Full bloods - advice and suggestions on what next please!

[Myalikki]

Hello!

Would anyone be willing to look over my recent home blood test results please? Test was done at 9:05am on 14th June, fasting and last levo dose was 8:30am the day before. I have been completely compliant with advice on taking levo.

I was diagnosed hypothyroid in November 2022 (no TPO antibodies then either...) and have been on 75mcg (consistently prescribed as 50mcg accord, 25mcg Mercury Pharma) since 17th March. Next NHS blood test is 28th June, with GP review on 29th June. I am assuming these results mean I need a dose increase, but sceptical my GP will offer it, and nervous it might be a battle. I also don't know what new dose to request/try - I weigh 55kg so guideline is somewhere around 90mcg, but I'm not sure what this would actually look like so would really appreciate some advice/suggestions.

Since March I've been working on my vitamins and minerals one at a time. Started with a loading dose of vitamin D and now maintain with 3 sprays of the red Better You spray. Then added 200mg magnesium glycinate at bedtime, and after Intrinsic Factor test came back fine, I added 400μg L-Methylfolate as I was struggling to find a good B complex, but I have the Pink Tribe soft gels now - guess this should be my next addition? Should I continue the separate folate too? I also eat 2 Brazil nuts a day (started about 6 weeks ago).

This is the first time I've ever had a T3 result, but I guess largely explains why I'm still feeling pretty rubbish - lots of fatigue, joint pain and muscle aches, brain fog etc. Spending a day in the office (I generally work from home) completely destroys me for the next day. My ferritin is raised again and I don't really know what that is about, but the GPs never seem to notice/care when I've mentioned it. Cholesterol has worsened but since ratios are good I am guessing I shouldn't worry about it too much. Liver profile might seem an odd inclusion, but my thinking was that the liver does a lot of the converting of t4 to t3 so I should probably check it?! Also, I got my raw data from 23andme and put it into codegen, which showed I have inherited one copy of the risk allele for DIO2 (CT), which is a bit annoying really as I am really hoping to avoid the whole saga of getting and taking t3...

Thank you so much in advance for any advice and suggestions!

Mya 😊

Thyroid Profile:

TSH 2.39 mIU/L (0.27 - 4.2) 53.9%

Free T4 (fT4) 15.6 pmol/L (12 - 22) 36.0%

Free T3 (fT3) 3.21 pmol/L (3.1 - 6.8) 3.0%

T4 76.8 nmol/L (59 - 154) 18.7%

T4:T3 Ratio 4.860 

Thyroglobulin Antbodies (TgAb) 14.5 IU/mL (≤ 115)

Thyroid Peroxidase Antibodies (TPO) 9 IU/mL (≤ 34)

Folate - Serum 12.4 ug/L (8.83 - 60.8) 6.9%

Vitamin D 94.3 nmol/L (50 - 250) 22.1%

Active B12 86.1 pmol/L (37.5 - 188) 32.3%

Ferritin 187 ug/L (30 - 150) 130.8%

C-Reactive Protein (CRP) 0.643 mg/L (≤ 3)

HbA1c 33 mMol/Mol (20 - 48) 46.4%

Creatinine 60.8 umol/L (55 - 100) 12.9%

Estimated glomerular filtration rate 90.0 ml/min/1.73m2  (> 90.0)

Cholesterol profile:

Cholesterol  6.05 mmol/L  (< 5.0)

Triglycerides  1.2 mmol/L  (2.3)

HDL cholesterol  1.89 mmol/L  (0.9 - 1.7)

Non-HDL Cholesterol  4.16 mmol/L  (< 4.0)

LDL cholesterol  3.614545455 mmol/L  (< 3.0)

Total Cholesterol/HDL Ratio  3.201058201  (< 6.0)

Triglyceride/HDL ratio  0.634920635  ( 2.62)

Liver profile:

Total protein  65.9 g/L  (60.0 - 80.0)

Albumin  47.9 g/L  (35.0 - 50.0)

Globulin  18.0 g/L  (19.0 - 35.0)

Alkaline phosphatase  62.3 U/L   (30.0 - 130.0)

Alanine transferase  23.5 U/L  (< 34.0)

Gamma-GT  18.1 U/L  (< 38.0)

Bilirubin  7.58 umol/L  (< 22.0)

[SovietSong]

I think the body weight/levo ratio is usually rounded up to the nearest 25 which would see you on 100 daily.I have all the same symptoms when I need increase brain fog, muscle weakness, joint pain especially in hands, fatigue.Do you also suffer constipation? as it seems a common symptom. If it was me I would print these results and take them with me to your appointment and demand an increase.

[Myalikki in reply to SovietSong]

Thank you, and yes, I have all the usual hypo stuff going on but the fatigue and aches and brain being foggy impact me most I feel, at least currently, but that might be because this week has been particularly hard work.I'd be happy to increase to 100mcg as I feel I've been lucky taking levo. Brand doesn't seem make much difference to me (of the ones I've had so far) and while I'm not feeling well, I couldn't say I had particular side effects from levo, just continued feeling not well.

[Jaydee1507 Administrator]

So with a TSH of above 2 and still low FT4/FT3 then you are ready for your next increase.

Your conversion isn't great but there's more time and dose increases and getting vitamins right for longer to allow for.

Having 1 copy of DIO2 isn't good as you say and yes will be a nuisance to possibly add T3 but its doable. Hold fire a little longer and see how things go.

Folate and B12 aren't great despite your 400mcg folate supplement do do add the Pink Tribe B complex and see where that takes you.

Vit D & ferritin are good.

[Myalikki in reply to Jaydee1507]

Thank you! Definitely angling for levo increase rather than endo/t3 right now. Do you think just ask for 100mcg regardless of weight guidelines rather than splitting tablets or having some complicated different doses different days of week regime?

With the pink tribe b12 supplement, as I have NHS blood test on 28th should I take it for a few days then stop for the test or just wait until after?

Sorry for such specific questioning, but I really do appreciate the guidance!

[Jaydee1507 Administrator in reply to Myalikki]

Your FT4 is only 36% of its range so a 25mcg increase likely wouldn't be too much at this point but its possible in time you may need an alternating dose or if you wanted to/needed to go more slowly.

I don't know what your dose by weight would be, but do bare in mind that that that number is an estimate and some people need less and some slightly more than the calculation estimates.

Probably best to start the B complex after your NHS bloods.

[Myalikki in reply to Jaydee1507]

Thank you, I will tell my gp I'm still struggling and hope he let's me increase to 100mcg. And start the b12 after the test.Thank you for giving your time to advise! Reading on the forum generally is so helpful but it's really reassuring to have confirmation for myself before going into the gp review

[tattybogle]

if GP reluctant to increase , show them these references and ask for a 'trial increase', based on their recommendations .. All of them suggest GP's keep TSH between 0.4 / 0.5 and 2/2.5 in all patients on Levo. ..... so increasing your dose (if needed based on symptoms) is considered perfectly safe as long as TSH remains above 0.4/0.5 ish... and they can't know what effect an increase will have in your TSH unless thy try it.

Some are taken from GP's 'update' sources , one was written specifically for gp's by Specialist Registrar's in Endocrinology , and Cardiology .. so there should be no argument about their validity .

healthunlocked.com/thyroidu.... /my-list-of-references-recommending-gps-keep-tsh-lower-in-range-

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Explanation of why getting TSH 'somewhere in range' is not good enough, and dose need to be optimised for the individual ~ the shoe size analogy:

healthunlocked.com/thyroidu... the-shoe-size-analogy.

[Myalikki]

Thank you, tatty! I have your posts all bookmarked for future hat tricks, as needed. Thank you for spending your energy pulling them all together