Help with difference in results on lower Levo d... - Thyroid UK

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Help with difference in results on lower Levo dosage

dancing-heart profile image
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I’d be so grateful if someone could help with an opinion on my latest results. A year ago I used Monitor My Health for T4,TSH & T3. I had been on Levo since 2015 and 100 mcg for some years. Because I was experiencing some symptoms around joint pain, inflammation, temporary high -parathyroid level results and all manner of things, an Endo said it may be worth reducing my dose to 75mcg to see if it helped with the joint issues. Now I’m gaining weight rapidly, having increased dry eye issues with bleoharitis, sometimes feel exhausted and have been falling to sleep sitting up in the evening and my hair is falling out. As well as scrambled memory and problem just maintaining focus. Just had another blood test done myself as the GP did one for TSH only 4 months back and said all is fine !! They refused my request to have T3 and T4 checked.

I’m also 55 so I realise I have peri-menopause that is probably involved here somewhere altho my GP doesn’t even appear to take that into the equation to help me.

The thing is, I was shocked to see the TSH rising , my T4 rising but only by a small amount and my T3 the same.

when I questioned it, they said well it’s within range and as they think I had De Quervains following Thyroiditis and a massive delay in being diagnosed back in 2015 ( cause unknown ) they say probs my thyroid gland has repaired itself .

Can anyone help ?

results Dec21. TSH 0.56 Dec22 TSH 1.68 (0.27-4.2 ml/L)

Dec21 FT4 16.2. Dec 22 FT4 16.6. (12-22pmol/L)

Dec21. FT3. 4.6. Dec 22. FT3. 4.6 (3.1–6.8 pmol/l)

Thank you so much 😊

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SlowDragon profile image
SlowDragonAdministrator

Have you had ever had thyroid antibodies tested ?

You need vitamin levels tested too

Which brand of levothyroxine are you currently taking

Do you always get same brand levothyroxine at each prescription

Teva brand levothyroxine upsets many people. Teva is only brand that makes 75mcg tablets

Always test thyroid levels early morning and last dose levothyroxine 24 hours before test

For full Thyroid evaluation you need TSH, FT4 and FT3

plus both TPO and TG thyroid antibodies tested at least once

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high thyroid antibodies 

Autoimmune thyroid disease with goitre is Hashimoto’s

Autoimmune thyroid disease without goitre is Ord’s thyroiditis. 

Both are autoimmune and generally called Hashimoto’s.

Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)

20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis 

In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)

Recommended on here that all thyroid blood tests early morning, ideally just before 9am and last dose levothyroxine 24 hours before test

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins

List of private testing options and money off codes

thyroiduk.org/getting-a-dia...

Medichecks Thyroid plus antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

If you can get GP to test vitamins then cheapest option for just TSH, FT4 and FT3

£29 (via NHS private service ) and 10% off down to £26.10 if go on thyroid uk for code

thyroiduk.org/getting-a-dia...

monitormyhealth.org.uk/

Monitor My Health also now offer thyroid and vitamin testing, plus cholesterol and HBA1C for £65 

Doesn’t include thyroid antibodies

monitormyhealth.org.uk/full...

Only do private testing early Monday or Tuesday morning. 

Watch out for postal strikes, probably want to pay for guaranteed 24 hours delivery 

Link about thyroid blood tests

thyroiduk.org/getting-a-dia...

Link about Hashimoto’s

thyroiduk.org/hypothyroid-b...

Symptoms of hypothyroidism 

thyroiduk.org/wp-content/up...

dancing-heart profile image
dancing-heart in reply to SlowDragon

Thank you, I have read the long list of information before and do try to adhere to the advice in it when I can - all be it battling with unhelpful clinical professionals. I believe they tested antibodies when I was finally diagnosed. Don’t have the results if that any more, they told me it was “ok” .

They tried to tell me I could only have TEVA in 75mcg but I refused and insisted I have 50mcg Accord ( same brand I had been on for many years) and the extra 25mcg by Wockhardt. There has been an issue about this every time I need a repeat prescription - I’m so fed up with it. Going between GP/ Pharmacy2U or other Pharmacy whoever will get it in for me.

I was under a rheumatologist who sent me for an extensive list of blood tests ( not Thyroid ) but he told me my Vit D was ok and so was my B12 . I questioned if it was active B12 and he said it’s the same thing. I questioned Vit D as it was 73.1 (50-350nmol) so I felt this was too low and he disputed this with me.

B12 was 496 ng/L (180-640 ng/L) Serum Folate 9.1 if/L. (3-20 uh/L)

Selenium 1.02 umol/L (0.9-1.67 umol/L

I have been taking a range of supplements for some time now.

He also did tests for Lupus and I had a whole body nuclear bone scan etc but nothing came up conclusive except synovitis left foot and upper body inflammation.

Perhaps I should get my blood test done again to cover more vitamins etc ??

I don’t know where to go from here really except start looking more closely at hormonal testing - as they have more or less told me there’s nothing wrong and to get on with it. I wouldn’t mind, but I hardly frequent the GP if I can help it as they’re a total let down for assistance.

SlowDragon profile image
SlowDragonAdministrator in reply to dancing-heart

FT3: 4.6 pmol/l (Range 3.1 - 6.8)

That’s only 40.54% through range

Vit D as it was 73.1 (50-350nmol)

B12 was 496 ng/L (180-640 ng/L)

Serum Folate 9.1 if/L. (3-20 uh/L)

All on low side

How long ago were these tested

What vitamin supplements are you currently taking

No ferritin result either

Getting all four vitamins tested and at optimal levels first step

Suggest you Test both thyroid antibodies too

SlowDragon profile image
SlowDragonAdministrator

High parathyroid

You should have had vitamin D and calcium levels tested with PTH

What were results

parathyroid.com/low-vitamin...

Hairloss is frequently linked to low iron/ferritin levels

dancing-heart profile image
dancing-heart in reply to SlowDragon

These were in April and May this year.

Calcium fell from the month prior 2.49 to 2.35 mmol/L

Adjusted Calcium fell 2.41 to 2.33 (2.2-2.6 mmol/L )

Parathyroid Hormone May22. 7.1 pmol/L (1.2 - 7.2 pmol/L )

And RBC has been above range 5.2 or 5.3 10*12/L (3.8-4.8 10*12/L ) since around 2018/19 - I don’t know if this is relevant to know. I constantly ask about it , but it seems to irritate them my asking and I don’t get an explanation why this might be.

I can’t find anything on Ferritin on any of the blood tests .. and I’ve had loads.

Prior to Covid they were investigating hyper-calcaemia and although I had already been taking Vit D daily for about 2 years prior, they just said I should have the prescription version instead 1600 iu per day . It has never made any difference as you can see from my Vit D blood test result. Paid to see an Endo privately in London and he repeated a blood & urine test and said levels had come back down so it didn’t confirm hyper parathytoidism. No follow up after that and I’ve run out of money to keep paying.

The Endo noted my skin is thin and fragile .My blood vessels are weak in my hands / fingers and will rupture/bruise vessels easily with normal activity at times. But then in 2020 I suffered a prolapsed disc in C6-7 and this as a result has affected nerves in my upper back-shoulders/arms and hands so other medical consultants say it’s likely to contribute to that, although my hands were going like this long before the neck injury.

Hope that helps. It’s very complex.

SlowDragon profile image
SlowDragonAdministrator in reply to dancing-heart

Suggest you get full thyroid and vitamin testing done in New Year

vitamin D, folate and B12

Push GP to test full iron panel test for anaemia including ferritin

dancing-heart profile image
dancing-heart in reply to SlowDragon

Thank you Slow Dragon, I will try to get those done again. Just to update, I bought a simple Ferritin test to do at home, I realise this may not be as accurate or as detailed, but I was curious and needed something to back up my request for a blood test from the GP , and the result was negative / insufficient. I have now got an iron blood test booked through the GP but earliest possible was 12Jan. So that’s quite a wait by the time I will get any results back. Should I take an iron supplement of some kind in the meantime do you think ?

Also I resorted to trying B12 and Folate transdermal patches instead of oral supplement because I don’t know if Im absorbing sufficient nutrients through the gut. My B12 and Folate were tested but they said they’re fine. I thought they were a bit low for someone who had been taking supplements for a few years. What’s your opinion / thoughts about trying to use the B12/Folate transdermal patches - if any ? Thank you so much 😊

SlowDragon profile image
SlowDragonAdministrator in reply to dancing-heart

no definitely do not supplement iron before test

Some of us have very high iron levels without any supplements

Exactly what B vitamins are you currently taking

Vitamin D you need higher dose, especially in winter

1600iu is small dose for anyone with thyroid disease

Try 2000iu in summer and 3000iu in winter

FT4: 16.6 pmol/l (Range 12 - 22)

Ft4 only 46.00% through range

You need dose increase in levothyroxine to 100mcg daily or if GP reluctant at least 75mcg and 100mcg alternate days initially….

Approx how much do you weigh in kilo

SlowDragon profile image
SlowDragonAdministrator

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...

article by Dr Malcolm Kendrick on magnesium 

drmalcolmkendrick.org/categ...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

SlowDragon profile image
SlowDragonAdministrator

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) 

Thorne currently difficult to find at reasonable price, should be around £20 

If you want to try a different brand in the meantime, one with virtually identical doses of the ingredients, and bioavailable too, then take a look at Vitablossom Liposomal B Complex. Amazon sometimes has it branded Vitablossom but it's also available there branded as Yipmai, it's the same supplement

amazon.co.uk/Yipmai-Liposom...

or available as Vitablossom brand here

hempoutlet.co.uk/vitablosso... &description=true

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 separate B12

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