Blood tests and supplement advice please if you have a minute.

[MrsQ20]

Hello everyone, I posted this a little while back but no comments so trying again, I know everyone is busy but I find help here invaluable. I am hoping I could get some advice on recent results. In late October I changed from 100-125mcg dose due to aches and sluggishness. Prior to this I had received some great advice on my previous posts on this brilliant forum about my previous results and adjusted supplements.

So currently I take:

Mid morning I take: Thorne Basic B 1 tablet, 3 sprays of Better You Vit D+K2 , H&B Collagen complex 1 tablet (alternate days), Solgar 200 ug selenium 1 tablet, Bio-ubiquinol Active QH 30mg 1 tablet, Biocare methylfolate 4 drops under tongue, methyl B12 6 drops under tongue. I had been taking a spoonful of H&B liquid iron most days prior to Christmas but haven't restarted this since it ran out. (I probably need to do a new test but funds a bit tight in Jan).

With evening meal I take:

2 magnesium gylcinate by Your Supplements and H&B 15mg zinc gluconate 1 tablet

I take HRT (since May) in gel form daily and tablets 2 weeks out of 4.

I am pescatarian and generally gluten free and reduced dairy.

I have been feeling better on the increased dose and changed supplements. I had a crash just after New Year which I put down to late night dancing, less strict diet and business over Christmas. Some of my supplements are running low and I was wondering what advice people had on my latest results? I think conversion is much better. Thank you so much.

[SlowDragon Administrator]

How long before test did you stop B complex?

Folate, B12 and ferritin all far too low

B12 is extremely low considering you’re supplementing

Have you been tested for Pernicious Anaemia

Perhaps you need B12 injections

[MrsQ20 in reply to SlowDragon]

thanks Slow Dragon - a week before - not tested for PA - would that require me persuading my dr?

[shaws Administrator in reply to MrsQ20]

Pernicious Anaemia needs to be diagnosed as those who have P.A. must have regular injections.

Pernicious anemia, one of the causes of vitamin B12 deficiency, is an autoimmune condition that prevents your body from absorbing vitamin B12. Left untreated, pernicious anemia can cause serious medical issues, including irreversible damage to your nervous system.

I also have P.A. and GP has told me that I can have as many B12 injections as I feel I need.

[MrsQ20 in reply to shaws]

ok thank you - did you get diagnosed because of feeling unwell or through tests for other things. I need to make my case clear to the dr and I am feeling better since being on 125mcg levo but not exactly bouncing with energy.

[shaws Administrator in reply to MrsQ20]

A blood test showed my B12 as 'low'. I requested B12 to be tested, which proved that I had pernicious anaemia.

My mother also had P.A. and after several years of injections her GP told her she needed no more injections.

Both my sister and myself thought that was 'good' but turned out to be terrible as Mother developed stomach cancer due to her GPs advice.

[SlowDragon Administrator]

Which brand of levothyroxine are you currently taking

Do you always get same brand at each prescription

Was test early morning and last dose levothyroxine done 24 hours before test

Ft4 is low in range

Are you currently taking 125mcg everyday

Approx how much do you weigh in kilo

[MrsQ20 in reply to SlowDragon]

accord and Mercury Pharma. I was prescriped Teva just after this for the 25mcg and said I didn’t want it but they said they couldn’t put a note on my file unless I had tried it. Made me feel worse so now got a note in my file. I never miss my dose of levo. I weigh 75kg. I have put on 11lb in past year.

[MrsQ20 in reply to SlowDragon]

also I always test early and take Levo after so it’s a 25 hours since last dose

[SlowDragon Administrator]

Ferritin is deficient

You need full iron panel

Meanwhile ….Working on improving with iron rich diet

[MrsQ20 in reply to SlowDragon]

I have been taking some iron liquid especially as I’m pescatarian but I’m not consistent with this. I eat lots of green veg

[SlowDragon Administrator in reply to MrsQ20]

Could you consider red meat?

Shellfish and Mussels are excellent source of iron 

healthline.com/nutrition/he...

Liquid iron probably not strong enough

Suggest you read the many posts and replies by humanbean on iron supplements

cks.nice.org.uk/topics/anae...

Serum ferritin level is the biochemical test, which most reliably correlates with relative total body iron stores. In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency.

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.

healthunlocked.com/thyroidu...

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...

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. ‘

Here’s absolutely excellent reply by @humanbean

on iron and ferritin panel test results for another member 

healthunlocked.com/thyroidu...

Good explanations of iron 

theironclinic.com/iron-defi...

theironclinic.com/ironc/wp/...

Helpful info on iron infusion and supplements 

healthunlocked.com/thyroidu...

[MrsQ20 in reply to SlowDragon]

Thank you for all the links - i will take time to read. No I don’t eat animals and don’t want to start

[SlowDragon Administrator]

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 separate B12 supplement as well as a B Complex 

Then once your serum B12 is over 500 (or Active B12 level has reached 70), you may be able to reduce then stop the B12 and just carry on with the B Complex.

If Vegetarian or vegan likely to need ongoing separate B12 few times a week 

B12 drops are excellent

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...

[MrsQ20 in reply to SlowDragon]

once again thank you for links and advice

[humanbean]

CRP HS - This is a measure of inflammation. It doesn't tell you where the inflammation is though. Optimal is less than 1, so your result is already optimal.

Ferritin - Your result is only 6.2% through the range which is much too low. Take a look at this link from the NICE guidelines on iron deficiency :

cks.nice.org.uk/topics/anae...

It states that

In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency.

Obviously you are iron deficient. Another issue is that the reference range for ferritin you were given is out of date as far as the NICE guidelines go. How can the "healthy" range be 13 - 150 if anything under 30 is deficient?

Another problem is that people can have poor levels of ferritin while also having high levels of serum iron. If they start supplementing iron the patient has no idea unless they test whether the iron is raising ferritin, or raising serum iron. Serum iron is "free" iron which is available to any pathogens to help them reproduce - definitely not desirable! This is why we always suggest that people get an iron panel done so they know more about their iron status before taking supplements.

This is a popular test :

medichecks.com/products/iro...

You can get 10% off the price with the discount code from this link :

thyroiduk.org/help-and-supp...

Also, you can register with Medichecks and get sent info on their sales discounts via email. Registration is free.

I've just realised that your results are from Medichecks so you know this already.

Folate & B12 are both far too low. Before supplementing you really need to get tested for Pernicious Anaemia (PA). If the test is positive you will need B12 injections. If the test is negative you can supplement with high dose methylcobalamin (a good form of B12). Once your B12 has improved with an injection or with some form of oral supplement you can start supplementing with folate in addition to the B12.

You should join the PA Society forum on HealthUnlocked and ask for advice on B12 Deficiency, Pernicious Anaemia, and low folate.

Optimal for Active B12 is a minimum of 70, but better still would be a result of 100+.

Note the rules are different for Serum B12.

Optimal for folate is upper half of the range if the range has an upper level. Alternatively get it into double digits. Personally I aim for a result of 15 - 20 but folate has a tendency to go up and down like a yoyo for me.

Vitamin D - your result is okay, but possibly a bit high. Depending on source, optimal is quoted as either 100 - 150 or 125. Personally I am happy with a result of 100, but others need it to be 150 to feel at their best. If you are taking a supplement you could reduce the number of times a week you take it to save money, or take 2 sprays a day instead of 3 for a while and see how you feel.

Free Thyroxine (T4) - result is 10% through the range. Optimal varies from person to person but is usually somewhere around 60% - 80% of the range.

Free T3 - result is 62.97% through the range. Optimal varies from person to person but is usually somwewhere around 50% - 70% of the range.

TSH is in range. Optimal for many of us is 1 or under.

Some people can feel well with a zero or almost zero Free T4 and a high in range or slightly over the range Free T3, some people are happy with a low Free T4 and a higher in range Free T3. It could be that you need Free T4 and Free T3 to both be around 60% - 80% through range. But we each have to find our own sweet spot. A Free T4 of 10% through range wouldn't be enough for most of us unless we were on T3 only and doing okay with that.

I think you need an increase of 25mcg Free T4 per day.

Selenium - 200mcg a day is quite a high dose. If you've been on it for more than a month or two I would suggest reducing your dose to 100mcg per day. Or, if money is available, you could pay for a test and see what your level is.

H&B Liquid iron is very low dose - 7.5mg iron per dose. There are higher dose options - you might want to try something a bit higher in dose. This is worth taking a look at for more options :

healthunlocked.com/thyroidu...

But as I said above, it is safest to do an iron panel before taking any iron supplements.

[MrsQ20 in reply to humanbean]

thank you do much. I’ll work through all the links to understand more. Is getting a PA test something that I need to persuade my dr to do?

[SlowDragon Administrator in reply to MrsQ20]

Explain to your GP you have been supplementing B complex for months and separate B12 supplement, but your B12 result remains low……this suggests Pernicious Anaemia……and you may need B12 injections

With PA gut can’t absorb B12 supplements

[MrsQ20 in reply to SlowDragon]

thank you. - I’ll try!!!!

[shaws Administrator in reply to MrsQ20]

If you do have P.A. (I have it too) your GP should ensure you have regular B12 injections.

[MrsQ20]

I am so embarrassed to say that I accidentally posted a screenshot of my daughter's results from last year instead of mine. She is 19 and I am trying to help her follow up with doctors at the moment which has been ongoing since October last year. She is struggling to tolerate iron supplements. I will use the advice here to support her and do a separate post on my results. Sorry for the confusion - brain fog symptoms - please be assured that all advice given here will still be used.

[shaws Administrator]

Don't worry about confusion as we've all had similar occasions at times .

[MrsQ20 in reply to shaws]

thank you so much- I feel so guilty about people’s precious time but will be using info here to help my daughter

[shaws Administrator in reply to MrsQ20]

Don't worry as you might also be giving advice when your or daughter's health has been restored. Our children need us to try to enable them to obtain 'good health' and sometimes that includes supplements.