thyroid labs update for FET cycle

[Melody79]

Hello, I know i've posted before but this is an update on labs now that i feel i'm doing much better, less lethargic and now on 100mcg levo per day.

Labs were done in the morning and didn't take meds before.

My main concern was the T3 but the endo suggested that this was ok for my age and based on the TSH/T4?

TSH (0.35-5.5 mU/L) 0.39

T4 (10.5-21.0 pmol/L) 16.6

Free T3 (3.5-6.5 pmol/L) 3.5

Folate 21.24

B12 (211-911 ng/L) 722

250H Vitamin D total 50.6 (didn't show ref range)

IRON

%saturation (16-50%) 19

CRP (0-9mg/L <4

Ferritin (10-291 ug/L) 29.2 - this seems to stay the same every month

Serum iron (9-30.4 umol/L) 13.1

Transferrin (2.5-3.8 g/L) 3.04

I take levo each morning before food. Folate and Vit D during the day (lunchtime). B12 is in the multivit I started, which is a liquid B complex called pink tribe. Only been taking few weeks so far.

Vit D, I admit i forget as i've been using better for you spray (red bottle).

I take Ferrous tablet 4 times a week to help the iron levels. The iron side of things baffle me, i know in the past i've been provided with many links that I have taken time to read but it's quite overwhelming for me.

I am under care of a fertility clinic and just about to proceed with a new cycle.

[SeasideSusie Remembering]

Melody79

My main concern was the T3 but the endo suggested that this was ok for my age and based on the TSH/T4?

What a load of tosh! We all need T3 regardless of our age, it's the life giving hormone that every cell in our bodies need so whatever our age we need our bodies to convert T4 into T3.

Looking at percentages through range:

T4 (10.5-21.0 pmol/L) 16.6 = 58.53% through range

Free T3 (3.5-6.5 pmol/L) 3.5 = 0% through range

These should be fairly well balanced.

Folate 21.24 - seems OK but what's the range?

B12 is OK.

Vitamin D total 50.6 (didn't show ref range) - this will be nmol/L, don't need range

Vit D, I admit i forget as i've been using better for you spray (red bottle).

Recommended level is 100-150nmol/L so best to try and remember to take it daily.

You can check how much you need daily by visiting the Vit D Council website which shows how much you need (link below). You need your result in ng/ml so you have to divide 50.6 by 2.5 to get that and it works out at 20.24ng/ml. The Vit D Council recommend that to reach the recommended level of 50ng/ml (125nmol/L) you need 3,700iu per day but I'd go for 4,000iu as you'll be able to do that with your spray.

vitamindcouncil.org/i-teste...

Your iron panel is poor despite taking iron tablets. Maybe increase the dose. Optimal iron panel levels according to rt3-adrenals.org/Iron_test_... are:

Serum iron: 55 to 70% of the range, higher end for men

Saturation: optimal is 35 to 45%, higher end for men

Total Iron Binding Capacity (TIBC) or Transferrin: Low in range indicates lack of capacity for additional iron, High in range indicates body's need for supplemental iron

Ferritin - some experts say the optimal level for thyroid function is 90-110ug/L.

[Melody79 in reply to SeasideSusie]

Hi, Thank you. Its the % range for Thyroid i can never work out. OK - So I have some T3 medication but don't take due to this endo, however, now i'm so confused as she keeps saying its ok. TBH the last T3 was 3.8. Should I be adding the T3 then?

for the folate the labs show range >4.12 and that's all.

Yes, I know my bad for the Vit D - she did say this was low, so must remember. Thank you, i'll do this.

So for the Iron then yes, i'm super low..so i'll increase my does of the ferrous tablet..

Aside from this, i am feeling much better on this does..considering my GP was keeping me on 75mcg and never changing it..with a TSH between 2.0-3.0 each time..not checking anything else!

thank you for the input x

[SeasideSusie Remembering in reply to Melody79]

Melody79

Its the % range for Thyroid i can never work out. OK

You can use any of the thyroid calculators, it doesn't matter what the test is as long as your have a result and a range with a lower number and upper number. I use this calculator for everything, popping the result/range into the TSH line usually:

thyroid.dopiaza.org/

i'm so confused as she keeps saying its ok. TBH the last T3 was 3.8. Should I be adding the T3 then?

In my opinion, and probably the opinion of most responders here, then yes adding T3 is the way to go but ideally you would optimise all your key nutrients first. Good ferritin level is needed for good conversion.

for the folate the labs show range >4.12 and that's all.

Your level is fine then, we tend to say if the range is shown as yours is then aim for high teens/twenty.

[Melody79 in reply to SeasideSusie]

Good ferritin level is needed for good conversion. ok thank you, i'll get this in check. I have another appt/blood test in around 6 weeks so will up the ferrous now and the Vit D.

Thank you for the quick reply

[SlowDragon Administrator]

Your Ft4 is only 58% through range

Request 25mcg increase in dose on alternate days

Or 12.5mcg daily

Your low ferritin is still an issue

Are you vegetarian or vegan or heavy periods

Look at increasing iron rich foods

Pregnancy guidelines 

thyroiduk.org/having-a-baby-2/

gp-update.co.uk/files/docs/...

See pages 7&8 re increasing dose levothyroxine as soon as conception confirmed

btf-thyroid.org/Handlers/Do...

Also here - dose increase in levothyroxine as soon as pregnancy test confirms conception 

cuh.nhs.uk/patient-informat...

thyroidpharmacist.com/artic...

Low ferritin and increased risk of miscarriage 

preventmiscarriage.com/iron...

Low iron and hypothyroid 

endocrineweb.com/news/thyro...

Folate and B12 and Neural tube defects and autism 

healthunlocked.com/thyroidu...

[Melody79 in reply to SlowDragon]

thank you - ok, i can take the extra, was just concerned my TSH would go too low? My T4 on previous labs were:

TSH 0.72 and T4 19.6 (so close to top of range) T3 3.6

No am not veg or vegan, periods are all ok. I try to up intake through foods but absorption isn't great (another issue is irregular bowels movements).

thank you for the links

[SlowDragon Administrator in reply to Melody79]

ferritin is low because FT3 is low

FT3 is low because vitamin levels are low, especially ferritin

But you also have room to increase dose Levothyroxine a little

[Melody79 in reply to SlowDragon]

will the dose increase alternative days not increase my t4 / reduce TSH (too low)?

So in turn these will help the T3 (along with optimal ferritin/other vit levels)?

would requesting/taking T3 medication help at all? I've read not to take when pregnant?

[SlowDragon Administrator in reply to Melody79]

will the dose increase alternative days not increase my t4 / reduce TSH (too low)?

No you have plenty of room to increase dose levothyroxine Ft4 only 58% through range

TSH is low because ferritin is terrible

T3 would almost always suppress TSH.

Far far more important to get vitamin levels OPTIMAL and dose levothyroxine increased

[Melody79 in reply to SlowDragon]

ok so best to address vitamins OPTIMAL before adding any T3. My T4 has been higher on my last labs.

vitamin D was 81.1 nmol/l in Aug 22

Ferritin seems to maintain between 24.5 - 29.2 ug/l - on taking ferrous tablets 4 x a week

tsh

[Melody79 in reply to Melody79]

t3

t3

[SlowDragon Administrator in reply to Melody79]

looking for optimal vitamin levels

Ferritin at least over 70 and nearer 100 maybe better

Vitamin D around 100nmol

B12 over 500

Folate towards top of range

[SlowDragon Administrator in reply to Melody79]

with such dire ferritin that’s never going to improve on such low dose ferrous fumerate

Suggest you try Three Arrows or iron patch

[Melody79 in reply to SlowDragon]

no problems with my B12 and folate seems ok to.

I have tried so many Vitamin D..better for you spray seems most convenient, tried drops in water also

why oh why does the dr think my levels aren't too bad..she did say to up does to 4 x a day (also this might be cos I suffer constipation). Also said don't want it going too high (range is 10 - 291) so pretty big range but said too high would be bad.

Makes sense tho as I feel tired again at times and hair loss still present.

Thank you - i'll check these out x

[Melody79 in reply to SlowDragon]

three arrows looks like USA product and can't get here in the UK

[SlowDragon Administrator in reply to Melody79]

Loads of members here in U.K. get Three arrows

[Melody79 in reply to SlowDragon]

what about taking desiccated liver supplement?

[SlowDragon Administrator in reply to Melody79]

Have you retested iron and ferritin yet

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...

Iron patches

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...

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. ‘

[Melody79 in reply to SlowDragon]

thank you for these - lots of reading I haven't had them done again so last test was 14/06/23 (also had full panel done) very hard in UK with my GP/Endo to push for anything (I pay private for Endo).