Advice on labs needed please

[Kriticat]

I've got my latest lab results after 3 months on 50mcg Tirosint. Blood drawn at 9.30 this morning, fasting, last tab taken 26 hours previously.

TSH 0.1 mIU/L (0.3 - 4.5) -4.8%

Free T4 (fT4) 1.3 ng/dl (0.8 - 1.8) 50.0%

Free T3 (fT3) 4.6 pmol/L (3.0 - 6.5) 45.7%

Vitamin B12 (active) 818 nmol/L (200 - 1050) 72.7%

Vitamin D 39 nmol/L (30 - 100) 12.9%

E2 8.6 pg/ml (10 - 66) -2.5%

I'm ignoring TSH as I've been on steroid medication, and it looks like my FT4 and FT3 are 50% through range.

Would it be worth increasing my dose of T4 before adding T3? It looks like quite a good conversion ratio so maybe T3 not necessary?

Does anyone know anything about starting oestrogen supplements in your 60s, long after menopause? I never took HRT...

Also, my D has dropped, I was advised to stop supplements due to high calcium and phosphorus levels, but think I might need to start again at least for the winter.

I'm not involving the endo at this stage, she'd just panic about the TSH! It seems that's all they care about!!!

Thanks for advice

[SlowDragon Administrator]

Yes, looks like you need 25mcg dose increase in levothyroxine

50mcg is only the standard starter dose

Retest in 6-8 weeks

Folate and ferritin results?

[Kriticat in reply to SlowDragon]

Thanks, I am slightly worried as I started on 75mcg 13 months ago and although I felt better at first, after a couple of months I was feeling worse again, and my FT4 was over range and my TSH was down to 0.01. That's when my dose was reduced to 50 mcg, then 25mcg as my TSH was still below range, by which time I was back to square 1! Since then, with the help of this forum I have decided to self medicate, and am feeling much better...though still not myself. Although it's hard to know what myself would be like after 10 years of struggling to get a diagnosis! Maybe this is me now....🙄I had folate and ferritin tested last time, end of October (Folate 10.0 ng/ml Range 3.0-19. Ferritin 118 ng/ml Range 15.0-195.0)

As they were both good I didn't ask for them again... and I take a b complex so don't expect to have a problem with folate.

[SlowDragon Administrator in reply to Kriticat]

Starting on 75mcg was too much

But you’re likely ready now

You could do 50mcg and 75mcg alternate days for 6-8 weeks then retest

[Kriticat in reply to SlowDragon]

Thanks, that sounds like a good plan, I hope I can follow it properly... I have done better than I expected at remembering to take it every morning, but whether I'll remember which dose to take might be a bit more of a challenge!

[SlowDragon Administrator in reply to Kriticat]

get a weekly pill dispenser

Otherwise you won’t remember

[SeasideSusie Remembering]

Kriticat

Would it be worth increasing my dose of T4 before adding T3? It looks like quite a good conversion ratio so maybe T3 not necessary?

FT4 and FT3 are nicely balanced and show no need for the addition of T3. With FT4 being only 50% through range then your results suggest that you may benefit from increasing your dose of Levo.

Some of your results/ranges don't seem right. Which calculator have you used to work out the percentages?

Vitamin B12 (active) 818 nmol/L (200 - 1050) 72.7%

This looks more like the range and result for Total B12, not Active B12. Active B12 has a narrow range of something like 37.5-188 and Total B12 has a wide range similar to the one you have quoted. I believe this is a Total B12 test and the result is good.

Vitamin D 39 nmol/L (30 - 100) 12.9%

The range of 30-100 is usually when unit of measurement is ng/ml. The range for unit of measurement nmol/L is generally just >50 or >75.

Can you clarify exactly what the unit of measurement and range is for this test.

E2 8.6 pg/ml (10 - 66) -2.5%

What exactly is this test, I've never seen this before?

Did you get folate and ferritin tested?

Does anyone know anything about starting oestrogen supplements in your 60s, long after menopause? I never took HRT...

I would take specialist advice on this. I have never taken HRT and am in my 70s now. I have been plagued by breast cysts since mid-40s and at the last ultrasound I had 10 cysts were found in the one breast checked and the radiologist said that one reason for cysts is excess oestrogen. The older we get the less oestrogen we produce so to start oestrogen only in your 60s is not something I would personally do, I would want to know from an experienced practioner if it was safe to take oestrogen only or whether it would need to be combined with progesterone or if, indeed, it was a good idea at all. I would imagine sex hormone testing would be a good idea if considering this.

[Kriticat in reply to SeasideSusie]

SeasideSusie would I be right in thinking that if I take a vitamin D supplement with K it would be less likely to increase my calcium and phosphorus?

[SeasideSusie Remembering in reply to Kriticat]

Kriticat

Taking D3 increases absorption of calcium from food (and the reason we need K2 is to direct the calcium to bones and teeth and away from arteries and soft tissues). So there is the possibility that it may increase your level of calcium. However, I take a high maintenance dose of D3 (was originally severely deficient) and my calcium when tested was not high, it was towards the lower end of the range. What happens with others I obviously can't say. I have no idea about phosphorus.

[Kriticat]

Thanks and sorry! I didn't check the units when entering into the chingkerrs thyroid calculator. They measure it slightly differently here in Greece... D is indeed in ng/ml. B12 is in pg/ml, but it doesn't say whether or not it's active. Folate and Ferritin both good last October (Folate = 10.0 ng/ml - R 3.0-19. Ferritin = 118 ng/ml - R15.0-195.0 )

E2 is oestradiol... someone on here suggested the pain that I've been having in my wrists could be from low oestrogen so thought I would check it, I have always been reluctant to supplement oestrogen because my grandmother died of uterine cancer, but I have recently read good things about bioidentical oestrogen. Still not sure... but I'm having to take steroid medication for the pain, which is also probably not great long term!

[TiggerMe in reply to Kriticat]

Probably me!...I'm a big fan of HRT where necessary... body identical is what it says just a little bit of what you are lacking, progesterone needed for balance if you still have all your bits 😊

Got to be better than steroids 😕

[SeasideSusie Remembering in reply to Kriticat]

Kriticat

Sorry, I was unaware of this reply, you replied to yourself rather than to me so I didn't get any notification.

Vitamin D 39 nmol/L (30 - 100)

D is indeed in ng/ml.

So the Vit D Council, Vit D Society and Grassroots Health all recommend a level of 50ng/ml.

ou 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 recommended level.

Checking the table on the Vit D Council's website

web.archive.org/web/2019070...

it suggests that you would need to take 2,500iu D3 daily to reach their recommended level. Retest after 3 months to check your level, once you've reached the recommended level you'll need to find your maintenance dose by trial and error.

Vitamin B12 (active) 818 nmol/L (200 - 1050)

B12 is in pg/ml, but it doesn't say whether or not it's active.

There is no doubt that with that reference range this is a Total B12 test.

Folate and Ferritin both good last October (Folate = 10.0 ng/ml - R 3.0-19. Ferritin = 118 ng/ml - R15.0-195.0 )

Folate is recommended to be at least half way through range, so 11 plus with your range so there is room to improve it.

Ferritin seems fine providing there is no inflammation falsely raising your level.

As for your low oestrogen, I think talking to your doctor or a hormone specialist might be a good idea.

[TiggerMe]

I've a couple of cysts in my breasts and they haven't changed since adding HRT, it isn't about increasing above a 'normal' level just stopping them completely disappearing for the benefit of my bones, brain, heart, thyroid, skin, bladder.... it's still a lot less hormone than your body has had for the previous 30/40/50 years?

healthunlocked.com/thyroidu...