test results help

[Abirose97]

I would love some advice with what to ask my family doctor for medication wise as I am still waiting for my thyroid specialist referral.

for context I will provide markers going back 6 months along with the ranges.

normal ranges:

t3 3.5-6.5

t4 9-23

TSH 0.2-4

June 2022 150mcg synthroid 20mcg liothyronine

t3 5

t4 14.9

tsh <0.01

Nov 2022 150mcg synthroid 20mcg liothyronine

t3 6.8

t4 18

tsh <0.01

this led to my doctor reducing my liothyronine to 10mcg

Jan 2023 150mcg synthroid 10mcg liothyronine

t3 6.7

t4 20.6

tsh 0.01

as you can see despite cutting my liothyronine in half my t3 levels have only gone down by 0.1 and my t4 continues to steadily rise despite no change to my synthroid medication. my TSH seems to be doing something seeing as the '<' sign is now gone. over the last few weeks I have felt a bit more hungry, a bit more irritable, my sleep has been a bit more interrupted, my libido decreased for a time but has come back more so recently. that could be due to my thyroid but I can also put it down to cold winter in Canada.

my mother who also suffers from thyroid issues (has done her whole life with hashimotos) suggests staying on 10mcg of liothyronine and decreasing my synthroid a little and asking for autoimmune testing and genetic testing. any other advice would be welcome.

thank you so much for your time reading this and potentially answering.

[SlowDragon Administrator]

Was test done early morning, ideally just before 9am

Last dose levothyroxine 24 hours before test

Day before test did you split T3 into 3 smaller doses spread through the day and last dose T3 approx 8-12 hours before test

Presumably you have Hashimoto’s

When were vitamin D, folate, ferritin and B12 levels last tested

What vitamin supplements are you currently taking

Are you on strictly gluten free diet and/or dairy free diet

[Abirose97 in reply to SlowDragon]

hi, I was unable to get test done before 9am most recently. I had to go around 3pm unfortunately. all other previous tests were atound 9am. I had not taken any medication for 24hrs before. vit d b12 and folate are all good. I am strictly gluten free and eat incredibly small amounts of dairy as I have seen no observable issues with the amount i now eat.

we are assuming I have hashimotos yes

should I mention with my doctor that the test time was different to the previous tests? he did not request any medication changes or particular time for my test I just did what I had been told my others in the past.

[Abirose97 in reply to Abirose97]

sorry by "we" I mean myself and my mother lol

[Abirose97 in reply to SlowDragon]

I currently take vit D and omega 3s daily

[Abirose97]

for a little more context other than those random symptoms I am very healthy, I have avoided all autumn and winter colds, I am very active, both in job and outside voluntarily, I feel I usually have enough energy throughout the day, and my digestion is good. so all good in other aspects.

[SlowDragon Administrator in reply to Abirose97]

Suggest you get folate, B12, ferritin and vitamin D tested

Then review thyroid again once all four vitamins are optimal

At moment if you took last dose T3 24 hours before test…..you look a little over medicated….but check vitamins first

[Abirose97 in reply to SlowDragon]

those were all tested in Nov 2022 and looked great so I'm assuming they are all now still as nothing has changed except thyroid medication

that is what I was thinking yes. do you think I am overmedicated for both t3 or t4?

sorry for all the questions I just want to go in prepared.

[SlowDragon Administrator in reply to Abirose97]

what were actual vitamin results and ranges

Only reduce T3 or levothyroxine….not both at once

Suggest perhaps reducing levothyroxine to 137.5mcg and retest in 6-8 weeks

Have you lost weight?

[Abirose97 in reply to SlowDragon]

okay that's great thank you.

sorry I actually cannot locate my folate and vit d results right now for some reason which is infuriating.

b12 655 range >160

ferritin 38 range 20-300

no my weight has stayed very steady (25 yr old 5'8" weight stays between 130lbs-135lbs constantly has done for 3 years)

okay I will ask to start with that reduction.

[SlowDragon Administrator in reply to Abirose97]

Ferritin is far, far too low

Likely responsible for thyroid levels being off

Are you vegetarian or vegan

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

Also See page 7 on here 

rcn.org.uk/-/media/royal-co...

Look at increasing iron rich foods in diet 

Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption

List of iron rich foods

dailyiron.net

Links about iron and ferritin

An article that explains why Low ferritin and low thyroid levels are often linked 

preventmiscarriage.com/iron...

irondisorders.org/too-littl...

davidg170.sg-host.com/wp-co...

Great in-depth article on low ferritin 

oatext.com/iron-deficiency-...

drhedberg.com/ferritin-hypo...

This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.

Thyroid disease is as much about optimising vitamins as thyroid hormones

healthunlocked.com/thyroidu...

restartmed.com/hypothyroidi...

Post discussing just how long it can take to raise low ferritin 

healthunlocked.com/thyroidu...

Never supplement iron without doing full iron panel test for anaemia first and retest 3-4 times a year if self supplementing. It’s possible to have low ferritin but high iron 

Medichecks iron panel test 

medichecks.com/products/iro...

Iron and thyroid link

healthunlocked.com/thyroidu...

Excellent article on iron and thyroid 

cambridge.org/core/journals...

Posts discussing why important to do full iron panel test

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Chicken livers if iron is good, but ferritin low

healthunlocked.com/thyroidu...

Shellfish and Mussels are excellent source of iron 

healthline.com/nutrition/he...

Heme iron v non heme

hsph.harvard.edu/nutritions...

Ferritin over 100 to alleviate symptoms 

healthunlocked.com/thyroidu...

Low Iron implicated in hypothyroidism 

healthunlocked.com/thyroidu...

Ferritin range on Medichecks 

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

We have received further information the lab about ferritin reference ranges. They confirm that they are sex dependent up to the age of 60, then beyond the age of 60 the reference range is the same for both sexes: 

Males 16-60: 30-400 ug/L

Female's: 16-60: 30-150

Both >60: 30-650 

The lower limit of 30 ug/L is in accordance with the updated NICE guidance and the upper limits are in accordance with guidance from the Association of Clinical Biochemists. ‘

[Abirose97 in reply to SlowDragon]

thank you for so many resources that's amazing

[SlowDragon Administrator in reply to Abirose97]

vitamin D result?

Folate?

[Abirose97 in reply to SlowDragon]

not veggie at all I eat a very iron rich diet and eat with vit C rich foods for optimal absorption have done for years.

I am just remembering now sorry that they won't test my vit d levels here if my calcium levels are okay. sorry for that. I think it was calcium anyway... calcium was 2.39 range 2.1-2.6

hemoglobin count at 150 range 120-160.

I have floradix but as you said I am hesitant to supplement with it. and I guess I was mistaken my folate levels were never tested. I did request them but they aren't showing up on my health account for lab results.

[SlowDragon Administrator in reply to Abirose97]

Canadian Thyroid support group

thyroidpatients.ca/

See if you can get info on getting vitamin D and folate testing done