The following results were taken after 24 hours of stopping Levothyroxine and before 9am. I have been feeling off balance etc and attributed it to thyroid function, however this does not appear to be the case?!
CRP 4.07 (<3)
Ferritin 31 (30-150)
Folate serum 5 (8.83-60.8)
Vitamin B12 Active 41 (37.5-188)
Vitamin D 37 (50-250)
TSH 2.36 (0.27-4.2)
Free T3 3.9 (3.1-6.8)
Free thyroxine 16.5 (12-22)
Thyroglobulin antibodies 16.2 (0-115)
Thyroid Peroxidase Antibodies 31.4 (0-34)
Peroxidase antibodies were 35.1 in 2021?!
I would be very grateful of any recommendations/suggestions.
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Tinker72
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First of all, your nutrient levels are very poor. Do you take any supplements at all?
CRP 4.07 (<3)
This is a bit above range and shows some inflammation.
Ferritin 31 (30-150)
We know from your CRP that you have some inflammation. Ferritin can be raised when inflammation is present so your ferritin level isn't quite true. Assuming it is also a bit raised then we can assume your true level is below 30 and according to NICE that suggests iron deficiency:
In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency.
Your GP should do a full iron panel to include serum iron, saturation percentage, total iron binding capacity plus ferritin. This will show if you have iron deficiency. Your GP should also do a full iron panel which will show if you have anaemia. You can have iron deficiency with or without anaemia. You can also have low ferritin without iron deficiency.
Folate serum 5 (8.83-60.8)
This is below range and according to NICE is folate deficiency:
◦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.
Discuss with your GP who should prescribe folic acid.
Vitamin B12 Active 41 (37.5-188)
Active B12 below 70 can be suggestive of B12 deficiency according to Viapath at St Thomas' Hospital:
Reference range:>70. *Between 25-70 referred for MMA
There is a link at the bottom of the page to print off the pdf to show your GP and you should be asked to be tested for B12 deficiency and pernicious anaemia. This must be done before starting folic acid (see below **)
Do you have any signs of B12 deficiency – check here:
If you do then list them to discuss with your GP and ask for testing for B12 deficiency and Pernicious Anaemia. **Do not take any B12 supplements or folic acid/folate/B Complex supplements before further testing of B12 as this will mask signs of B12 deficiency and skew results and if you have B12 deficiency and it is not detected and treated then this could affect your nervous system. B12 deficiency should be treated before starting folic acid because folic acid can sometimes improve your symptoms so much that is masks B12 deficiency.**
Vitamin D 37 (50-250)
Again very poor. You might want to check out a recent post that I wrote about Vit D and supplementing:
it shows that to reach their recommended level they suggest that you supplement with 4,900iu D3 daily, nearest to buy is 5,000iu.
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).
Retest after 3 months.
Once you've reached the recommended level then a maintenance dose will be needed to keep it there, which may be 2000iu daily, maybe more or less, maybe less in summer than winter, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. This can be done with a private fingerprick blood spot test with an NHS lab which offers this test to the general public:
Doctors don't know, because they're not taught much about nutrients, but there are important cofactors needed when taking D3. You will have to buy these yourself.
D3 aids absorption of calcium from food and Vit K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems such as hardening of the arteries, kidney stones, etc. 90-100mcg K2-MK7 is enough for up to 10,000iu D3.
D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds if taking D3 as tablets/capsules/softgels, no necessity if using an oral spray.
For D3 I like Doctor's Best D3 softgels, they are an oil based very small softgel which contains just two ingredients - D3 and extra virgin olive oil, a good quality, nice clean supplement which is budget friendly. Some people like BetterYou oral spray but this contains a lot of excipients and works out more expensive.
For Vit K2-MK7 my suggestions are Vitabay, Vegavero or Vitamaze brands which all contain the correct form of K2-MK7 - the "All Trans" form rather than the "Cis" form. The All Trans form is the bioactive form, a bit like methylfolate is the bioactive form of folic acid.
Vitabay and Vegavero are either tablets or capsules.
Vitabay does do an oil based liquid.
Vitamaze is an oil based liquid.
With the oil based liquids the are xx amount of K2-MK7 per drop so you just take the appropriate amount of drops.
They are all imported German brands, you can find them on Amazon although they do go out of stock from time to time. I get what I can when I need to restock. If the tablet or capsule form is only in 200mcg dose at the time I take those on alternate days.
If looking for a combined D3/K2 supplement, this one has 3,000iu D3 and 50mcg K2-MK7. The K2-MK7 is the All-Trans form
Magnesium should be taken 4 hours away from thyroid meds and as it tends to be calming it's best taken in the evening. Vit D should also be taken 4 hours away from thyroid meds. Vit K2-MK7 should be taken 2 hours away from thyroid meds. Don't take D3 and K2 at the same time unless both are oil based supplements, they both are fat soluble vitamins which require their own fat to be absorbed otherwise they will compete for the fat.
Don't start all supplements at once. Start with one, give it a week or two and if no adverse reaction then add the next one. Again, wait a week or two and if no adverse reaction add the next one. Continue like this. If you do have any adverse reaction then you will know what caused it.
These poor levels will need to be improved to enable your thyroid hormone repacement to work properly.
TSH 2.36 (0.27-4.2)
Free T3 3.9 (3.1-6.8)
Free thyroxine 16.5 (12-22)
The aim of a treated hypo patient on Levo only, generally, is for TSH to be 1 or below with FT4 and FT3 in the upper part of their reference ranges, if that is where you feel well.
Your TSH is far too high, your FT3 is only 21.62% through range with FT4 only 45% through range, both far too low.
Whilst working on nutrient levels it would be beneficial to have an increase in your dose of Levo, I would ask for 25mcg extra daily then retest in 8 weeks to see how all your levels - thyroid and nutrients - are doing.
Check out this pinned post with references about keeping TSH lower and use any appropriate ones when discussing your TSH and a dose increase with your GP:
The fact that your TPO antyibodies were over range in 2021 suggests autoimmune thyroid disease, aka Hashimoto's, which is the most common cause of hypothyroidism. Hashi's and gut absorption problems tend to go hand in hand and is most likely the reason for your poor nutrient levels.
Most doctors dismiss antibodies as being of no importance and know little or nothing about Hashi's and how it affects the patient, test results and symptoms. It would be best to read, learn, understand and help yourself where Hashi's is concerned.
Some members have found that adopting a strict gluten free diet can help, although there is no guarantee.
Gluten contains gliadin (a protein) which is thought to trigger autoimmune attacks so eliminating gluten can help reduce these attacks.
You don't need to be gluten sensitive or have Coeliac disease for a gluten free diet to help.
thank you so much for your comprehensive review, I will read through all the literature and recommendations. I don’t take any supplements at present. I’ve managed to book and see a Private Endocrinologist next week, as the symptoms I’m currently experiencing are awful and I’m just dismissed by GP. Thank you so much for your time.
Once on any thyroid hormone replacement we generally feel at our best when the TSH is down under 2 and probably under 1 and even lower in the TSH range.
This should happen when your dose of T4 - levothyroxine is slowly increased by 25mcg every 6-8 weeks to build up your dose of T4 into the top quadrant of its range - and this in turn should slowly increase your T3 reading as it is too low a T3 for you that causes the symptoms of hypothyroidism.
Currently you T4 reading is coming in at around 46% through the range with your T3 tracking behind at around 22% - so both currently too low to see the benefits of this treatment option.
We generally feel at our best when the T4 is up in the top quadrant of its range as this should convert to a decent level of T3 at around a 1/4 ratio - T3/T4 and the accepted conversion ratio is said to be 1 / 3.50 - 4.50 with most people feeling at their best when they come in this ratio at 4 or under.
So to find how well your are converting the T4 into T3 we divide your T4 by your T3 and I'm getting your conversion coming in at 4.23 so a little wide of centre but this should improve as you increase your dose of Levothyroxine.
No thyroid hormone replacement works well until your core strength vitamins and minerals are up and maintained at optimal and I now aim for my ferritin to be at around 100 : folate at around 20 : active B12 75++ ( serum B12 500++ ) and vitamin D at around 100.
I think you will start to feel a lot better after you build up your core strength vitamins and minerals of ferritin, folate, B12 and vitamin D.
Your inflammation is high so your body is showing some signs of upset - this too can impact of T3/T4 conversion , and currently your thyroid antibodies are within range.
Hi Pennyannie, thank you very much for your review and recommendations. I really appreciate it. I was diagnosed with sub clinical hypothyrpdosm in 2021, GP only agreed to treat symptoms as antibodies were 78.9 in June of that year. November 2021 they were 35.7 and now showing normal. Is this normal, I’m a bit confused?
Oh, ok, - you are looking therefore at a thyroid auto immune disease and antibodies tend to wax and wane and guessing your diagnosis described as Hashimoto' AI thyroid disease ?
That too would explain your inflammation reading.
It will likely make sense to get tested for celiac - another AI disease that tends to run in tandem and then you might like to start thinking of ways to calm down your immune symptom response.
Hashimoto's forum members find there are benefits to cutting out certain foods such as gluten, dairy, wheat etc - and healing their gut - which appears to be a common problem and which can cause inflammation.
With Hashimoto's the immune system attacks the thyroid and you may find you experience phases of erratic thyroid production and feel ' swings ' of hyper type symptoms which once over leave you feeling more hypothyroid than before.
With these attacks this AI disease is systematically disabling your thyroid and you will likely become more reliant on a thyroid hormone support as you thyroid becomes less productive.
You might like to read around Hashimoto's AI thyroid Disease and understand many find the research and work of Dr Izabella Wentz very helpful -
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