Blood tests 2nd time in 2 weeks. Results posted on my NHS but then told the blood was too old! Your comments please?

[A1Amber]

Vit D level 77nmol/LB12 level 461 ng/L (197 - 771)

Folate level 4.2 ug/L (2.9 - 18.7)

Ferritin level 147 ug/L (20 - 260)

Second thyroid test in 2 weeks

T3 3.86 pmol/L (3.1 - 6.8)

T4 18.1 pmol/L (11 - 23)

TSH 1.9 mU/L (0.27 -4.5)

The endocrinologist I have through Spire has also requested TSH binding site inhibitor globulin level. This result 2 weeks ago was recorded on my NHS test result as 1.76 u/L (<1.74) and the GP phlebotomist telephoned to say the lab had informed her the blood had been too old. The new result has not yet arrived on my NHS test page.

I am on 200mg/ day of Almus thyroxine.

Now I have a more complete picture does it seem my thyroid health and medication are ok please?

[SlowDragon Ambassador]

What vitamin supplements are you currently taking

B12, Folate and vitamin D are all a bit low

was blood test done early morning, ideally just before 9am, and last dose levothyroxine 24 hours before test

Free T4 (fT4) 18.1 pmol/L (11 - 23) 59.2%

Free T3 (fT3) 3.8 pmol/L (3.1 - 6.8) 18.9%

Assuming tested as recommended….shows poor conversion of Ft4 to Ft3

[A1Amber in reply to SlowDragon]

Test was done at 10.30. No choice in the matter!

[SlowDragon Ambassador in reply to A1Amber]

but last dose levothyroxine was 24-25 hours before test

What vitamin supplements are you currently taking

Most people when adequately treated will have Ft3 at least 60% through range

For good conversion of Ft4 to Ft3 you need GOOD vitamin levels

Are you currently taking vitamin D and daily vitamin B complex

[A1Amber in reply to SlowDragon]

Yes the last levothyroxine was over 24 hours before and I take B12 1 x 100 ug and D3 2 x 62.5 ug.I take 200 mg levothyroxine last thing at night and on rising my vitamins 1 x 20 mg omeprazole and 2 x 30 mg etoricoxib.

Thank you for your advice.

[SlowDragon Ambassador in reply to A1Amber]

Omeprazole is a PPI

PPI lower vitamin levels

Presumably you are prescribed PPI because on etoricoxib?

You will need to work hard to maintain OPTIMAL Vitamin levels

being hypothyroid frequently causes low stomach acid and low vitamin levels ?….Omeprazole will lower vitamin levels even further 

Especially magnesium and B12

gov.uk/drug-safety-update/p...

webmd.com/heartburn-gerd/ne...

pharmacytimes.com/publicati...

PPI and increased risk T2 diabetes 

gut.bmj.com/content/early/2...

Iron Deficiency and PPI 

Request GP do full iron panel test

High ferritin due to inflammation can be misleading

medpagetoday.com/resource-c...

futurity.org/anemia-proton-...

onlinelibrary.wiley.com/doi...

sciencedirect.com/science/a...

[SlowDragon Ambassador in reply to A1Amber]

Low vitamin D and magnesium

Low vitamin D

NHS Guidelines on dose vitamin D required

ouh.nhs.uk/osteoporosis/use...

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...

2 good videos on magnesium

healthunlocked.com/thyroidu...

[SlowDragon Ambassador]

Low B12 and folate

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

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) 

currently cheapest on eBay at £18

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

 

Low B12 symptoms 

b12deficiency.info/signs-an...

methyl-life.com/blogs/defic...

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.

once/if your serum B12 is over 500 (or Active B12 level has reached 70), stop the B12 and just carry on with the B Complex.

B12 drops 

healthunlocked.com/thyroidu...

B12 sublingual lozenges 

amazon.co.uk/Jarrow-Methylc...

cytoplan.co.uk/shop-by-prod...

B12 range in U.K. is too wide

Interesting that in this research B12 below 400 is considered inadequate 

healthunlocked.com/thyroidu...

How other member saw how effective improving low B vitamins has been 

healthunlocked.com/thyroidu...