My blood results update (from last week) - and a fuller picture hopefully

[Sneedle]

Hello everyone,

I have my Medichecks thyroid bloods now, correctly obtained as per suggestions on this site.

Time 8.45am.

TSH 1.2 mIU/L (.27 - 4.2) 23.7%

Free T4 (fT4) 16 pmol/L (12 - 22) 40.0%

Free T3 (fT3) 3.6 pmol/L (3.1 - 6.8) 13.5%

T4:T3 Ratio 4.444 

Can you tell me about conversion, do I have an issue?

Is TSH ok?

I include again the other results from last week so it makes sense in context:

Thyroglobulin Antbodies (TgAb) 14 IU/mL (≤ 115)

Thyroid Peroxidase Antibodies (TPO) 9 IU/mL (≤ 34)

C-Reactive Protein (CRP) 3.58 mg/L (≤ 5)

Folate - Serum 14.80 ug/L (8.83 - 60.8) 11.5%

Vitamin D 80 nmol/L

Ferritin 67.3 ug/L (13 - 150) 39.6%

B12 inactive 313 nmol/L (145 - 569) 39.6%

Magnesium 0.84 mmol/L (0.7 - 1) 46.7%

Saliva cortisol but Medichecks so probably not much use : down at bottom of post sorry!

Background

Aged 53 diagnosed UAT about 17 years ago about a year after giving birth. Never well. On Levo (Teva) 75mcg. Considering asking GP for trial of 100mcg as suggested here (sorry I can't remember who!).

Recently even worse (light-headed, dry tongue (not mouth, lots of saliva) palpitations in chest every now and again, feeling very dehydrated but not relieved by 2 litres water a day, crushing fatigue). Stress I can't do much about is a major factor.

Diagnosis of CFS about 16 years ago.

Severe trauma in history, still working on mental health, anxiety can be intense (so adrenals bound to be affected).

MTHFR and related methylation genes polymorphisms. I have some other genetic data (not comprehensive) which I want to look into in terms of thyroid health. Work in progress.

On HRT oestrogen transdermal patches (150) and mirena coil.

Every so often I see a nutritionist who uses a bioresonance machine (Quest4). It came up with sluggish thyroid about three weeks ago, which is why I've landed here. It also said stage 3 adrenal exhaustion.

Gluten is a problem and I'm now gf (about 4 days and counting!).

Spoke to GP re symptoms yesterday did not mention private testing yet as not up to having the conversation but she wants me to increase b vits and iron. Also wants me to increase HRT to 200 from 150 I'm not sure about this as it might muddy the waters.

Supplements

I will see the nutritionist again soon but in the meantime have put myself on:

- Biocare Nutrisorb Methyl B complex

- Continue on Vit D 12 000 daily to try to reach 100 (extremely high, did not realise I was taking that much as had changed brand last Nov however I'm only at 80 now...!).

- Natures Plus Source of Life Gold Mini-tabs multi vits which seems to have just about everything

- Dr Berg's Adrenal and Cortisol formula

- Wiley's Finest Wild Alaskan Fish Oil (as per nutritionist from last time) EPA DHA Omega 3

Any Iron suggestions welcome, I like the Spatone but hate the individual packaging waste!

Bearing my now accurate thyroid bloods and all this in mind, is there anything else I can be doing? I feel just horrible.

Thank you for your help.

[GlowCoach Administrator]

Firstly as you know you need a dose increase. neither FT4 or FT3 are above 50% even and TSH over 1.

Likely you do have a conversion issue. I'm not sure that improving vitamins will be enough + dose increase to get your FT3 to where it needs to be for you to have energy and feel well. You should still improve the vitamins though as that will help in itself and help your body use the hormone better.

Ferritin - recommend iron rich foods a few times a week like chicken livers or pate.

The B complex you are using contains relatively low doses of B's, especially for someone with MTHFR. I attach photo of Thorne Basic B so you can compare with your supplement label and you will see the difference. People with MTHFR will likely need at least 800mcgs folate a day, I personally need 1800mcgs a day to get my folate level optimal. Once on a higher dose B complex, buy a separate folate 400mcgs and slowly add every other day to start with.

Well done on going gluten free. Take your time with that and get used to it, shopping etc then consider eliminating dairy, possibly soy also. A lot to take in but worth it.

MTHFR people don't do well with processed foods so eat as much whole foods as possible and try detoxing with epsom salt baths etc.

Thorne basic B ingredients

[Sneedle in reply to GlowCoach]

Thanks Jaydee1507.

Would you recommend the Thorne basic B as the best b vit complex for my needs right now? Is it the one MTHFR people generally take when they are trying to raise folate? Do you know roughly at what point I should test again for a useful result? I've successfully raised my vit D (by accident) to 80 by unwittingly taking megdoses since Nov. But I get the idea that is not the approach with B vits?

What are the indicators which tell you that there's a conversion problem? Can you explain what stops the conversion taking place? Is it permanent? It's mentioned a lot by people but I need to understand and explain to family. Also, does that mean I have lots of extra T4 swimming around unused - I'm concerned about adding in extra levo if I'm not using it all. I also plan to wait until I have got my adrenal stuff under control as per B Durant. Questions, questions! Cheers.

[SlowDragon Administrator in reply to Sneedle]

does that mean I have lots of extra T4 swimming around unused - I'm concerned about adding in extra levo if I'm not using it all. 

No it doesn’t. Levothyroxine is Ft4 and currently only 40% through range

Important to be on high enough dose levothyroxine so that there’s enough Ft4 to convert. Aiming for Ft4 at least 60-70% through range

Improving vitamin levels frequently improves conversion rate too

Adrenals try to compensate for lack of thyroid hormones, improving thyroid levels should naturally settle adrenal levels

[Sneedle in reply to SlowDragon]

Thank you for these answers - re adrenals, are you saying you recommend an increased dose of levo to 100mcg as the first step (apart from vits etc. which I am starting to address) and not be overly concerned with the adrenals? I understood (perhaps wrongly) that it's best to treat adrenals first before increasing dose of levo otherwise your symptoms can worsen? Dr.Peatfield I think does it adrenals first? My stress levels have been and continue to be extreme which I'm trying to improve but it's very slow work. Any nuggets welcome!

[SlowDragon Administrator in reply to Sneedle]

Yes….improving thyroid levels should (slowly) improve adrenals

[GlowCoach Administrator in reply to Sneedle]

Yes the Thorne Basic B is a good one but as I said may in addition need extra 400mcgs folate or more, see how you feel/blood results but I could feel when I had enough and not enough. Its a large capsule though but you can tip it out if you want to to swallow if needs be. The alternative is this one which is budget friendly too and contains similar amounts of vits. They are smaller and more easily swallowed. amazon.co.uk/Yipmai-Liposom...

For B12 it doesnt matter too much if you have excess, in fact not a bad thing at all, as water soluble and you just pee out the extra. Folate is slightly different and its possible to get symptoms from too much but you would need to be taking several thousand mgs for that to happen. Not as good idea to dive in at a high dose, just work up slowly and gradually in small steps as needed.

Probably 3 months is enough to retest or when you retest thyroid.

Conversion issues can be somewhat low vitamin related but more importantly genetic. There are 2 genes, DIO2 is the most important but also DIO1 determine how well you can convert T4 to T3. I have 1 copy of each out of a possible 2 of each and need additional T3 to my Levo as Levo alone is not enough regardless how much I take. As its genetic, yes its permanent, nothing to be done other than add T3.

You can tell someone has a conversion problem when their vitamins are optimal and Levo upper part of range and FT3 lagging below 50% of range. You still only have an FT4 below 50% so plenty of room for more Levo to see if you convert and no danger of excess at this point. Possibly a little previous to be thinking about conversion issues.

[Sneedle in reply to GlowCoach]

Oh I've just seen this reply fabulous thanks for all the delicious information!

[Imaaan]

Regarding iron, if your digestion is top notch, I like Feramax. If it's a lil wonky, I like combining Optifera heme iron (3 tablets) with Thorne iron bisglycinate ( 2 capsules) .

Fair warning: Optifera tablets are huge and it only has 11mg in each.

Thorne Ferrasorb is another option and it includes b12 and folate along with 5mg of b6.

[Sneedle in reply to Imaaan]

Hmm my digestion...not sure it can cope. I'll look at the Ferrasorb and Optifera (warning taken on board- they sound like horse pills). Cheers.