Please can I ask for some advice on my recent blood tests done on the 29/3/23 and added below ( ref ranges are in brackets).
GP want o reduce my dosage from 125 to 100, which I’ve done, and I’ve put on more weight in just a few weeks…. (They won’t do the T3 test, so I have no idea the levels are there). I have added some armour thyroid 1 grain daily but I’m still very symptomatic and confused as to how I should take it… I have reduced all gluten, almost gluten free, I’m not extreme, but I do watch my calories and make smart choices !
your help and advice will be really appreciated. 😊. Poonam
Serum ferritin 33ug/L (13-150)
HbA1c 35 nmoll/mol (20-41)
Serum TSH <0.010 mIU/L (0.27-4.2)
Serum T4 levels ms 23.5 pmol/L (12-22)
Vit D 58 nmol/L (50-220)
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Poonam1
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Your GP has reduced your meds because your results are showing you are over medicated with a suppressed TSH and over range FT4 levels.
I would not introduce further meds without testing FT3 and if further meds are introduced you will need to reduce Levothyroxine. For many of us the T4:T3 ratio is of vital importance but as NDT contains both hormones you will have raised your T4 levels even higher.
Also 1 grain NDT is biologically equivalent to about 88mcg T4 so replacing your 25mcg Levo reduction with 1 grain will have made you further over-replaced. When thyroid hormones reach excessive levels the body will deactivate a proportion which can effect the workings of it all, resulting in hyper or hypo symptoms. How are you feeling?
Thanks for your reply, I will take any advice to feel better as I'm feeling quite unwell at the moment. symptoms include joint pain, oedema in my legs and ankles and in the tops of my arms. I'm not eating much at all and the little I do eat bloats me to the point were I'm too uncomfortable and 2 sizes bigger in the evening, than I started off in the morning. GP will not discuss any other symptom and have conveyed that they are very please with my blood results, they just want to reduce my thyroxine.
I am currently trying to supplement myself with vit D 800IU, B complex and folic acid and didn't realise that my Vit D and ferritin was considered low. I have added my B12 and folate results below too, as never know if they're optimal or not.
As radd has said, definitely look to test FT3 in addition to TSH & FT4 for a more complete picture of your thyroid health. I wouldn’t increase your medication at the moment, as your FT4 is over range and we need to view your FT3 to advise further.
If your GP is unable to test FT3, you could look to do this privately, as many forum members do;
I would look to improve your key vitamin levels, eg eating iron rich foods to improve ferritin. I learned a lot about raising ferritin by reading posts by humanbean so do look up her posts on this subject.
Have you tested other key vitamins, namely B12 and folate?
If you are trialling a gluten free diet, you need to eliminate all gluten from your diet, as even a small amount can increase inflammation in some people. I recommend 100% elimination for a couple of months to see if this improves your symptoms. Remember that gluten is found in many everyday store cupboard items, so do look carefully on all labels.
No thyroid hormone replacement works well until your core strength vitamins and minerals - those of ferritin, folate, B12 and vitamin D are up and maintained at optimal levels.
Everywhere I researched suggested ferritin needed to be at least over 70 for T4 to convert well to T3 within the body and it is T3 the active hormone that needs to be measured alongside your T4 reading.
I now aim for a ferritin at around 100: folate at around 20 : active B12 - 75 ++ ( serum B12 - 500 ++ and vitamin D at around 100:
It's likely futile taking Armour at the moment -
1 grain Armour contains 9 mcg T3 + 38 mcg T4 -
The bulk is T4 - which you will not be able to convert with such a low ferritin -
and the T3 content not at a high enough content level to restore health and well being at this moment in time.
Thanks for your reply, I will take any advice to feel better as I'm feeling quite unwell at the moment. symptoms include joint pain, oedema in my legs and ankles and in the tops of my arms. I'm not eating much at all and the little I do eat bloats me to the point were I'm too uncomfortable and 2 sizes bigger in the evening, than I started off in the morning. GP will not discuss any other symptom and have conveyed that they are very please with my blood results, they just want to reduce my thyroxine.
I am currently trying to supplement myself with vit D 800IU, B complex and folic acid and didn't realise that my Vit D and ferritin was considered low. I have added my B12 and folate results below too, as never know if they're optimal or not.
So I detailed above the levels I try to aim for and another rule of thumb is to aim for a good 50% through a range.
I am not familiar with either of these ranges for B12 or folate - and it seems using these ranges your serum B12 is ok and your folate needs further supplementing.
I'm not that knowledgeable on vitamins and minerals - you could read further around this on the subsection top right entitled vitamins and minerals as to supplements etc.
But I think the other question is why are you bloating up like this during the day ?
Your stomach sounds as though it is upset - and this in turn might be stopping absorption and conversion of the T4 medication to T3 which happens in the liver.
Maybe look to food intolerances, and start by at least removing gluten from your food.
The fillers in the T4 medication might be upsetting your system ?
Many forum members experience stomach upset on some brands of T4 ?
What is the cause of your hypothyroidism ?
If you are with Hashimoto's Auto Immune Thyroid Disease - have you been checked for celiac disease as this tends to run in tandem and healing the gut the first step and paramount before any medication will work well and be fully effective.
It looks like you were slightly over medicated hence the reduction of thyroxine but both your ferritin and vitamin D levels are low so you might want to consider supplementing those.
I am already supplementing with vit D 800IU, folic acid and B12, not sure what to add to the programme to raise my vitamin profile which I am now keen to do, if it sorts out all of my symptoms.
Was this test done early morning and last dose levothyroxine 24 hours before test
For good conversion of Ft4 (levothyroxine) to Ft3 (active hormone) we must have GOOD Vitamin Levels
Optimal vitamin levels are
Vitamin D at least over 80nmol and around 100nmol maybe better
Serum B12 over 500
Folate and ferritin at least half way through range
Your results show
Vitamin D insufficient
Ferritin borderline deficient
Folate very low
Low vitamin levels results in poor conversion of Ft4 to Ft3…..so Ft4 rises….but Ft3 falls
Never agree to dose reduction in levothyroxine without testing TSH, Ft4 and Ft3 together
Likely you had low Ft3 and now dose levothyroxine reduced, Ft3 even lower
First step is get all four vitamins improved, so supplementing vitamin D, magnesium, and vitamin B complex daily
Low ferritin
Request full iron panel test for anaemia via GP
Meanwhile increasing iron rich foods in your diet to try to increase iron/ferritin levels
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
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
I have added some armour thyroid 1 grain daily but I’m still very symptomatic and confused as to how I should take it… I have reduced all gluten, almost gluten free,
Adding any dose of NDT will almost always significantly reduce TSH
Were you taking NDT before this test?
Obviously absolutely essential to test TSH, Ft4 and Ft3 together. Day before test split Armour as half dose waking and half dose Approx 8-12 hours before test
Gluten Free diet has to be absolutely strictly gluten free to be effective
I hope your well Sorry for the late reply… I am at the moment and for the past 4 weeks taken 100mcg of levo (I was on 125), I am now more symptomatic with weight gain by half a stone, constipation, stomach pains on eating anything with bloating, hair fall and a fuller face, dry eyes and headaches. I took my dose the levo dose (125 mcg) approx the morning before the blood test at 8.25 am and then then took 125+ 1 grain of armour straight after the test. I’m at a loss and very unwell at the moment and an GO that is now happy with everything as well as the peripheral oedema I’m dealing with and wheezing, mainly in the morning and evenings… please please can you advise on how to deal with thyroid symptoms based in the blood results previously added to the chat? (I am already supplementing with vid d 800iu x2 folic acid and bcomplex). Many many thanks in advance ❤️💕☹️
Retest thyroid TSH, Ft4 and Ft3 plus vitamin D, folate, ferritin and B12 after minimum 6-8 weeks on constant unchanging dose and brand levothyroxine and NDT
Test early morning and last dose levothyroxine 24 hours before test
Day before test split NDT as 2 or 3 smaller doses with last dose Approx 8-12 hours before test
Unlikely to need folic acid and Vitamin B complex ….take one or the other
Stop vitamin B complex a week before blood test anyway as contains biotin and biotin can falsely affect test result
During that week….take folic acid or folate instead of vitamin B complex
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
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
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.
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. ‘
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