Help and advice regarding latest blood test results

[Griffin43]

Hello everyone. I would really appreciate any advice regarding my latest blood tests please. I didn't eat anything beforehand but wasn't able to go to the lab until 11am so it had been a bit longer that 24hrs after my last Levothyroxine (taken around 7am usually).Have been on 75mcg Levothyroxine since diagnosed with Hashimoto's in 2010 and have not been feeling well for a long time. Last few months have been particularly bad. Have been on a gluten free diet for 3 years but not dairy free.

My GP and the Endo I saw a few years ago see nothing wrong with me as the levels are within range. The GP when I last asked, refused to test for Vitamin deficiency, ferritin etc as he said that there was no point because when I did the tests in Oct 2020, after asking him for them, I wasn't anemic.

The Endo experience a few years ago was really awful. After explaining my symptoms and my worry about weight loss and asking for help, I was told we read too much on the Internet and that I was anorexic... The Nutricionist of the Endo Department was quite sympathetic. But with low weight and low muscle mass recommended a much higher intake of food, including bread and cheese before bedtime, that I tried unsuccessfully. No mention of avoiding gluten.

These are the results of the blood tests done in Portugal where I live most of the time now.

TSH: 1.13 mU/l (Range 0.34 - 4.25) 20.20%

FT4: 14.8 pmol/l (Range 9 - 19.1) 57.43%

FT3: 3.1 pmol/l (Range 2.4 - 6) 19.44%

Ferritin 87µg (Range 10.0-150.0)

Vitamin B12 (Cianocobalamin) 491ng/L (Range 160-950)

I have been taking 1000mcg B12 tablet for over 2 months now. Didn't stop taking it before the blood tests because I understood that I would have had to wait a few months after stopping it. In Jan 22, with no supplement, it was 244ng/L

Folic Acid(Folate)12.7ng/mL (Range 3.1-20.5)

Vitamin D (25-Hidroxicalciferol) 25.0ng/mL (/52.5 nmol/L)

Normal Range:30-100 ng/m (75-250 nmol/L)

Deficiency: < 20 ng/mL ( < 50 nmol/L)

Insufficiency: 20 - 30 ng/mL (50 -75 nmol/L)

Any advice/information would be much appreciated thank you.

[SlowDragon Administrator]

If not already on vitamin D supplements you need to start

Aiming for vitamin D at least around 40ng/mL (100nmol)

Rather than just taking B12 add in a separate daily vitamin B complex

supplementing a good quality daily vitamin B complex, one with folate in (not folic acid) 

This can help keep all B vitamins in balance and will help improve B12 levels too

Difference between folate and folic acid 

chriskresser.com/folate-vs-...

Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid.

thyroidpharmacist.com/artic...

B vitamins best taken after breakfast

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

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate methyl folate supplement and continue separate B12

[Griffin43 in reply to SlowDragon]

I'm sorry to bother you again but regarding the Vitamin D dose of 40ng/mL (100nmol) - I assume you mean daily? - and do you happen to know if what I refer to below seems the right thing and if so, how would the 40ng/mL translate into I.U? I have tried to find a way to work it out on the Internet but I've not managed to... I have Vit D3 drops from a brand ( Vigantol) that states that 30 drops contain 0,5mg of Colecalciferol (equivalent to 20.000 I.U. of Vit D3). I have also been told that these drops can be taken once a week.

And if it's too difficult to work out, could you suggest a specific Vit D to look for? And if it should be taken daily?

On a positive note I found that I should be able to get the Thorne Basic B complex in Portugal too 😊

Thank you again 🌸

[SlowDragon Administrator in reply to Griffin43]

40ng/mL - That wasn’t a dose …..that’s optimal test result

Suggest you try 2000iu vitamin D per day

You might need more

Trial and error what dose each person needs

Likely higher dose in winter than summer

Retest vitamin D in 3-4 months see if level is improving

[Griffin43 in reply to SlowDragon]

No wonder... 😊 I really feel things shouldn't appear so difficult and confusing all the time... And again thanks so much for your help and patience 🌸🌸🌸

[SlowDragon Administrator]

working on improving low vitamin levels should improve poor conversion rate of Ft4 to Ft3

Your thyroid results suggest you have room for dose increase in levothyroxine

Perhaps initially try 75mcg and 100mcg alternate days

(or add 12.5mcg every day)

Retest again in 6-8 weeks

[Griffin43 in reply to SlowDragon]

Thank you very much for your help. It makes me feel hopeful and confident in implementing the changes suggested 🌹🌸🌷

[pennyannie]

Hello Griffin :

Just for reference the accepted conversion ratio when on T4 monotherapy is said to be :-

1 / 3.50 - 4.50 - T3/T4 with most of us feeling at our best when we come in this range at 4 or under.

So if I divide your T3 into your T4 I'm getting your current conversion ratio at around 4.70 so wide of the centre showing conversion struggling.

We generally also feel at your best when our T4 is up in the top quadrant as this should in theory convert to a good level of T3 at a slightly lower % through it's range.

Once your core strength vitamins and minerals are optimal you will hopefully see an improvement in your conversion ratio and be better placed to then ask for an increase in medication.

[Griffin43 in reply to pennyannie]

Thank you for the information 🌸