do you think this is of any importance? Could this be relevant to my B12 low level?
Component Results
Component Your Value Standard Range
White blood cell (WBC) count 7.4 10*9/L 3.6 to 10.5 10*9/L3.6 - 10.5 10*9/L
Red blood cell (RBC) count 4.80 10*12/L 3.85 to 5.20 10*12/L3.85 - 5.20 10*12/L
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
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
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