Blue Horizon test results

[Lizzery]

I have now received the results from Blue Horizon, with a comment that the TSH is low. Does this mean that I am taking too much or too little thyroxine. I was taking 100mg, but doc advised a reduction, so am presently taking 75/100 mg on alternate days.

[SeasideSusie Remembering]

Lizzery

Assuming that you did your test as we advise, ie

* No later than 9am

* Last dose of Levo 24 hours before test

* Water only before test

* No biotin/B Complex/any supplement containing biotin for 3-7 days before test

then the following comments apply:

with a comment that the TSH is low. Does this mean that I am taking too much or too little thyroxine.

We don't adjust dose by TSH but unfortunately no doctor seems to understand this. TSH is useful for diagnosis but once on thyroid hormone replacement for hypothyroidism then it's the FT4 and FT3 (the actual thyroid hormones, TSH is a pituitary hormone) which tell us our thyroid status, the most important of these being the FT3 result, this tells us if we are overmedicated.

Your FT4 is 68% through it's range and your FT3 is 40% through range, so you are definitely not overmedicated and if anything you could do with an increase in your Levo.

Your conversion of T4 to T3 could be better (more balanced) and your low ferritin is probably the cause of poor conversion.

CRP: 1.28 (<5)

This result is OK, this is an inflammation marker so the lower the better.

Ferritin: 29.7 (13-150)

This is iron deficiency according to NICE so you need to speak to your GP about this:

You need to speak to your doctor about this.

From: cks.nice.org.uk/topics/anae...

In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency.

You need an iron panel which includes Serum Iron, Total Iron Binding Capacity, Saturation Percentage plus Ferritin. This test will show if you have iron deficiency.

You also need a full blood count which will show if you have anaemia.

You can have iron deficiency with or without anaemia.

You can have low ferritin without iron deficiency.

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: 0.93 (0.66-0.99)

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 bundles.

TPO antibodies: 69 (<34)

Your raised antibodies confirm autoimmune thyroid disease, known to patients as Hashimoto's. Did you already know this? This is the most common cause of hypothyroidism and as you already have one autoimmune disease mentioned in your profile (RA) then this is no surprise, when you have an autoimmune disease it's quite likely that you'll develop another.

Vit D: 71nmol/L

On the low side.

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 level recommended by the Vit D Council, Vit D Society and Grassroots Health, ie 100-150nmol/L with a recent blog post on Grassroots Health recommending at least 125nmol/L.

B12: 479pmol/L = 649pg/ml

This is a good result. 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."

Folate: 11.5 (8.83-60.8)

This is low. Folate is recommended to be at least half way through range which is about 35 plus with that range. Supplementing with a good quality, bioavailable B Complex such as Thorne Basic B is recommended. 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).

[Lizzery in reply to SeasideSusie]

Thank you so much for your very detailed reply, which I shall study carefully.

I think I mentioned in an early post, that because of other health issues, I haven’t really watched what was going on with my thyroid. Reading this site, and others queries, I now think there are issues that I’ve just thought, oh well old age etc, that need more investigation.

Thanks again.

[SlowDragon Administrator]

As you have Hashimoto’s are you on strictly gluten free diet

If not, request GP do coeliac blood test BEFORE considering trial on strictly gluten free minimum 3-6 months

Are you still on steroids. Steroids can lower TSH so it’s especially essential to evaluate on Ft4 and Ft3 results

[Lizzery in reply to SlowDragon]

Thanks for your reply. No a gluten free diet has never been mentioned. I did have a DNA test done a few years ago, and one of things it pointed to was the possibility of celiac issues.

I’m at present taking 2mg steroids and leflunomide daily.

Until I’ve started reading this site, I’d never realised that some of the niggles that I have are probably related to thyroid and medication. I’ve always had hot sweats, and obviously this was put down to menopause, but as I’m 70 now this can’t be the case. Only recently though I’ve had episodes of an extremely hot face without sweating, which would come on quite quickly, and then go just as quickly, together with palpitations now and again. Since the medication has been tweaked, these issues seem to have disappeared, although it may be coincidence.

I have however had tinnitus for years, and never linked that to thyroid. You live and learn.

Thanks again.

[SlowDragon Administrator in reply to Lizzery]

Your ferritin level is terrible

Folate far too low

Look at increasing iron rich foods in your diet to improve ferritin

Consider a daily vitamin B complex and also daily vitamin D supplement

Vitamin D

GP will often only prescribe to bring vitamin D levels to 50nmol. Some areas will prescribe to bring levels to 75nmol or even 80nmol

leedsformulary.nhs.uk/docs/...

GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)

mm.wirral.nhs.uk/document_u...

But with Hashimoto’s, improving to around 80nmol or 100nmol by self supplementing may be better

pubmed.ncbi.nlm.nih.gov/218...

vitamindsociety.org/pdf/Vit...

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

Test twice yearly via NHS private testing service when supplementing 

vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function.

There’s a version made that also contains vitamin K2 Mk7. 

One spray = 1000iu

amazon.co.uk/BetterYou-Dlux...

Another member recommended this one recently

Vitamin D with k2

amazon.co.uk/Strength-Subli...

It’s trial and error what dose we need, with thyroid issues we frequently need higher dose than average

Vitamin D and thyroid disease 

grassrootshealth.net/blog/t...

Vitamin D may prevent Autoimmune disease 

newscientist.com/article/23...

Web links about taking important cofactors - magnesium and Vit K2-MK7

Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Great article by Dr Malcolm Kendrick on magnesium 

drmalcolmkendrick.org/categ...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

[SlowDragon Administrator in reply to Lizzery]

Low folate

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

Only add one supplement at a time or make one change at a time and wait 2-3 weeks after to assess

Suggest starting with vitamin D, followed by vitamin B complex, then magnesium

After Christmas suggest you seriously consider trialing strictly gluten free diet…..you might be astonished

[SlowDragon Administrator in reply to Lizzery]

Gluten intolerance

Poor gut function with Hashimoto’s can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common. 

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps, sometimes significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link) 

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies 

Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse

chriskresser.com/the-gluten...

amymyersmd.com/2018/04/3-re...

thyroidpharmacist.com/artic...

drknews.com/changing-your-d...

Non Coeliac Gluten sensitivity (NCGS) and autoimmune disease

pubmed.ncbi.nlm.nih.gov/296...

The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported

nuclmed.gr/wp/wp-content/up...

In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned

restartmed.com/hashimotos-g...

Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.