Help wih my results

[Verde1]

I have asked my GP to check my conversion of T3 or T3 reverse, but he has not asked for the blood test of the same....

Also U asked for B12, Folate, ferritin and Vitamin D, and also for the antibodies..... What he asked the lab was:

5 April 2023 at 9am without taking any levotyroxine

• Test result - Urea & Electrolytes;Serum total 25-hydroxy vitamin D level Report, Abnormal, No Further Action (Patient Informed). They haven’t informed me....

• Coded entry - Serum total 25-hydroxy vitamin D level (Xabo0) 153 nmol/L [50 - 100]; Above high reference limit; Vitamin D 100-250 nmol/L : Advise review Vitamin D intake; Please note that the reference ranges of vitamin D have changed to; harmonise with Local and National guidelines.; From 18/11/21 onwards, vit D results are 10-20% higher than; previous due to assay reformulation.

• Coded entry - Acute kidney injury warning stage (XabmE) - NA

• Coded entry - Serum sodium level (XE2q0) 138 mmol/L [133 - 146]

• Coded entry - Serum potassium level (XE2pz) 4.4 mmol/L [3.5 - 5.3]

• Coded entry - GFR calculated abbreviated MDRD (XaK8y) 88 mL/min/1.73m*2

• Coded entry - Serum creatinine level (XE2q5) 62 umol/L [49 - 90]

• Coded entry - Serum urea level (XM0lt) 3.7 mmol/L [2.5 - 7.8]

• Test result - Serum free T4 level;Serum TSH level Report, Abnormal, No Further Action (Patient Informed).

• Coded entry - Serum free T4 level (XaERr) 9.4 pmol/L [10 - 20] - Below low reference limit

• Coded entry - Serum TSH level (XaELV) 47.6 miu/L [0.2 - 4]; Above high reference limit; Confirmation of fluctuating TSH ?poor compliance, undertreatment; or malabsorption.; Ideal T4 replacement therapy indicated by TSH 0.2-2.0 miu/L;

• Test result - Serum ferritin level Report, Normal, No Further Action (Patient Informed).

• Coded entry - Serum ferritin level (XE24r) 28 ng/ml [10 - 322]

• Test result - Full blood count Report, Normal, No Further Action (Patient Informed).

• Coded entry - Full blood count (424..)

• Coded entry - Haemoglobin concentration (Xa96v) 133 g/L [115 - 160]

• Coded entry - Monocyte count - observation (42N..) 0.28 10^9/L [0.2 - 0.8]

• Coded entry - Lymphocyte count (42M..) 1.59 10^9/L [1 - 4.5]

• Coded entry - Neutrophil count (42J..) 2.78 10^9/L [2 - 7.5]

• Coded entry - Eosinophil count - observation (42K..) 0.05 10^9/L [0.04 - 0.4]

• Coded entry - Percentage hypochromic cells (XaIo4) 0 %

• Coded entry - Large unstained cells (XE2bq) 0.11 10*9/L [< 0.6]

• Coded entry - Basophil count (42L..) 0.09 10^9/L [< 0.1]

• Coded entry - Mean cell volume (42A..) 96 fL [78 - 100]

• Coded entry - Platelet count - observation (42P..) 292 10^9/L [150 - 400]

• Coded entry - Total white blood count (XaIdY) 4.89 10^9/L [4 - 11]

• Coded entry - Haematocrit (X76tb) 0.4 [0.37 - 0.47]

• Coded entry - Red blood cell distribution width (XE2mO) 14.4 % [< 15]

• Coded entry - Mean cell haemoglobin level (XE2pb) 32.2 pg [27 - 32] - Above high reference limit

• Coded entry - Red blood cell count (426..) 4.13 10^12/L [3.8 - 5.8]

• Test result - Serum vitamin B12 level;Serum folate level Report, Normal, No Further Action (Patient Informed).

• Coded entry - Serum folate level (42U5.) > 24 ng/ml [5.4 - 24] - Above high reference limit

Coded entry - Serum vitamin B12 level (XE2pf) 397 ng/L [211 - 911]; Ongoing monitoring of people being treated with B12 or folic; acid is generally considered unnecessary (CKS 2011)

• Test result - Serum thyroid peroxidase antibody concentration Report, Abnormal, but expected, No Further Action (Patient Informed).

• Coded entry - Serum thyroid peroxidase antibody concentration (XabCy) > 1,300 kU/L [< 100] - Above high reference limit

Can someone advise me with this values please, also the endocrinologist asked to do cortisol last month, but she dismissed me from the clinic even before checking the results.. . Doctor is saying it is ok....

Coded entry - Serum cortisol level (XE2xW) 227 nmol/L; 9AM cortisol 140-400nmol/L: does not exclude adrenal insufficiency; Suggest seek advice from Endocrinology.....

I keep thinking that I have a problem with converting T4 into T3 that I am instead converting into RT3... but this results.....

I am auto medicating myself with vitamin D 3and k2.

And yes I reduced my t4 intake... this month....

I am looking forward to heal myself not yet gluten and lactose free. But seriously considering to...

Thanks afor your help in advance. You're amazing.

[GlowCoach Administrator]

So how much Levo are you taking per day? You need to take it on an empty stomach and 1 hour away from food or caffeine containing drinks. Do you take a PPI?

Your Thyroid numbers are very low and you desperately need an increase looking at this test. RT3 is irrelevant as you just need to take more Levo.

Approx how much do you weigh in kilos?

What supplements are you taking?

Your ferritin is deficient. NICE guidelines state a level of 30 or less is a deficiency. Make an appointment with your GP too hopefully be prescribed iron.

Many with autoimmune thyroid disease aka Hashimoto's benefit from a gluten free diet. A smaller percentage of those also need to remove dairy from their diet to feel well.

Your B12 is low, you would benefit from a good B complex that contains methyl or active type vitamins. This B complex has all the right vitamins at a not unreasonable cost for 90 days supply. amazon.co.uk/Liposomal-Soft...

Just going to ask SeasideSusie about the vit D level as they have changed their reference range.

[Verde1 in reply to GlowCoach]

I was on 100mcg levotyroxine per day usually take it at 6:20am take breakfast at 7:300am I weight 60kg roughly and my highest is 1.63m but I have a belly of what some people claims is adrenal deficiency and liver as my liver was a bit fat... stopped any alcohol(usually would dink 2, 3 or 4 glasses wine a week), soft drinks for over 2 years. Stopped eating pasta for a year now but still eat my bread, don't eat many deaerts or biscuits at all. But I ate loads of fruit.... don't feel ok with nuts and all foods with lectins ...

After endocrinologist dismissed me decided to reduce for almost haf.

But need to take some more....

I am taking iron that doctors prescribed,but miss some days out, weekend, but seems I need to take more.

Thank you.

[GlowCoach Administrator in reply to Verde1]

Why did you reduce to half dose? So you have been on 50mcgs for this test?

Why were you seeing an Endo?

By weight you need around 96mcgs Levo, not a precise amount just a guide.

To feel well we need OPTIMAL vitamin levels for our thyroid hormone to work properly plus of course the right amount of Levo.

Do take your iron at the opposite side of he day to Levo, a good 4 hours apart. Take it daily and with a glass of ornage juice to help it absorb better.

Add in a B complex as above.

It may well help you to try a gluten free diet.

[Verde1 in reply to GlowCoach]

Hi Jaydee1507,

I reduced the dose, as still have symptoms I want to find the real route cause of my problem. Didn't exactly reduced to 50mcg. Slightly higher. But yes I am aware need to be careful, increasing again...

Like I mentioned here, going also to try to go gluten free... uhmmm

Thank you for your advice 🙏🏼 ☺️

[GlowCoach Administrator in reply to Verde1]

So you have Hashimoto's, for some people this is genetic, nothing you can do to change that at this point in time. By now most, if not all of your thyroid has been destroyed so the only way that you can feel well is to take the right amount of thyroid hormone and supplement vitamin levels to OPTIMAL levels to let the hormone work properly. There are no other options unfortunately.

Good luck going gluten free, it helps so many people.

[Verde1 in reply to GlowCoach]

Thank you

[greygoose]

As Jaydee says, you do not need rT3 tested - the NHS won't do that, anyway. It's a very expensive test and takes a long time to get the results, and it won't tell you if anything you cannot tell from the other tests.

rT3 is not a problem in and of itself. It is inert and only stays in the body for about two hours before it is converted to T2. High rT3 is the result of a problem, it is not the problem itself.

An rT3 test will tell you if you have a high level, but it won't tell you why. And there are many, many reasons for high rT3, and only one of them is anything to do with thyroid, and that is when your FT4 is too high. Your FT4 is under-range so hardly likely to be causing high rT3. But, about 30% of T4 is automatically converted to rT3, anyway.

If you want to know how well you convert, you just compare your FT4 level to your FT3 level. But as your FT4 is below range, your FT3 is bound to be low however well you convert. To get a realistic idea of conversion, your TSH needs to be around one, and your dose of levo high enough to get your FT4 to at least mid-range.

[Verde1 in reply to greygoose]

Thank you gor for your explanation 😊

[SlowDragon Administrator]

TSH level 47.6 miu/L [0.2 - 4] - Long way above range

free T4 level 9.4 pmol/L [10 - 20]- Below low reference limit

Serum thyroid peroxidase antibodies > 1,300 kU/L [< 100]

Serum folate > 24 ng/ml [5.4 - 24]

Serum vitamin B12 397 ng/L [211 - 911]

Serum ferritin 28 ng/ml [10 - 322]

vitamin D level 153 nmol/L [50 - 100]

So you need to go back on to 100mcg levothyroxine everyday and retest again in another 2-3 months

Which brand of levothyroxine are you using

Meanwhile working on improving low B12 and low ferritin

What vitamin supplements are you currently taking

You could reduce vitamin D dose a little

Need a daily vitamin B complex and separate B12 as well

And increase iron rich foods in your diet to improve ferritin

Have you had coeliac blood test. If not, get tested BEFORE trialing strictly gluten free diet

[Verde1 in reply to SlowDragon]

Thank you SlowDragon. I will look into B supplements.

I did the coeliac blood test before Christmas come out negative. But I have diverticulitis, also had a polyp removed beginning January.

I take just vit. D3 K2 this one I get from amazon and iron tablets from doctors.

I consume some liver when find in supermarkets. Eat fish, salmon cod prawns chicken, turkey, pork.

Eat loads of watercress, boiled broccoli, boiled aspargus with potatoes and egg.for lunch (around 4 times a week)...I am reducing my vitamin D a bit.

Thank you

I am grateful for your help.

[SlowDragon Administrator in reply to Verde1]

Only 5% of Hashimoto’s patients test positive for coeliac but a further 81% of Hashimoto’s patients who try gluten free diet find noticeable or significant improvement or find it’s essential

A strictly gluten free diet helps or is essential due to gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link) 

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and may slowly lower TPO antibodies 

Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse

chriskresser.com/the-gluten...

amymyersmd.com/2018/04/3-re...

thyroidpharmacist.com/artic...

drknews.com/changing-your-d...

Non Coeliac Gluten sensitivity (NCGS) and autoimmune disease

pubmed.ncbi.nlm.nih.gov/296...

The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported

nuclmed.gr/wp/wp-content/up...

In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned

restartmed.com/hashimotos-g...

Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.

Similarly few months later consider trying dairy free too. Approx 50-60% find dairy free beneficial

Hashimoto’s and leaky gut often occur together

[Verde1 in reply to SlowDragon]

Sorry forgot to mention that the brand I am getting of levotyroxine is accord 100mcg.

I am going to look into the B complex and separeted B12 the ones suggested.

Thank you

[SlowDragon Administrator]

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 a week after starting B12, add a separate vitamin 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 

natureprovides.com/products...

Or

B12 sublingual lozenges 

uk.iherb.com/pr/jarrow-form...

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 also 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