In the midst of pursuing diagnosis with GP and probably private thyroid specialist. Wanted to re-test with key vitamins (Medichecks) to see where I'm at. Any opinions much appreciated.
CRP HS 1.06 mg/L (<3)
Ferritin 30 uh/L (30-150)
Serum folate 8.8 (8.83-60.8)
Active B12 84 pmol/L (37.5-188)
Vitamin D 69 nmol/L (50-250)
TSH 6 (0.27-4.2)
Free T3 4.6 pmol/L (3.1-6.8)
Free T4 16.3 pmol/L (12-22)
TgAB 261.2 kIU/L (0-115)
TPOAb 286.2 kIU/L (0-34)
Ferritin has increased by 5 in the last month, which seems positive since I've only been supplementing for a few weeks, so the heme iron seems to be doing the job (finally a form I can actually absorb!). B12 and folate still seem on the low side(?), but hard to compare because units of measurement are different to other lab. I've started on a methyl B complex last few weeks and now adding extra methyl folate - are these best taken together, or spaced out? I use a D+K2 spray, 4000iu a day. Thyroid levels very similar to a month ago, but antibodies have increased by around 60 units. Is that normal, or do they just fluctuate?
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seveneleven
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Did you do the test as per the protocol recommended here? Test at 9am, fasting, no biotin containing supplements for 3-7 days (Biotin can interfere with thyroid blood results as it is used in the testing process)?
Do take your heme iron with orange juice to help absorption, also add in iron rich foods - chicken livers, pate, red meat a few times a week.
If you've only just started on the B complex & adding in extra folate then I would give it a good 3 months before retesting vitamins. Its not really fair to assess vitamins now when you've only just started supplementing.
B complex & folate can be taken at the same time. Usually suggested time is morning after breakfast as can be stimulating if taken later in the day.
Antibodies do fluctuate naturally. Some find that a gluten free diet helps reduce them, others not.
Thank you. Yes tested before 9am fasting, no biotin supplements for 5 days prior. Not taking iron with orange juice as I find citrus gives me reflux, but now wondering if there's maybe actually a low stomach acid issue going on, as seems to be common among hypothyroid folk?
Theres quite likely low stomach acid issues going on. You can try adding a teaspoon of apple cider vinegar (must contain the ‘Mother’, see label) to a glass of water before your main meal. This helps acidify the stomach. Alternatively some people do well with betain & pepsin before main meal.
Did you follow our advice re testing, ie test no later than 9am with water only before the test and leave off B Complex or biotin for 3-7 days before test? If so:
CRP HS 1.06 mg/L (<3)
As an inflammation then the lower the result the better, your's isn't too bad.
Ferritin 30 uh/L (30-150)
Did you get a full iron panel (serum iron, saturation percentage, total iron binding capacity and ferritin) carried out before supplementing? This should always be done because we can have decent iron levels but low ferritin and if this is the case then supplementing can take serum iron and saturation too high and lead to iron overload.
Supplementing is best done with GP prescribing so that your levels can be monitored regularly. If you are going to continue to self supplement I suggest you do a Medichecks Home Blood Test, which is the full iron panel, and keep an eye on your levels (post on here if necessary), and do this every couple of months to check your levels.
Serum folate 8.8 (8.83-60.8)
This is very low but not folate deficiency. According to NICE
◦Serum folate of less than 7 nanomol/L (3 micrograms/L) is used as a guide to indicate folate deficiency.
◦However, there is an indeterminate zone with folate levels of 7–10 nanomol/L (3–4.5 micrograms/L), so low folate should be interpreted as suggestive of deficiency and not diagnostic.
So your level, even though at the very bottom of this range, is in the indeterminate zone and you may wish to discuss with your GP.
It is recommended that folate be at least half way through range so with that range you're aiming for 35 plus.
Active B12 84 pmol/L (37.5-188)
Below 70 would suggest testing for B12 deficiency, yours isn't too bad but would be better 100 plus. The amount if a B Complex should improve your level over time.
Vitamin D 69 nmol/L (50-250)
This is low and would be better between 100-150nmol/L.
You might want to check out a recent post that I wrote about Vit D and supplementing:
they suggest 3,700iu D3 daily would be the amount required to raise your level to their recommended level. 4,000iu D3 is the nearest to buy and if this doesn't raise your level within a couple of months then I'd suggest increasing dose a bit or changing to a different type of supplement, eg oil based softgel.
The Vit D Council, the Vit D Society and Grassroots Health all recommend a level of 100-150nmol/L (40-60ng/ml), with a recent blog post on Grassroots Health mentioning a study which recommends over 125nmol/L (50ng/ml).
TSH 6 (0.27-4.2)
Free T3 4.6 pmol/L (3.1-6.8)
Free T4 16.3 pmol/L (12-22)
TgAB 261.2 kIU/L (0-115)
TPOAb 286.2 kIU/L (0-34)
You would need 2 x over range TSH with raised antibodies for NHS GP to diagnose and prescribe. As you've had similar results before then you should now get a diagnosis and Levo prescribed by your GP.
Thanks. Yes, followed all advice. I've not had iron panel though. When I've had iron tested in the past it's always been low-middle, never high. Heavy periods and no red meat probably a factor. I will try and get an iron panel done though. I need to do it myself because according to GP my ferritin at 25 and folate at bottom of range were absolutely fine (in range = normal!), so not going to get any help there. I can't tolerate anything except heme anyway.
Unfortunately both tests showing raised TSH and antibody levels have been private, and GP said can't accept those. If NHS test next week shows above range, might help, but would still only have one (previous NHS test was high but in range) and would need to leave a few months before another, if I wanted her to prescribe.
She's good compared to some I've had in the past, as she's at least open to looking into things, but she does seem to be one who particularly takes NICE as the bible. I'm still trying to get my NHS blood results from last week. Admin don't understand why I want them emailed bc GP can give them to me at my appointment next week, and they need permission from her. Literally never had a doctor actually hand over results at an appointment, and anyway I need to know what sort of game plan I need for the conversation beforehand! Ugh.
GP has to have seen test results before you are allowed a copy
The best way to get access to current and historic blood test results is to register for online access to your medical record and blood test results
UK GP practices are supposed to offer everyone online access for blood test results. Ring and ask if this is available and apply to do so if possible, if it is you may need "enhanced access" to see blood results.
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
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.
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.
Many people cannot tolerate starting on more than 50mcg levothyroxine initially
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.
Insist GP do 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
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
Thanks, yes they unfortunately don't have anything online yet, not even appointments. Think Scotland is a bit behind in digitising. She has seen the results, because I got a request from her via admin to make an appointment last week to discuss them. It happened last time that they were reluctant as well, but got someone different this time so had to explain again. Looks like I'll need to just wait because I don't want to get on the wrong side of them.
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