How to take Levo before a blood test when I split my dose, and feritin level

[Watamu]

Dear friends, I would like advice on how to stagger my Levo before my next blood test on 8th. I normally take my 75mcg tab in two halves,, half in the morning and half in the evening. I started doing this because I found that when I took it in one dose it took a long time to feel the benefit, then I was almost hyper, baking bread at 8 pm at night etc.

I have decided that I need to do something about my thyroid medication. The GP I spoke to several weeks ago took some persuasion that I needed a Ferritin overload test on your advice, (that is what she called it) that I forgot to mention my thyroid levels with her until the very end of the appointment when she said they were within range and OK. By this time I was thoroughly exhausted and the brain fog wasn't great that day. She wasn't pleased when I told her that NICE had changed the lower level for the range for Ferritin, and that I was surely iron deficient. I had the overload test done on 9/1/23 see below. On the 24th Jan I had a telephone appointment to discuss my ferritin result, the GP on this occasion still didn't agree that my ferritin was a problem. She instead suggested I have a face to face appointment the following week. At this appointment she was more interested in my hearing loss in one ear and suggested I have a hearing test because she said often a hearing aid can stop tinitis. So I am waiting for this appointment. I insisted on discussing my ferritin again, she reluctantly agreed that I take some supplements and that I have a blood test in three months time. She brushed over my dizzyness and heaviness. She didn't go through the Ferritin overload test with me so I have no idea what the other results mean. But surely if my oxygen levels are low that could contribute to my dizzyness.

Im hoping after the thyroid blood test on the 8th, and after the very nice GP I spoke to last Sat (not attached to my GP practice) has written to the Endo, that my Levo will be increased to100/75 alternate days. I managed to get my correct weight (i wear a caliper which weighs 3kg) and can see that my dose is not enough for my weight of 67kg. We have a system in Cambs whereby if the normal GP appointments are not early enough we can request an out of hours appointment with a different organisation, this is what I usually do because GP appointments at my surgery are usually four weeks to wait. This suits me fine because I get an earlier appointment but I never get to see the same GP twice.

I am now taking Spatone liquid iron, but feel it may take some time to build my feritin level up. Any ideas what else I can take to boost Iron. I have started eating liver and minced beef, despite not being a fan of red meat. I normally eat fish and veg. beans, pulses etc.

I have also been taking B12 liquid , Thorne B complex, and vitamin D and K2 spasmodically as my level for this was good on my test in October. All of these I have stopped from today in view of the coming blood test.

I feel that I am stabbing in the dark, but with the help from this very informative forum i have learnt a lot. I hope that by getting my ferritin, vitamins and thyroid medication all optimal for me that I will have a happier year ahead. And I thank you all for your help.

These are percentages taken from the info provided by this forum

• TSH 1.86 mIU/L (0.35 - 5.50) 29.3% better around or under (Endo says between 0.5-2.5) so because I'm within the range GP's say its OK.

• Free T4 (fT4) 15 pmol/L (10.5 - 21.0) 42.9% at least 60-70% through range

• Free T3 (fT3) 5.0 pmol/L (3.5 - 6.5) 50.0% better at 46-67% through range

• T4:T3 Ratio 3.000 

• Folate - Serum 16.92 ug/L (≥ 4.12)- what does this mean?

• Vitamin B12 (active) 475.0 nmol/L (211.0 - 911.0) 37.7%

• Vitamin D 123.3 nmol/L

• Ferritin 23.5 ug/L (10.0 - 291.0) 4.8% - see lab note on blood test.

Ferritin Overload Test

Component Results

Component Your Value Standard Range

CRP <4 mg/L 0 to 9 mg/L0 - 9 mg/L

Please note change of method and reference interval. For further information please contact the Biochemistry Duty Doctor.

Ferritin 23.5 ug/L 10.0 to 291.0 ug/L10.0 - 291.0 ug/L

A normal ferritin may not exclude iron deficiency if levels are at the lower end of the normal range or in the presence of inflammation.

Serum Iron 11.4 umol/L 9.0 to 30.4 umol/L9.0 - 30.4 umol/L

Please note change of method and reference interval. For further information please contact the Biochemistry Duty Doctor.

Transferrin 2.65 g/L 2.50 to 3.80 g/L2.50 - 3.80 g/L

% Saturation 19 % 16 to 50 %16 - 50 %

General Information

Ordered by Craig Dean Scott Trevor NEEDS

Collected on 09/01/2023 08:39 from Venepuncture (Serum)

[Imaaan]

With those ferratin and b12 levels, I would be in deep trouble. It might explain why you're struggling to tolerate a single dose of your levothyroxine. You need more iron than the amount available in Spatone. Why have you decided on this particular brand? If its because of digestive issues, you might benefit from a heme iron pill and/or iron bisglycinate because they are more gentler.

As for splitting, I'd be more inclined to take a single dose and weather the storm of symptoms. If you cant maybe take the second dose no later than 3pm the day before????

[Watamu in reply to Imaaan]

Thank you Imaaan, I read about Spatone on this forum and got them because they are meant to be kind on the digestive system, and indeed they are, but I see that the iron is a very small amount. I have read about heme and non-heme, what brands do I need to look for? I'll get this latest blood test done and hopefully get an increase in my levo, and up my iron intake and when hopefully I feel a bit better try taking one dose again of levo.

[Imaaan in reply to Watamu]

On this forum, Solgar and Thorne iron bisglycinate have been mentioned. I started taking Thorne iron bisglycinate along with my heme iron supplement. The brand is Optifera.

Heme is better absorbed by the body but unfortunately the amount in the Optifera is low and only 11mg.I take 3 tablets along with 1 or 2 capsules of the Thorne.I've been dealing with digestive issues and have been able to tolerate both.

Another heme iron that was recommended by a UKmember is Three Arrows heme iron. Also, they have a heme plus which includes b12 , folate along with 20mg of heme iron. I've been meaning to try this out.

Aside from supplementing try to eat red meat and liver more frequently

[Watamu in reply to Imaaan]

Thank you Imaaan, I'll look out for those and decide which to try. I just feel that if I can get my iron sorted I will feel soooo much better

[Lalatoot]

Watamu I would suggest you get bloods done when your ft4 is at its lowest. The lower result might help in any request for a levo increase.When folk dose once per day or every 24 hours their lowest ft4 will be 24 hours after last dose.

When you multi dose your lowest ft4 will be just before your next dose is due. So count the longest gap between doses and leave that same gap between your last levo dose and your blood test.

For example, I dose levo at around 6am and again around 10pm. The longest gap I have between doses is 16 hours. So I leave 16 hours between my last dose of levo and my blood test. I don't take any dose then until after my blood test.

You can do this by altering the time of your 2nd levo dose the previous day to leave that gap of hours.

[Watamu in reply to Lalatoot]

Thank you Lalatoot, I take my tabs at about 11 pm and 8 am so the longest gap is 15 hours therefore I should take my last dose at 6pm the day before my test i.e. on the 7th, my blood test is at 9 am on the 8th.

[Lalatoot in reply to Watamu]

Great. Just do that each blood test then you can compare like for like.

[SlowDragon Administrator]

Your ferritin is terrible

Post I wrote today re low ferritin and getting it increased

healthunlocked.com/thyroidu...

Are you vegetarian or vegan

Pre or post menopause?

[Watamu in reply to SlowDragon]

thank you SlowDragon, just quickly read thro the posts you recommended. It seems very complicated this business of ferritin and iron. Definitely post menopause, I'm 75. I had an early menopause with no symptoms after a traumatic emergency caesarian when I lost a lot of blood, also had problems with muscle relaxant during the anaesthetic. I think maybe i never recovered from the blood loss then, but was not given any extra bloods which I am grateful for now, as bloods were not screened for HIV in those days. Then 12 year ago I had a hip replacement after falling on ice, i was in theatre for 8 hours because the pin and plate hadn't worked so they had to do a full hip replacement. I have had no problems with this since. I was given extra blood on this occasion. But when I first took ill in Kenya on30th Oct 2019 the doctor I saw there said my blood levels were below normal Haemoglobin, Hematocrit and Red Cell Count and gave me Ranferon (I think) and told me to get tested as soon as I returned to the UK which was on Nov 5th , I stayed with my daughter and went to see her GP because I was too ill to come back home. Her GP was the first time I had a thyroid test done and told I was borderline under active , but she didn't pick up on the low blood levels even tho I told her. Nor did my own GP when I got back home. I think maybe I have been low for years and only now it has become a big problem. I have had a lot of stress over the past four years which I think has also contributed to my health issues.

I'm not vegetarian, but don't really like meat, I eat fish, beans, pulses, fruit, veg. I have started making chicken liver pate and making more meals with mince meat.

[Batty1]

I don’t understand why doctors tell patients that a hearing aid will reduce tinnitus…. IT WON’T if anything what hearing you have the aid will destroy it …. Its like having thyroid disease and taking a pill to assist your thyroid if you stop the pill your thyroid becomes worse the hearing aid does the exact same thing to your hearing but it will not take away the tinnitus.

If your hearing is really bad and you want a hearing aid then go for it but don’t expect it to clear up your tinnitus.

[Lalatoot in reply to Batty1]

Thanks for this Batty. I have hearing loss and tinnitus and wondered about this. Will just carry on now as I am as I'd wondered if I should be looking at aids.

[Watamu in reply to Batty1]

Thank you Batty1, my hearing loss is in one ear and I had a hearing test done several years ago but was told it wasn't bad enough for a hearing aid and that my other ear was fine and was compensating. My hearing loss is the least of my worries, I felt that she was making an issue of this to draw attention away from my concern over my ferritin. Tinitis is a drag but I don't notice it all the time, when I'm tired its worse. My brother uses hearing aids but doesn't use them all the time, he said get one, they are great for listening to music.

[Batty1 in reply to Watamu]

Yes tinnitus is a huge drag. When my tinnitus acts up I take Lipo Flavonoid plus its a supplement and like everything it may not help you I just know 100% it helps my tinnitus (doesn’t take it away) it quiets it down …. It say take 3 capsules a day I can take one for 2 or 3 days and that works for me it’s expensive worth a shot as long as you don’t have issues with ingredients.

Supplement for tinnitus help

[Watamu in reply to Batty1]

Thank you Batty1, I will try that and see if it helps.

[humanbean]

Serum Iron 11.4 umol/L (9.0 to 30.4 ) 11.2% through the range

Transferrin 2.65 g/L (2.50 to 3.80) 11.5% through the range

% Saturation 19 % (16 to 50)

Ferritin 23.5 ug/L (10.0 - 291.0) 4.8% through the range

CRP <4 mg/L (0 to 9)

Optimal levels for iron and iron-related levels can be found here :

rt3-adrenals.org/Iron_test_...

Please note that contradictory results are common.

...

Serum iron

• 55 to 70% of the range

• higher end for men / lower end for women

Your result (11.2% through the range) is well below optimal suggesting that you need more iron.

.

TIBC (total iron binding capacity) or Transferrin

• Low in range indicates lack of capacity for additional iron

• High in range indicates body's need for supplemental iron

Your result (11.5% through the range) is far too low, suggesting that you have little or no capacity for more iron.

.

Saturation

• optimal is 35 to 45%

• higher end for men / lower end for women

Your result (19% through range) is well below optimal, suggesting that you need more iron.

.

Ferritin

• Low level virtually always indicates need for iron supplementation

• High level with low serum iron/low saturation indicates inflammation or infection

• High level with high serum iron and low TIBC indicates excess iron

• Over range with saturation above 45% suggests hemochromatosis

Your result (4.8% through range) is far too low. What is classed as optimal for ferritin differs according to source. On this forum a common suggestion is that optimal is approximately 50% - 70% through the range, and yours is much lower than that suggesting that you need more iron.

.

CRP - C-Reactive Protein

This is a measure of inflammation in the body, so the lower the better. Yours is given as < 4 which appears to be as low as the test machine can test, so this seems fine.

.

The low Transferrin being out of step with all the other results is common. In my own case all my results were screaming at me that they needed more iron but my TIBC (which has the same interpretation as Transferrin) was actually substantially below range. I ignored the TIBC result and supplemented iron anyway - the TIBC got outvoted by me, the iron, the saturation, and the ferritin.

.

Finding an iron supplement that you can tolerate can be a problem for some people. I wouldn't recommend Spatone because each sachet only contains 5mg of pure iron, and also it is very expensive in the quantities you are likely to need.

When I was raising my own iron levels I was prescribed ferrous fumarate 210mg, 1 tablet, 3 times per day. The total iron content was 207mg pure iron per day. I could only tolerate this with food because iron is very irritating to the stomach.

I would not recommend that anyone take what I did, at least in that dose. Newer research has shown that iron isn't well absorbed in those quantities. I just mentioned it to highlight how low the iron content of Spatone is.

There are many iron supplements available, and it is up to you to find which one works for you. See this reply to another member on the supplements available in the UK.

healthunlocked.com/thyroidu...

I would suggest that people start with trying ferrous gluconate, which is available without prescription in the UK from pharmacies with the pharmacist's permission. The maximum dose per day is 6 tablets in divided doses e.g. 2 tablet, 3 times per day. However, I would suggest starting with 1 tablet per day, and raising dose by 1 tablet a week or fortnight up to a maximum of 3 or 4. If you tolerate this and it raises your iron levels then great. But if you don't like it or don't absorb it well then try ferrous bisglycinate (also known as iron bisglycinate). This is available online, in some pharmacies, and on websites selling supplements.

Some links you should read :

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Please note that iron supplements must be taken 4 hours away from thyroid hormones because they can block the absorption of thyroid hormones.

[humanbean in reply to humanbean]

I forgot to mention...

People taking iron supplements should stop taking them for 5 - 7 days before testing.

If the supplements they take are low dose then they can be stopped for a shorter time e.g. a couple of days.

[Watamu in reply to humanbean]

Thank you humanbean, I'll search out a higher dose of iron. I already stopped all my supplements ready for my blood test on 8th.