Levo before a blood test

[Andrew36]

Hello I have been hypothyroidism for over ten years now and I can never get the tsh stable . I have had an endoscopy and although they found I think slight inflammation of the dudoneum they have said I am not celiac. Also I read online that if I take my levothyroxine on a morning and I have a blood test booked for on a morning before 9am then I shouldn't take that morning dose until after my blood test , but yesterday my doctor said I should take it as usual so I'm a bit confused. Any help 🙏 😢.

[tattybogle]

Our knowledge is more accurate than the GP on this issue See replies (2 and 4) to this post for evidence : healthunlocked.com/thyroidu... suggested-thyroid-hormone-test-timing-protocols

[Andrew36 in reply to tattybogle]

Thanks

[tattybogle in reply to Andrew36]

note * TSH is not affected by time of last dose .

So if they are ONLY testing TSH then it won't make a difference whether you take it before test or not .. and this is probably why so many doctors say "take as normal / it doesn't matter"

fT4 result is the one that is affected by time of last dose .

[Andrew36 in reply to tattybogle]

So in this situation my ft4 has been stable within range but my tsh has been really high . So I am OK having my medication before my morning bloods. OK thanks for the help I really appreciate it 🙏

[tattybogle in reply to Andrew36]

"so i am ok having my medication before" .....not really ....it's better to be consistent ~always have early am bloods ~always take levo afterwards ..because you never know when the lab will test fT4 .

Catching fT4 at the peak can lead to GP unnecessarily reducing levo dose if fT4 is high .

What has been happening to your TSH, can you give us any results ?

[Andrew36 in reply to tattybogle]

OK thanks for the info it helps. Yes I have been having regular blood tests because of the tsh I am going to try and copy and paste from my doctors app

[Andrew36 in reply to tattybogle]

Tsh -17.76 miu/LFt4. 15.5 pmol/L

Ferritin -76ng/mL

Folate - 9.2 ug/L

B12 - 449ng/L

Vit D - 55.4 nmol/L

Thyroid antibody - 977 iu/ml . Last taken 2010

Magnesium - 0.8 mmol/L

I have a blood test booked in for t3

[SlowDragon Administrator]

Absolutely essential to test vitamin D, folate, ferritin and B12 at least once a year

Always worth trying strictly gluten free diet

How much levothyroxine are you taking

Do you always get same brand levothyroxine at each prescription

Please add most recent results

TSH, Ft4 and Ft3 plus have you had thyroid antibodies tested

And vitamin results

[Andrew36 in reply to SlowDragon]

Hello I will gather all the blood tests as I have had them done in the last 6 months and I will post them here soon. I am currently under an endo who has requested I have a t3 test and he said he is shocked I have never had a t3 test

[Andrew36 in reply to SlowDragon]

Tsh - 17.76 miu/L -Ft4 - 15.5 pmol/L

Ferritin - 76ng/mL

Folate - 9.2 ug/L

B12 - 449ng/L

Vit D - 55.4 nmol/L

Thyroid antibody - 977 iu/ml . Last taken 2010

Magnesium - 0.8 mmol/L

I have a blood test booked in for t3

[SlowDragon Administrator in reply to Andrew36]

please add range on Ft4 result

If you took levothyroxine before test Ft4 is falsely high

How much levothyroxine are you currently taking

Do you always get same brand levothyroxine at each prescription

Do you always take levothyroxine on empty stomach and then nothing apart from water for at least an hour after

Is TSH 1.76 or 17.76

On levothyroxine TSH should ALWAYS be below 2

what vitamin supplements are you taking

Vitamin D is insufficient

Need ranges on Folate, ferritin and B12…..but they all look on low side

High thyroid antibodies confirms autoimmune thyroid disease also called Hashimoto’s

Now you have had endoscopy you can trial absolutely strictly gluten free diet

Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels 

Low vitamin levels affect Thyroid hormone working 

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances.

Most common by far is gluten. Dairy is second most common. 

 A trial of strictly gluten free diet is always worth doing

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

[Andrew36 in reply to SlowDragon]

Hello please see my ranges for folate feeretin and b12 below 🙂Tsh -17.76 miu/L -Ft4. 15.5 pmol/L - 0.38 - 5.5

Ferritin -76ng/mL - 22 - 322

Folate - 9.2 ug/L. - 5.4 - 9999

B12 - 449ng/L. - 211 - 911

Vit D - 55.4 nmol/L. - they say >50 may be adequate?

Thyroid antibody - 977 iu/ml . Last taken 2010

[SlowDragon Administrator in reply to Andrew36]

Low vitamin D

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 with Hashimoto’s, 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 

vitamindtest.org.uk

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

Suggest you try 2000iu per day and retest in 2-3 months. You may need higher dose in winter than summer

amazon.co.uk/BetterYou-Dlux...

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...

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...

[SlowDragon Administrator in reply to Andrew36]

ALWAYS test thyroid early morning, ideally just before 9am. Last dose levothyroxine 24 hours before test

Only drink water between waking up and test. Take levothyroxine after blood test

[Bearo]

Your vitamin D is very low - are you supplementing for this?

[Andrew36 in reply to Bearo]

I bought some solgar vitamin d3 4000iu about 6 months ago and am struggling to be consistent with them. Thanks for replying too 🙂

[SlowDragon Administrator in reply to Andrew36]

Get a weekly pill dispenser for vitamins

Personally I prefer Better You vitamin D mouth spray, very effective as it is absorbed in mouth so avoids poor gut function.

There’s a version made that also contains vitamin K2 Mk7. 

One spray = 1000iu

amazon.co.uk/BetterYou-Dlux...

[Andrew36]

Hello guys iv been absent from this conversation because I have had some stuff to deal with but I just want to say I really appreciate all your help and I am going to post the reference ranges shortly. Thanks again

[Andrew36]

Tsh -17.76 miu/L -Ft4. 15.5 pmol/L - 0.38 - 5.5

Ferritin -76ng/mL - 22 - 322

Folate - 9.2 ug/L. - 5.4 - 9999

B12 - 449ng/L. - 211 - 911

Vit D - 55.4 nmol/L. - they say >50 may be adequate?

Thyroid antibody - 977 iu/ml . Last taken 2010

Magnesium - 0.8 mmol/L

I did notice my ferretin went from " 113 "on 1 March 2022 to" 76 "on the 25 Jan 2023 is that a normal drop . Thanks

[Jaydee1507 Administrator in reply to Andrew36]

Small tip. If you want someone to get a notification then use the reply button under their response to you. I'll tag SlowDragon so she knows you have posted labs.

[Andrew36 in reply to Jaydee1507]

Sorry still getting used to it 🙂

[SlowDragon Administrator in reply to Andrew36]

Low vitamin levels directly linked to being hypothyroid

Looking for ferritin too be around half way through range minimum…..as a bloke that’s definitely over 100…..probably nearer 150

Never supplement iron without doing full iron panel test for anaemia

Medichecks iron panel test 

medichecks.com/products/iro...

Look at increasing iron rich foods in diet 

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

dailyiron.net

[tattybogle]

fT4 range ?

[Andrew36 in reply to tattybogle]

0.38 - 5.5

[tattybogle in reply to Andrew36]

That's definitely a TSH range , not FT4

fT4 will be something like [12-22] .. or [7 -14] or[9 -23]