Hi could I have your thoughts on these results please,I have been on 25mg levo for 15 years and have a lot of low thyroid symptoms.
MMY RESULTS.: Hi could I have your thoughts on... - Thyroid UK
MMY RESULTS.
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ETHEL103
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Jaydee1507Administrator
You had a lot of good responses about your vitamin levels in this thread. healthunlocked.com/thyroidu...
As thyroid patients we do need to become our own health advocates with GP’s and Endocrinologists. They get little training in how to make us feel well, instead relying on lab numbers on paper. Take some time to read up on your condition, learn and get your confidence up. This will stand you in good stead when discussing your condition and challenging things that medic say.
Have you tried asking a different doctor at the same practice for a dose increase. Best to make a face to face appointment to do that and pick a sympathetic doctor.
Hi I did try to get a face to face but they only book urgent at my surgery the pharmacist call was all I could get.
Can you post your results photo in a reply to this message please? I posted how to do this in a different post.
upload photo
When was the last time you took Levo before this test? How many hours before, and what time of day was this test taken please?
We recommend taking Levo 24 hours before your blood test. So on the day of the test take it AFTER the blood draw. Book the test for 9am and do the test fasting.
Have you started supplementing your low vitamin levels?
Recommend you start learning a little about how your condition is treated to get a bit of confidence up when you speak to the pharmacist about your dose increase. Point out that you are still on a starting dose and your Levo has never been increased to help your symptoms.
The following are quotes from the NICE guidelines that you might find useful.
The goal of treatment is to alleviate symptoms and align thyroid function tests within or close to the reference range.
Even when thyroid function tests are within the reference range, changes to treatment may improve symptoms for some people.
Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.
1.4.1 Aim to maintain TSH levels within the reference range when treating primary hypothyroidism with levothyroxine. If symptoms persist, consider adjusting the dose of levothyroxine further to achieve optimal wellbeing, but avoid using doses that cause TSH suppression or thyrotoxicosis.
SlowDragonAdministrator
Please type up results
These aren’t readable
TSH
Ft4
Ft3
Thankyou for your reply.Test was taken 24 hours from last levo and I took blood at 9am.All very vague re vit d levels it's showing under the level but not enough for prescription 43.Told me to take supplements so I will ask how much.Taking hubby's at the mo.B12 was 346 Ferretin was45.6 which they said was normal but well below 11 to 307.
TSH was4.8
t4 was20
FT3 was 4.3.
All within range except tsh which they said was higher but nothing needed at the moment.
Vitamin levels all very poor.
Hardly surprising as on such low dose levothyroxine
Being hypothyroid results in low stomach acid and poor nutrient absorption, results in low vitamin levels
Low vitamin levels tends to result in poor conversion of Ft4 to Ft3 …..this results in high Ft4 and low Ft3 …..as shown by your results
First step is to improve low vitamin levels and then retest thyroid levels again in another 2-3 months and likely to be able to increase levothyroxine
Only add one vitamin supplement at a time, then wait 10-14 days to assess before adding another
Starting with vitamin D
Then B12
Then vitamin B complex
Then magnesium
Meanwhile look at increasing iron rich foods in diet to improve ferritin levels
Thankyou.Will do as you say re vitamins.Im also on Lansoperazol for 15 years as I had bad reflux.Is this adding to my problems.I do eat lots of protein foods every day.Fish twice a week,chicken and red meats and eggs the other days.Dont think I can increase anymore as I struggle with weight gain.I do go to gym,swim and walk a few miles 3 times a week .I am classed as obese even though I weigh just over 12 stone and size 14.I am 5ft 4 ins tall.
Even more reason to get vitamin levels optimal and dose levothyroxine increased
Vast majority of hypothyroid patients have LOW stomach acid as cause of acid reflux
Lansoprazole is a PPI to treat high acid
As dose levothyroxine is increased you should be able to slowly reduce Lansoprazole
Suggest you request GP increase levothyroxine to 50mcg daily
Your TSH is easily high enough to push for dose increase
BUT having been left extremely under medicated a long time likely to need to initially only increase SLOWLY…..50mcg and 25mcg alternate days for 6-8 weeks before increasing to 50mcg and retest 2-3 months after getting on 50mcg daily
Wow can't thank you enough for replying. I have just had a message from MMH saying there might a mistake with some results in the past 36 hours.Not sure what to think now.
I thought your results were odd as your FT4 was 20 which is fairly high and yet you are only on 25mcgs Levo. I would get them to retest you and then start a new post with those results.
Thousands of posts on here about low stomach acid
healthunlocked.com/search/p...
Web links re low stomach acid and reflux and hypothyroidism
nutritionjersey.com/high-or...
stopthethyroidmadness.com/s...
thyroidpharmacist.com/artic...
How to test your stomach acid levels
healthygut.com/articles/3-t...
meraki-nutrition.co.uk/indi...
huffingtonpost.co.uk/laura-...
lispine.com/blog/10-telling...
Useful post and recipe book
healthunlocked.com/thyroidu...
Protect your teeth if using ACV with mother
healthunlocked.com/thyroidu...
Ppi
Omeprazole or Lansoprazole will lower vitamin levels even further, especially B12 and magnesium
gov.uk/drug-safety-update/p...
webmd.com/heartburn-gerd/ne...
pharmacytimes.com/publicati...
PPI and increased risk T2 diabetes
gut.bmj.com/content/early/2...
Iron Deficiency and PPI
medpagetoday.com/resource-c...
futurity.org/anemia-proton-...
onlinelibrary.wiley.com/doi...
sciencedirect.com/science/a...
But never assume you have low stomach acid
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.
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. 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
Low ferritin
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
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...
Effective supplement
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. ‘
SlowDragonAdministrator
Low vitamin D
GP should prescribe 1600iu everyday for 6 months but you likely be better off self supplementing at least at 2000iu daily
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 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...
Vitamin K2 mk7
betterbones.com/bone-nutrit...
healthline.com/nutrition/vi...
Thankyou you have been really helpful and I'm at the moment writing notes for my call Wed.I guess I'm not going to be very popular lol.
SlowDragonAdministrator
Roughly how old are you?
guidelines on dose levothyroxine by weight
Even if we frequently don’t start on full replacement dose, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose
NICE guidelines on full replacement dose
nice.org.uk/guidance/ng145/...
1.3.6
Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.
Also here
cks.nice.org.uk/topics/hypo...
pathlabs.rlbuht.nhs.uk/tft_...
Guiding Treatment with Thyroxine:
In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months.
The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).
The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range.
……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.
The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.
12st = 76kilo
76kg x 1.6mcg suggests that your eventual dose levothyroxine might be around 125mcg levothyroxine per day
SlowDragonAdministrator
lastly
Comprehensive list of references for needing LOW TSH on levothyroxine
healthunlocked.com/thyroidu....
TSH should be under 2 as an absolute maximum when on levothyroxine
gponline.com/endocrinology-...
NHS England Liothyronine guidelines July 2019
sps.nhs.uk/wp-content/uploa...
Page 9
Test for Deficiency of any of the following: Vitamin B12, Folate, Vitamin D, Iron
See page 13
1. Where symptoms of hypothyroidism persist despite optimal dosage with levothyroxine. (TSH 0.4-1.5mU/L)
Graph showing median TSH in healthy population is 1-1.5
SlowDragonAdministrator
See from your other posts that you also have AF
Atrial fibrillation can be linked to LOW thyroid hormones
Atrial fibrillation can occur with low Ft3 or low Ft4
pubmed.ncbi.nlm.nih.gov/175...
60 patients (22.4%) had low FT3 levels (<2 pg/ml) and 24 patients (9%) had low FT4 levels (<0.9 ng/dl).
Levothyroxine doesn’t “top up” failing thyroid it replaces it.
Magnesium is extremely important for heart health too
Have you ever had thyroid antibodies tested for autoimmune thyroid disease
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.
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)
Hi I thought I had A fib all through the pandemic and wasn't diagnosed till I went to St Thomas's for an ablation and it was found I had atrial flutter and its now gone.
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