Latest Bloods - Dr requested a review

[ssjg]

An update after my last post in February. Dr put my Levo up by 25mcg, so I have been taking 125mcg per day since the beginning of March. Due to no appts, I’ve eventually got the bloods done that I requested through the GP.

They’ve just texted me a routine appt for May, after the Dr has reviewed my results but not said why?

1) I can see my TSH has dropped from 3.28 to 0.27 (0.27-4.20) as it’s only been a few weeks, could the dose increase be too high?I’m feeling normal again, I was still a little tired beforehand.

2) I said my wrists/ankles inflamed and there is a new test I’ve not had before, Erthrocyte Sedimentation which has elevated levels?

3) I know they keep wanting to speak to me about my cholesterol as it has barely come down since I was diagnosed, potential statins?

4) Also, unrelated, can I take my daily antihistamine (Cetirizine) at the same time as my Levo?

My results on 4th April

TSH 0.27 mIU/L (0.27 - 4.2) 0.0% C-Reactive Protein (CRP) 20 mg/L (≤ 7)

Vitamin B12 286 nmol/L (130 - 800) 23.3%

Ferritin 138 ug/L (30 - 150) 90.0%

Folate 10.5  (4 - 27) 28.3%

Cholesterol 8.07 mmol/l

Triglycerides 2.36 mmol/lHDL 2.14 mmol/l

Cholesterol:HDL ratio 3.8LDL 4.86 mmol/l

Will post image of FBC

Previous post/resultshealthunlocked.com/thyroidu...

Any thoughts and help would be great fully received

[SlowDragon Administrator]

previous post here

healthunlocked.com/thyroidu...

Very low B12

Are you vegetarian or vegan?

If not …did GP test for Pernicious Anaemia.

What vitamin supplements are you currently taking

[ssjg in reply to SlowDragon]

Thank you Slowdragon.

I’m not vegan or vegetarian. In fact the opposite and I probably eat too much steak, salmon and pork.

Apart from the Better You VitD2/K spray which I started in Feb after my Medichecks result, I haven’t started anything as yet as I wanted to get baseline result recorded with GP before supplementing, so I could say what I needed to take.

I thought they were testing for Perineous Anemia but getting the GP to run tests was hard work, and then there was a 5 week wait for bloods to be taken.

I didn’t know they were rerunning TSH tests as I’ve only been on increased Levo dose for 5 weeks.

Noted on the statins, and having read post on here I am concerned that’s what they are calling me in for.

Test results 2

[ssjg in reply to SlowDragon]

FBC

Results

[SlowDragon Administrator]

Just testing TSH is useless

cheapest option for just TSH, FT4 and FT3

£32 (via NHS private service ) and 10% off if go on thyroid uk for code

thyroiduk.org/getting-a-dia...

monitormyhealth.org.uk/

Only test thyroid levels after at least 6-8 weeks on new dose

ALWAYS test early morning, ideally just before 9am and last dose levothyroxine 24 hours before test

No vitamin D result?

High cholesterol frequently linked to low Ft3

nhs.uk/conditions/statins/c...

If you have an underactive thyroid (hypothyroidism), treatment may be delayed until this problem is treated. This is because having an underactive thyroid can lead to an increased cholesterol level, and treating hypothyroidism may cause your cholesterol level to decrease, without the need for statins. Statins are also more likely to cause muscle damage in people with an underactive thyroid.

[SlowDragon Administrator]

Vitamin B12 286 nmol/L (130 - 800) 23.3%

Folate 10.5  (4 - 27) 28.3%

So as GP not testing suggest you start on B12 now

Do you have 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 and add a separate vitamin B Complex a week or two later

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.

B12 drops 

healthunlocked.com/thyroidu...

or

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...

Low folate

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...

Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid.

thyroidpharmacist.com/artic...

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. Or try ebay 

Other options 

healthunlocked.com/thyroidu....

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

[ssjg]

Thank you for you advice and links. Would you be concerned that my TSH is now at 0% through the range?

Could I be at risk of being over medicated now given it’s only been 5 weeks since the +25mcg increase?The bloods were taken at 3pm, non-fasting and I took my normal dose when waking as I didn’t know they were retesting my thyroid. So perhaps not comparable to my other results. I appreciated there is no T4 result.

Should I continue on 125mcg Levo for another 5 weeks when the Dr is due to review?

Could this explain lightheaded and dizzy feel I’ve had recently?

[tattybogle in reply to ssjg]

Hi ssjg just tagging SlowDragon for you so she will see your reply .

Re. the TSH being at the bottom of the range .. it wouldn't concern me at all ... see this post showing long term TSH between 0.04 and 0.4 in patients on levo had no greater risks than TSH 'in range' did : healthunlocked.com/thyroidu.... useful-evidence-that-tsh-between-0.04-0.4-has-no-increased-risk-to-patients-on-levothyroxine-as-long-as-ft4-and-ft3-are-in-range-.

Also as TSH was tested at 3pm , that is when it would be at it's lowest point in the day.. had it been tested earlier eg 9 am. it would have been a little higher and therefore in range .. so if GP suggest it;s too low point this out. TSH variation through the day (due to circadian rhythm)~ see image below.

Re. the cholesterol .. give the new dose some more time ~ 5 weeks is very early days on a new dose to have any effect on cholesterol.

Re. the feeling ligh headed/dizzy ~ as above .. 5 weeks is very early days for a new dose .. give it a few more weeks to allow body to get used to the higher dose .. things often feel a bit off for the first 4/5 weeks on a new dose anyway, even if that dose is actually going to be an improvement once it's settled in ..... so yes i thing you should stay on 125 until Doctor reviews and if you feel ok at that point ,don't agree to reduce , but push for another blood test (on the basis that 5 weeks was bit too soon and you want to see how TSH is now it's had longer to settle in) the get that test done correctly @9 am before taking that days Levo .and without eating breakfast. See the 3rd and 4th reply to this post for references re. testing at 9am before levo/ fasting : healthunlocked.com/thyroidu....

TSH (grey line) lowest point is around 1-3pm