Feeling constantly tired and no energy

[shell461]

So I paid for a female hormone blood test that came back with female testosterone levels 0.087 Low so I spoke to a locum doctor who said that they need to do their own tests so I went on Tuesday morning and I’ve just been and collected a copy of the results. I have been taking 75mg of levothyroxine for the last 15 years and having read through some of the posts on here I paid for a thyroid test and TSH and T4 were middle range and T3 was low range so I purchased some T3 and I’ve been taking 12.5mg a day, sorry for the long post xx

[Jaydee1507 Administrator]

Welcome to the group. If you could complete your profile it helps members understand your thyroid journey so far and offer recommendations better. Click on your image icon to start.

Your image is very blurry and small, impossible to make out some of the text. Could you take a picture of it in 2 parts and post as a reply to your post. You can only upload one image per reply so you will need to reply twice.

When did you take your last dose of levo & T3 before the test?

[shell461 in reply to Jaydee1507]

Hi Jaydee, thank you for the welcome. I took the Levo and T3 at 8am the day before. I’m just going to take the pictures again then upload them x

[shell461 in reply to Jaydee1507]

It’s not letting me upload the pictures, the reply button is staying grey 🤷🏼‍♀️

[Jaydee1507 Administrator in reply to shell461]

Click on the image icon centre of reply box to upload your photo. Or just write a couple of words too.

image upload button

[shell461 in reply to Jaydee1507]

it still won’t let me do it, I wrote a few lines until I’d run out of spaces and the reply button is still grey

[Jaydee1507 Administrator in reply to shell461]

You could type them out:

Folate - 4.3 (3-20)

We need the ranges as well as they vary from lab to lab.

[shell461 in reply to Jaydee1507]

ok, I’ll try that

[shell461 in reply to shell461]

TSH 0.05 (0.40-4.50)

Vit D 85.7 (50.00-250.00)

Serum free T4 9.9- (7.00-17.00)

Serum ferritin 13 (11.00-307.00)

Serum folate 23 (3.10- 19.90

Vit b12 402 (145-910.00)

Is this all that’s required?

[Jaydee1507 Administrator in reply to shell461]

What time was the blood test?

Your FT3 (if it had been tested) would be showing a false low as there was more than 12 hours from last dose to test. A gap of 8-12 hours is the recommended timing as T3 only has a short half life.

If you normally take your full dose all at once then the day before the test split it in 2 and take last part 8-12 hours before test is due.

You really now need to do a private test to include FT3 & do the correct timings for last dose.

Free T4 (fT4) 9.9 pmol/L (7 - 17) 29.0%

75mcgs Levo is a fairly low dose. Your FT4 is far too low. Should be at around 70%.

Ferritin is deficient according to NICE guidelines that state that a level of 30 or less is deficient. Point this out to GP and you should push to get a full iron study test and possible iron tablets which need to be taken 4 hours apart from your Levo as they can affect its absorption.

Vit D is close to optimal which is 100-150. Are you supplementing already? Do take a K2 supplement or buy a D3 with K2 already added as it helps it go to your bones where it is needed. You just need a tiny bit more.

The range for B12 is too wide and your level is not optimal. Recommend a good active/methyl B complex that will keep allyour B vitamins in balance. This B complex has all the right vitamins at a not unreasonable cost for 90 days supply. amazon.co.uk/Liposomal-Soft...

Are you already supplementing folate?

[shell461 in reply to Jaydee1507]

i supplement with vitamins D and vitamin B complex High Strength (which had been recommended on here) and I also take Centrum Advance50+ and I also take a zinc oral spray. So do I need to buy iron tablets and vit b12 oh and vit d with k2?

[shell461 in reply to shell461]

The blood test was at 10:50

[Jaydee1507 Administrator in reply to shell461]

Multivitamins are not recommended in this group for a number of reasons, including being too low a dose to raise levels to optimal, including iodine which is not recommended when hypo and including iron which prevents absorption of the other vitamins and should be taken apart from other vitamins/Levo.

TBH you're probably wasting your money anyway with the Centrum advanced.

You GP should prescribe iron but you do also need a full iron panel - see GP.

How long before this test did you stop the multivitamin & B complex?

It looks like a separate 1000iu B12 would be good for you, either sublingual or mouth spray. Pick one of the three from below.

gb.pipingrock.com/methylcob...

cytoplan.co.uk/vitamin-b12-...

amazon.co.uk/Better-You-Boo...

With no FT3 result I can't advise on if you need more etc Suggest private testing.

Your GP may now not be happy with a below range TSH. It might be time to confess that you are taking T3 and gather some medical papers, references etc to present to your GP.

[shell461 in reply to Jaydee1507]

Ah right i didn’t know that about multivitamins so they will be going in the bin. I wasn’t aware that I should stop taking these vitamins. Could you please point me in the direction of the paperwork that I will need to ward off the wrath of the doctor

[Jaydee1507 Administrator]

The studies reporting that biotin affects thyroid results involved very large doses of biotin and there is a much smaller amount in a multivit & B complex. None the less we should stop taking them for around 4 days before a thyroid blood test.

The first paragraph in the NICE (NHS) Thyroid Disease, Assessment and Management guidelines says :

nice.org.uk/guidance/ng145

"Your responsibility”

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian. "

healthunlocked.com/thyroidu...

[SlowDragon Administrator]

Ferritin is big issue

Get FULL iron panel test via GP

cks.nice.org.uk/topics/anae...

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.

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 

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

Links about iron and ferritin

An article that explains why Low ferritin and low thyroid levels are often linked 

preventmiscarriage.com/iron...

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...

Posts discussing Three Arrows as very effective supplement 

healthunlocked.com/thyroidu...

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...

Good iron but low ferritin 

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. ‘

[SlowDragon Administrator]

You likely not on high enough dose levothyroxine

However….because you are taking T3 ….your TSH is low

TSH is all GP will look at and most likely want to (inappropriately) reduce levothyroxine

Many members on levothyroxine plus T3 find they need both Ft4 and Ft3 Approx 60-70% through range

retest correctly

Come back with new post once you get results

[shell461 in reply to SlowDragon]

I’ve just ordered the £42 blood test from monitor my health, once I get the results back I’ll make an appointment with the doctor because he wants to see me about the tsh result.

[SlowDragon Administrator in reply to shell461]

You will need to admit to GP that you’re taking T3 and that liothyronine will always lower TSH