I'd very much welcome your views on these blood test results for my 85 year old father (they were taken first thing in the morning before his thyroid meds). He is active for his age and currently without major health issues (always had a good organic diet and around 10 stone). He has cold hands and complains of feeling the cold, has low energy, foggy thinking and an early morning temperature of 36.0-36.3. Today's temp at noon was 36.5 with a pulse of 74. Blood pressure is slightly low.
He has been on T4 for a number of years and is currently on 75 mcg T4 which he takes in the morning. He has two copies of the gene variant (DIO2) that affects T4-T3 conversion. Very high thyroglobulin antibodies since at least 2017. We did a trial of gluten free which reduced the TPO antibodies but didn't affect the thyroglobulin levels - or if they did, they were still outside the range. He takes very little gluten now. He is on various vitamins - methyl bs, D3/K2/A, magnesium and a multi mineral.
I have taken him to various private practitioners over the years to try and sort out his thyroid. The most recent practitioner we consulted said these results were OK and we didn't need to change his meds. I don't think they are - even for someone of my father's age and symptoms. Any advice or suggestions would be very welcome. Thank you.
Medichecks results are:
TSH 3.02 mU/L (0.27-4.2)
Free T3 3.3 pmol/L (3.1 – 6.8)
Free thyroxine 14 pmol/L (12 – 22)
Thyroglobulin antibodies >4,000 IU/mL (<115)
TPO antibodies 48 IU/mL (< 34)
Vitamin D 68 nmol/L (50-200)
Vitamin B12 – active 73 pmol/L (37.5 – 150)
Folate – Serum 8.18 ug/L (3.89 - 19.45)
Ferritin 75.1 ug/L (30 - 400)
CRP HS 0.59 mg/L (0 - 5)
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Eagle18
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poor chap must feel rotten, 75mcg is one dose up from the starter dose. I’d ask GP for a raise and test again in 8 weeks.
Oh and crack out the liver and onions twice a week for that ferritin. (Lambs liver in Waitrose is cheap and enough for 3-4 meals, we eat for tea, some for lunch and make pate by wooozing up the rest with a bit of damson gin, great on a nairns GF cracker 👏 probs need to up the D3 a bit too.
What’s the multi mineral could that be affecting?
Oh and @lalaloot transformed my life this week pointing out I was taking magnesium too close to my night time Levo split dose. Moved it 4 hours away and despite it being period week my muscle aches and stiffness have vanished.
These results show that he is currently undermedicated which is why he has the symptoms you mention. 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. You can see that his TSH is far too high and FT4 and FT3 far too low. See
Replacement therapy with levothyroxine should be initiated in all patients to achieve a TSH level of 0.5-2.0pmol/L.
Also, Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (the professional publication for doctors):
"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l. In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance. But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l. This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l).*"
*He confirmed, during a talk he gave to The Thyroid Trust in November 2018 that this applies to Free T3 as well as Total T3 and this is when on Levo only. You can hear this at 1 hour 19 mins to 1 hour 21 minutes in this video of that talk youtu.be/HYhYAVyKzhw
You can obtain a copy of the article which contains this quote from ThyroidUK
Email : tukadmin@thyroiduk.org
and ask for the Dr Toft article from Pulse magazine. Print it and highlight Question 6 to show your GP.
Thyroglobulin antibodies >4,000 IU/mL (<115)
TPO antibodies 48 IU/mL (< 34)
These raised antibodies confirm autoimmune thyroid disease (Hashimoto's) as the cause of his hypothyroidism. This complicates things because we can swing from being hypo to a false hyper episode and back again. But his other results confirm he is hypo at the moment and undermedicated.
Vitamin D 68 nmol/L (50-200)
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).
You might want to check out a recent post that I wrote about Vit D and supplementing:
and you can check out the link to how to work out the dose he needs to increase his current level to the recommended level.
Current level of 68nmol/L = 27.2ng/ml
so it looks like he needs to supplement with 3,700iu D3 daily (nearest is 4,000iu) along with important cofactors magnesium and Vit K2-MK7.
Vitamin B12 – active 73 pmol/L (37.5 – 150)
This is low and would be better 100 plus.
Folate – Serum 8.18 ug/L (3.89 - 19.45)
Folate is recommended to be at least half way through range so that would be around 12 plus.
Taking a good quality B Complex should help raise both B12 and Folate levels. Maybe consider Thorne Basic B (sometimes difficult to obtain and can sometimes be expensive).
A good alternative is Vitablossom Liposomal B Complex also sold as Yipmai on Amazon, available here:'
We should leave B Complex off for 3-7 days before any blood tests due to it containing biotin which may give false results.
Ferritin 75.1 ug/L (30 - 400)
Ferritin is recommended to be half way through range although some experts say the optimal level for thyroid function is 90-110ug/L. We shouldn't supplement with iron unless an iron panel is done, if we have good levels of serum iron and saturation percentage then taking iron will raise them and may lead to toxicity.
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
Thank you so much for your long and detailed reply which is very much appreciated. We will show the information to Dad's GP and hope that an increase in T4 will help.
Dad takes Biocare Methyl B complex which we thought was a good one to take but the Thorne product you mention has much higher B doses. We'll give that one a go instead and see how he gets on. We'll also make some changes regarding the other vitamins.
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