Recent blood tests following increase 8 weeks ago of levothyroxine to 100mcg daily from 100mcg 3 x a week, 50mcg 4 x a week.
Could someone please help me to determine what supplements I should be taking. GP has suggested 1000 units of Vit d. I think my ferritin and possibly folate looks low also.
Tsh 0.16 (range:0.34-4.94)
T4 14.9 (9-19.1)
T3 3.9 (2.4-6)
Vit D 42 nmol (50-200)
Serum Ferritin 30 ug/L (30-250)
Serum Folate 5 ug/L (3-20.5)
Vit B12 397 Ng/L (200-900)
MCV 82.1 fl (75-105)
Thank you.
was test done early morning and last dose levothyroxine 24 hours before test
Do you always get same brand levothyroxine at each prescription
FT4: 14.4 pmol/l (Range 9 - 19.1)
Ft4 only 53.47% through range
FT3: 3.9 pmol/l (Range 2.4 - 6)
Ft3 only 41.67% through range
Presumably you are now increasing levothyroxine to 100mcg everyday?
Ferritin, folate, vitamin D and B12 all too low
Low vitamin levels tend to lower TSH, especially low ferritin
Thank you so much for your very informative reply. Test was done at 9.40am however I did not realise I should not take my levothyroxine beforehand - so was taken 2 hours prior. Yes the brand is the same (accord) and have been taking 100mcg per day since mid Jan 23. Prior to the increase in Jan, I had been taking 100mcg 3x a week and 50mcg 4 x a week. Following the dose increase in Jan, my tsh fell from 0.9 in Jan 23 to 0.12 (27/2/23) and 0.16 (3/23). My T4 also fell from 16.9 in Feb to 14.9 in March. Unfortunately i only have t3 results for March 23.
The doctor has not suggested any changes to current 100mcg per day. Also has not identified any issues with ferritin etc.
When you give a percentage through range, what should I be looking for please? Is there a target?
Thank you.
suggest you work hard on improving all your terribly low vitamin levels
Likely to see TSH increase and symptoms improve as vitamin levels increase
And retest again in another 6-8 weeks
Test privately including thyroid antibodies, if not had these tested yet
90% of primary hypothyroidism is autoimmune
Important to know if this includes you (likely with low vitamin levels)
Thank you very much, I am pretty sure I have had antibodies tested some years ago however nothing was raised with me by the GP so assumed there was no problem. Forgive my ignorance but if you have tested negative for antibodies in the past, will you always be negative. Thanks and thank you for your amazing info.
Negative antibodies can change over time
Or antibodies could have been positive and GP not told you
Over 90% of primary hypothyroidism is autoimmune
NHS only tests Thyroglobulin (TG) antibodies if TPO antibodies are high/positive
Significant minority of Hashimoto’s patients only have high TG antibodies
And 20% of Hashimoto's patients never have raised antibodies
healthunlocked.com/thyroidu...
Paul Robson on atrophied thyroid - especially if no TPO antibodies
Ferritin is deficient at 30
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.
GP should be doing full iron panel test for anaemia
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...
Meanwhile….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
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...
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...
Chicken livers if iron is good, but ferritin low
healthunlocked.com/thyroidu...
Shellfish and Mussels are excellent source of iron
healthline.com/nutrition/he...
Heme iron v non heme
hsph.harvard.edu/nutritions...
Ferritin over 100 to alleviate symptoms
healthunlocked.com/thyroidu...
Great research article discussing similar…..ferritin over 100 often necessary
ncbi.nlm.nih.gov/pmc/articl...
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. ‘
Have you had thyroid antibodies tested for autoimmune thyroid disease
Also both TPO and TG thyroid antibodies tested at least once
Very important to test vitamin D, folate, ferritin and B12 at least once year minimum
About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high thyroid antibodies
Autoimmune thyroid disease with goitre is Hashimoto’s
Autoimmune thyroid disease without goitre is Ord’s thyroiditis.
Both are autoimmune and generally called Hashimoto’s.
Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease (Hashimoto’s or Ord’s thyroiditis)
20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis
In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)
Low vitamin D
GP should prescribe 1600iu everyday for 6 months
Suggest you start on at least 2000iu daily. Retest in 3-4 months
NHS Guidelines on dose vitamin D required
ouh.nhs.uk/osteoporosis/use...
GP will often only prescribe to bring vitamin D levels to 50nmol.
Some areas will prescribe to bring levels to 75nmol or even 80nmol
leedsformulary.nhs.uk/docs/...
GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)
mm.wirral.nhs.uk/document_u...
But with Hashimoto’s, improving to around 80nmol or 100nmol by self supplementing may be better
pubmed.ncbi.nlm.nih.gov/218...
vitamindsociety.org/pdf/Vit...
Once you Improve level, very likely you will need on going maintenance dose to keep it there.
Test twice yearly via NHS private testing service when supplementing
Vitamin D mouth spray by Better You is very effective as it avoids poor gut function.
There’s a version made that also contains vitamin K2 Mk7.
One spray = 1000iu
amazon.co.uk/BetterYou-Dlux...
Another member recommended this one recently
Vitamin D with k2
amazon.co.uk/Strength-Subli...
It’s trial and error what dose we need, with thyroid issues we frequently need higher dose than average
Vitamin D and thyroid disease
grassrootshealth.net/blog/t...
Vitamin D may prevent Autoimmune disease
newscientist.com/article/23...
Web links about taking important cofactors - magnesium and Vit K2-MK7
Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine
betterbones.com/bone-nutrit...
medicalnewstoday.com/articl...
livescience.com/61866-magne...
sciencedaily.com/releases/2...
Interesting article by Dr Malcolm Kendrick on magnesium
drmalcolmkendrick.org/categ...
Vitamin K2 mk7
Only add one supplement at a time
Wait at least 10 days before adding another to assess any effects
Low B12
Do you have any 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
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...
Vitamin B complex
supplementing a good quality daily vitamin B complex, one with folate in (not folic acid)
This can help keep all B vitamins in balance and will help improve B12 levels too
Difference between folate and folic acid
healthline.com/nutrition/fo...
B vitamins best taken after breakfast
Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule)
Thorne currently difficult to find at reasonable price, should be around £20-£25. iherb.com often have in stock.
If you want to try a different brand in the meantime, one with virtually identical doses of the ingredients, and bioavailable too, then take a look at Vitablossom Liposomal B Complex. Amazon sometimes has it branded Vitablossom but it's also available there branded as Yipmai, it's the same supplement
amazon.co.uk/Yipmai-Liposom...
or available as Vitablossom brand here
hempoutlet.co.uk/vitablosso... &description=true
Or
Igennus Vitamin B complex. Nice small tablets. Full dose is 2 tablets per day. Most people are fine with just single tablet
igennus.com/products/super-...
IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results
endo.confex.com/endo/2016en...
endocrinenews.endocrine.org...
In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate methyl folate supplement and continue separate B12
Help With My Test Results
Thyroid function blood test results. Please help me understand these. 
Help with supplements please
Help with supplements please
