Medicheck Advanced Thyroid Test Results...your advice please

[mogs1604]

Hi Everyone, i would be very grateful for your advice on results below.

Blood draw at hospital 8.45am on 23/02/23; fasting; no Levo 24hours. No Biotin to allow for.

I have been on 100mcg Levo since Nov 2018 after dose reduction from 150mcg following possible Hyper episode (posted on here). When i realised you could ask for copies of test results i saw that for several years TSH was showing <0.05 miu/L "Consider dose reduction if clinically appropriate to avoid possible long-term side-effects". No mention of that by GP's.

Take: TDN Nutrition D3 + K2 (MK7) 3000iu / 100ug alternate days

Nature Provides liquid sublingual B12 Methyl / Adenosylcobalamin 3000mcg/1ml daily

15mg Mirtazapine nightly - anxiety / sleep

Aim for 1 good portion of liver per week

Have probably been on Levo 25+ years (male, now 68) and never really felt great. Post Hypo diagnosis i've always been cold sensitive, but this and last winter have been off the scale. Keep putting aches/pains/tiredness down to age....

What jumped out at me was low T3, Ferritin and D3 (given that i supplement D3)?

Medichecks Dr comment: "Excellent set of results but i know that doesn't help with your symptoms."

Hope i've covered bases. Many thanks in advance

TSH 2.41 mIU/L (0.27 - 4.2) 54.5%

• Free T4 (fT4) 18 pmol/L (12 - 22) 60.0%

• Free T3 (fT3) 4.1 pmol/L (3.1 - 6.8) 27.0%

• T4:T3 Ratio 4.390 

• Thyroglobulin Antbodies (TgAb) 20 IU/mL (< 115)

• Thyroid Peroxidase Antibodies (TPO) 23 IU/mL (< 34)

• C-Reactive Protein (CRP) 0.45 mg/L (0 - 5) 20.0%

• Folate - Serum 13.6 ug/L (3.9 - 19.5) 62.2%

• Vitamin B12 (active) >150 pmol/L (37.5 - 150) 100% (will drop dose a bit?)

• Vitamin D 87 nmol/L (50 - 200) 24.7%

• Ferritin 57 ug/L (30 - 400) 7.3%

[GlowCoach Administrator]

So with a TSH of 2.41 no wonder you have no energy and clearly need an increase of 25mcgs. Your FT4 at 60% and FT3 at 27% are just too low and back that up. An increase will help the anxiety which is a hypo symptom.

B12 is fine and an excess will be lost via urine so not to worry about it being over range.

D3 is not bad also. A level of around 100 is good for thyroid hormone use so perhaps a tiny bit more during winter as we are now.

Ferritin needs a bit of work to get upp to 90-100. Eating chicken livers a few times a week or pate will help over time.

[Hidden in reply to GlowCoach]

Hi, thanks for the advice....interesting...

I was looking at the 60% / 27% as not converting T4, so maybe overthinking it with my limited grasp of things. I guess i've been tying the anxiety to being hyper after the episode i had so it would be great to at least diminish anxiety and cold sensitivity through upping levo.

Good too if i can sort D3 & ferritin via supps. and food.

[GlowCoach Administrator in reply to Hidden]

Sorry I'm confused. Are you the same person as mogs1604 ? This doesn't appear to be your post.

[Hidden in reply to GlowCoach]

Sorry, yes - i signed up here as mogs1604...not sure what i've managed to do here as i do use morfinell elsewhere.

[GlowCoach Administrator in reply to Hidden]

morfinell hasn't posted or replied here previously. It's going to get very confusing if you use 2 accounts on HU.

I think with your TSH where it is it's hard to be sure how well you are converting. That's something that its better to review once you're on a full dose of Levo. At the moment you still need at least one possibly more levo increases so there's plenty of time and more Levo for conversion to improve.

[mogs1604 in reply to GlowCoach]

Many thanks. Will look to titrate up to optimal T4 and see where T3 stands.

[tattybogle]

The reduction 4 yrs ago from 150mcg to 100mcg was very heavy handed.

while a reduction was obviously needed due to symptoms of overmedication... removing a third of the dose was probably not .

Your TSH went up to 3.6 from <0.05 following this big reduction in 2018 ,, and is still 'up there' now .

fine/ subtle adjustments in dose are usually preferable to huge drops.

25mcg tablets exist .. to give dose of 125mcg

finer adjustments that that can easily be prescribed by alternate daily dosing:

eg 100/ 125 / 100 / 125 gives effective daily dose of 112.5mcg

5 days 100 / 2 days 125 gives dose of 107mcg

6 days 100 / 1 day 125 gives dose of 103mcg

You can use this list of references to show GP that is is safe / recommended to keep TSH between 0.4 / 0.5 and 2 /2.5 in patients on levo . healthunlocked.com/thyroidu...

So based on those recommendations ,a small dose increase to 112.5mcg or 125mcg / daily could be tried to see if it improves how you feel .. without risking overmedication again.

'a bit too much' feel lousy ,as you know .. but so does 'a bit too little'

i find 12.5mcg adjustments are enough to give a significant difference in symptoms without doing anything too drastic to blood results .

if you adjust dose , even by a small amount , do give it long enough forthe body to accomodate itself t the new levels before making you mind up how it will feel... i have found the fist 5 weeks are not a reliable indicator of how it will feel once settled in .. so i now pay more attention to how things feel from week / 4/5 onwards

So , ask your GP to put his sledgehammer away and get his precision screwdriver out instead to try and find a middle ground that hopefully works better for you .

[Hidden in reply to tattybogle]

Hi and thanks for your in depth response - chuckled over your sledgehammer / precision screwdriver analogy. I'd obviously caught him (GP) at the end of a bad day - he was more wired than i was! Told me my whole thyroid thing was a red herring, intimating that i was basically a head case.

I've def got brain fog though as i'd never thought through the fine-tuning dose variations you've outlined. Thank you so much for that....i was just thinking it's a case of 100>125>150 etc. Might take a while doing the adjustments but i'm well up for that given how lousy and cold i feel at present.

If i can sort this just by tweaking the levo it would be great....it seems a nightmare if you have to go the NDT / T3 route.

[pennyannie]

Hello Mogs :

We generally feel best with a T4 in the top quadrant of its range as this should in theory convert to a decent level of T3 - at around a 1/4 ratio T3/T4.

T3 is the active hormone that runs the body and it is too low a level of T3 for you that causes all the symptoms of hypothyroidism that you describe just as too high a level of T3 for you may give you symptoms of hyperthyroidism.

It does get confusing when ageing as your body is naturally slowing down and we are programmed to believe those aches and pains are age related, and yes, it has been colder than previous years with many probably reducing temperature controls due to costs.

With a TSH up and over 2 there is no reason to deny you a dose increase in T4 x 25 mcg and then a retest in 6-8 weeks to check for relief of symptoms, I haven't looked back at this ' hyper ' incident but your antibodies are currently low and in range but these can wax and wane so need to go back now and read your previous post/question - not much to add - though sorry read of your daughter's diagnosis of Hashimoto's and possibly there is a genetic predisposition ?

It's evident that your T4 needs increasing as does your supplementation of vitamins and minerals as your metabolism has been ' slowed ' too much with your body struggling naturally to extract key nutrients through your food.

Once your T4 is in the top quadrant the accepted conversion ratio is said to be 1 / 3.40 - 4.50 T3/T4 and we generally feel best when we come in this ratio at 4 or under.

So as it stands you are slightly wide of centre at around 4.40 and this will likely improve once your core strength vitamins and minerals are up and maintained at optimal.

I am female and now aim for a ferritin of 100: folate at 20: active B12 75++ and vitamin D at around 100 and everywhere I read suggested ferritin needs to be at least over 70 for any thyroid hormone replacement to work well.

[mogs1604 in reply to pennyannie]

Hello Penny, sorry for delay in responding.

Thanks for great advice. I looked at the T4 result as being mid-range and about right, so i see now i've got room to increase it, and hopefully T3 in tandem. Regarding the ratio, am i right in thinking if i got T4 to 19.5 then T3 should be around 5.5? I see now that this needs to be a slow/steady process and allow time to gauge symptoms.

I'll take the D3/K2 daily from now and see where that stands at re-test. Have a feeling i'll struggle to get ferritin up via food alone. I was prescribed short course of Ferrous Fumerate some years ago but wouldn't it need to be ongoing to correctly judge any positive progress?

Thanks for helpful advice everyone.

[pennyannie in reply to mogs1604]

No worries :

Well if you look at the ranges at the lower end we have a T3 at 3.10 base number and a T4 base number of 12.00 so around a 1/4 ratio - whereas if we look at the top end of ranges the T3 is 6.80 and the T4 at 22.00 - which is at around a 1/ 3.23 ratio.

It is ok to go over the range a little if it leads to a better QOL - and a T3 at the top of the range at 6.80 would probably see a T4 of around 27.

A T3 at 5.50 working on the 1/4 ratio T3/T4 would see a T4 at around 22.00

and you would probably be told you were up at the top of the range and possibly encouraged to drop your dose of T4 a little - which actually happened to me and though I objected my dose of T4 was reduced though I just felt well and ok.

It's just a ratio and a tool to use to assess how well you are converting T4 to T3.

You need to look to at least double your ferritin level :

I found an iron bisglycinate - marketed as a Gentle Iron - kinder on my stomach than the prescription ones.

You could also try eating liver once or twice a week - as ferritin does take time to build and why I now aim to keep my level up as it makes a massive difference to your overall well being as well as helping convert the T4 into T3.

I now self medicate and take NDT and do not go to the doctor and run with a T3 at around 6.80 -7.20 and much improved.

[mogs1604 in reply to pennyannie]

Thanks, all clear on ratio.

Looking to reorder D3 on Amazon and saw AAVALABS Gentle Iron so will start 1 alternate days plus liver weekly. Going to call surgery tomorrow to request 25mcg Levo increase but tweak to start on 112.5mcg daily average.

Many thanks. Will post on hopeful progress.

[pennyannie in reply to mogs1604]

Check the recommended iron supplement strength and dose as you have a way to go and could likely take them everyday as can your T4 be increased by 25mcg daily.

[mogs1604 in reply to pennyannie]

Says take 1 capsule daily Iron Bis. giving 42mg elemental iron & 55mg Vit C

Should you get / monitor full iron panel if taking daily ongoing?

[pennyannie in reply to mogs1604]

I don't think so - your result was not so low as to suggest further investigations.