Please help me understand these results

[Lady333]

Hi, I had a private thyroid panel done last week (930am and without taking my levothyrozine supplement- I’m currently on 100mg/day & 125mg/twice per week) and have received the results. I will make an appointment with my GP as soon as possible, but as I’ve always been underwhelmed with their advice, I would love to hear what you all think? Typical symptoms, hair loss, exhaustion, can’t catch my breath, terrible skin, bloating & weight gain. I was diagnosed with hypothyroidism when I was 19 (I’m 33 now) and have had 2 children. Thank you 🙏

[SeasideSusie Remembering]

Lady333

CRP: 5.95 (<5.00)

This is showing some inflammation, as it's a non-specific inflammation marker it can't tell you where the inflammation is.

Ferritin: 72.9 (13-150)

This seems pretty good. However, because your CRP is raised it's likely that your ferritin is raised due to inflammation too so it's possibly not a true level.

Ferritin is recommended to be half way through range (about 82 with that range) although some experts say that the optimal ferritin level for thyroid function is 90-110ug/L.

If you wish to improve this level 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

bda.uk.com/resource/iron-ri...

everydayhealth.com/pictures...

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.

Magnesium: 0.84 (0.7-1.0)

Testing magnesium is unreliable. About 99% of magnesium is stored in bone, muscles and soft tissues, leaving about 1% in the blood. So testing what's in the blood isn't giving an accurate picture of our magnesium status.

A red cell magnesium test is the better indicator of magnesium status, not the standard serum magnesium test. The red cell test is expensive and requires phlebotomy which is why it's not included in these test bundles.

Cortisol: 286

I'm not too good with serum cortisol tests but I have an inkling that over 300 would be better for an early morning sample. Maybe someone else can comment.

TSH: 4.86 (0.27-4.20)

FT4: 19 (12-22)

FT3: 4.4 (3.1-6.8)

Your TSH is over range. Your FT4 is 70% through range. Your FT3 is 35.14% through range.

Calculator here: thyroid.dopiaza.org/

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.

Your TSH is out of sync with your FT4, and your FT4 and FT3 aren't particularly well balanced. One would expect to see TSH near the lower end of range with your FT4. I can see from your previous post that you asked if you could drink coffee before your test, you didn't get an answer because your post was a "reply" to yourself rather than a particular member so nobody would know of your question. If you did have coffee then this could have affected your TSH result, we always advise water only before the test.

TPO antibodies: 52 (<34)

Your raised antibodies show that the cause of your hypothyroidism is autoimmune, known to patients as Hashimoto's. Did you already know this? As Hashi's can cause inflammation, this may be the reason why your CRP is raised.

Vit D: 65nmol/L

This is low and it's recommended to be 100-150nmol/L. Are you supplementing? If you let me know I can suggest what dose of D3 you should be taking, plus the important cofactors when taking D3.

B12: 384pmol/L (145-569)

384pmol/L = 520pg/ml

This is on the lowish side, it's recommended to be at least 550pg/ml to avoid any deficiencies that can begin to appear in the cerebrospinal fluid below 550.

Folate: 35.1 (8.83-60.8)

Folate is recommended to be at least half way through it's range, so you're just about there.

As your B12 is on the lowish side I would consider taking a good quality, bioavailable B Complex which will improve your B12 level and should also raise your folate too.

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).

[Lady333 in reply to SeasideSusie]

Thank you so much for this information and responding so quickly!

I am still taking a pre-natal vitamin in the evening that contains VitD, I didn’t think it could cause any harm as it is also fish oil. I am not taking any other supplements.

I also did not drink any coffee before my blood work to be on the safe side, thankfully. I didn’t realize I had only responded to myself, thanks for making me aware!

I also did not know that the cause of my hypothyroidism was autoimmune, that is good know, thank you.

I have a phone appointment with my GP tomorrow evening, the earliest they could fit me in. Are there any questions you recommend I ask them, or any way to lead the appointment to make sure that I am referred to a specialist in order to monitor this better in the future?

Thank you 🙏

[SeasideSusie Remembering in reply to Lady333]

Lady333

Vit D: 65nmol/L

I am still taking a pre-natal vitamin in the evening that contains VitD,

OK, so the dose in your pre-natal vitamin is probably not enough. You might want to check out a recent post that I wrote about Vit D and supplementing:

healthunlocked.com/thyroidu...

and you can check out the link to how to work out the dose you need to increase your current level to the recommended level.

Your current level of 65nmol/L = 26ng/ml

On the Vit D Council's website

web.archive.org/web/2019070...

you would scroll down to the 3rd table

My level is between20-30 ng/ml

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 3,700iu per day. The nearest to buy would be 4,000iu so see what amount is in your pre-natal vitamin then make it up to somewhere around 3,500-4,000iu daily.

Retest after 3 months.

Once you've reached the recommended amount 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:

vitamindtest.org.uk/

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

natureprovides.com/products...

It may also be available on Amazon.

One member recently gave excellent feedback on this particular product here:

Here is what she said (also read the following replies):

healthunlocked.com/thyroidu...

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:

naturalnews.com/046401_magn...

explore.globalhealing.com/t...

and ignore the fact that this is a supplement company, the information is relevant:

swansonvitamins.com/blog/ar...

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 also did not know that the cause of my hypothyroidism was autoimmune, that is good know, thank you.

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.

Gluten/thyroid connection: chriskresser.com/the-gluten...

stopthethyroidmadness.com/h...

stopthethyroidmadness.com/h...

hypothyroidmom.com/hashimot...

thyroiduk.org.uk/tuk/about_...

Supplementing with selenium l-selenomethionine 200mcg daily is said to help reduce the antibodies, as can keeping TSH suppressed.

Are there any questions you recommend I ask them, or any way to lead the appointment to make sure that I am referred to a specialist in order to monitor this better in the future?

Even if your GP does agree to a referral, it's very unlikely that a consultant would agree to see you with your results in range. However, it might be worth discussing your cortisol result with your GP, I don't know if it's low enough to be a cause for concern.