Hi Grey-Sky, I see this is your first post, welcome!
There can be a few reasons why your TSH is different, ie time of day test was done (TSH has a circadian rhythm and is highest early morning and lowers throughout the day, so it's important to always do the test at the same time to be able to compare); certain food/drink can affect TSH so we should have nothing but water before a test; taking any supplement containing biotin (eg B Complex) can give false results for any blood test so should be left off for a few days before the test.
This is the advice we give members when having thyroid tests:
* Book the first appointment of the morning, or with private tests at home no later than 9am. This is because TSH is highest early morning and lowers throughout the day.
In fact, 9am is the perfect time, see first graph here, it shows TSH is highest around midnight - 4am (when we can't get a blood draw), then lowers, next high is at 9am then lowers before it starts it's climb again about 9pm:
If we are looking for a diagnosis of hypothyroidism, or looking for an increase in dose or to avoid a reduction then we need TSH to be as high as possible.
* Nothing to eat or drink except water before the test - have your evening meal/supper as normal the night before but delay breakfast on the day of the test and drink water only until after the blood draw. Certain foods may lower TSH, caffeine containing drinks affect TSH.
* If taking thyroid hormone replacement, last dose of Levo should be 24 hours before blood draw, if taking NDT or T3 then last dose should be 8-12 hours before blood draw. Adjust timing the day before if necessary. This avoids measuring hormone levels at their peak after ingestion of hormone replacement. Take your thyroid meds after the blood draw. Taking your dose too close to the blood draw will give false high results, leaving any longer gap will give false low results.
* If you take Biotin or a B Complex containing Biotin (B7), leave this off for 7 days before any blood test. This is because if Biotin is used in the testing procedure it can give false results (most labs use biotin).
These are patient to patient tips which we don't discuss with doctors or phlebotomists.
Do you currently take thyroid meds, if so what and the dose?
Do you take any supplements?
Folate - Serum 10.6 nmol/L (Range: 8.83 - 60.8)
This is low, folate is recommended to be at least half way through range. A good quality bioavailable B Complex is suggested along with a separate folate supplement. The folate supplement is likely to be temporary until your folate level reaches nearer half way through range then it can be stopped and just carry on with the B Complex. However, do not take anything for now, SEE BELOW and sort out B12 first.
Vitamin B12 - Active 40.7 pmol/L
This is very low. Active B12 below 70 suggests testing for B12 deficiency according to Viapath at St Thomas' Hospital:
If you do then list them to discuss with your GP and ask for testing for B12 deficiency and Pernicious Anaemia. Do not take any B12 supplements or folic acid/folate/B Complex supplements before further testing of B12 as this will mask signs of B12 deficiency and skew results and if you have B12 deficiency and it is not detected and treated then this could affect your nervous system. B12 deficiency should be treated before starting folic acid because folic acid can sometimes improve your symptoms so much that is masks B12 deficiency.
The Vit D Council, the Vit D Society and Grassroots Health all recommend a level of 100-150nmol/L (40-60ng/ml), with a recent blog post on Grassroots Health mentioning a study which recommends over 125nmol/L (50ng/ml).
So now you look at how much is needed to reach 50ng/ml and you'll see that they suggest 3,700iu per day. 4,000iu is the nearest you can buy but it may be cheaper to buy 5,000iu and take 6 days a week rather than 7.
Retest after 3 months.
Once you've reached the recommended level then a maintenance dose will be needed to keep it there, which may be 2000iu daily, maybe more or less, maybe less in summer than winter, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. This can be done with a private fingerprick blood spot test with an NHS lab which offers this test to the general public:
Doctors don't know, because they're not taught much about nutrients, but there are important cofactors needed when taking D3. You will have to buy these yourself.
D3 aids absorption of calcium from food and Vit K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems such as hardening of the arteries, kidney stones, etc. 90-100mcg K2-MK7 is enough for up to 10,000iu D3.
D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds if taking D3 as tablets/capsules/softgels, no necessity if using an oral spray.
For D3 I like Doctor's Best D3 softgels, they are an oil based very small softgel which contains just two ingredients - D3 and extra virgin olive oil, a good quality, nice clean supplement which is budget friendly. Some people like BetterYou oral spray but this contains a lot of excipients and works out more expensive.
For Vit K2-MK7 my suggestions are Vitabay, Vegavero or Vitamaze brands which all contain the correct form of K2-MK7 - the "All Trans" form rather than the "Cis" form. The All Trans form is the bioactive form, a bit like methylfolate is the bioactive form of folic acid.
Vitabay and Vegavero are either tablets or capsules.
Vitabay does do an oil based liquid.
Vitamaze is an oil based liquid.
With the oil based liquids the are xx amount of K2-MK7 per drop so you just take the appropriate amount of drops.
They are all imported German brands, you can find them on Amazon although they do go out of stock from time to time. I get what I can when I need to restock. If the tablet or capsule form is only in 200mcg dose at the time I take those on alternate days.
Another "all trans" one worth considering if the others aren't availaable:
Magnesium should be taken 4 hours away from thyroid meds and as it tends to be calming it's best taken in the evening. Vit D should also be taken 4 hours away from thyroid meds. Vit K2-MK7 should be taken 2 hours away from thyroid meds. Don't take D3 and K2 at the same time unless both are oil based supplements, they both are fat soluble vitamins which require their own fat to be absorbed otherwise they will compete for the fat.
Don't start all supplements at once. Start with one, give it a week or two and if no adverse reaction then add the next one. Again, wait a week or two and if no adverse reaction add the next one. Continue like this. If you do have any adverse reaction then you will know what caused it.
Thyroid antibodies are low so don't suggest autoimmune thyroid disease (Hashimoto's).
It's difficult to comment on your TSH, FT4 and FT3 until you've clarified what thyroid meds you take and whether you followed our testing protocol I mentioned above.
Firstly, thank you very much for the very detailed response which will take me some time to consider.
To respond to a couple of you questions. I've been diagnosed by my GP with Hypothyroid 10 weeks ago, for which I was prescribed an initial dose 75mg/day levothyroxine after an initial TSH test showing 5.6. A 6 week retest gave tsh of 1.7 and the more recent one given above at 1.1mu/l. (There is something of a story regarding how the thyroid test was ordered by the GP that I don't want to bore you with, but suffice to say that some prompting was needed).
Regarding the most recent tests in the OP, both were carried out without taking the levothyroxine that morning (over 24 hours since the last dose. In both cases around 2 pints of water were drunk before the tests (otherwise I generally don't provide enough blood for the test to be completed. The slight variation was that the medichecks (finger prick - 2.4mu/l) test was on a wednesday around 7am, and the GPs test (from the nurse taking the blood sample with a hypodermic needle - 1.1mu/l) was on a monday morning at 09:30 after a very active weekend and I had a veggie smoothie for breakfast (I was on autopilot and forgot to delay having breakfast). No supplements were taken before either test unless you consider a pint of guinness on saturday night a supplement?
With respect to the symtoms for the various vitamin deficiencies, I do exhibit a small number of the listed symptoms but I'm hesitant to draw any conclusion from this until I've had time to print out each list then look for common factors and list those symptoms which I percieve to be affecting me. Certainly the problems that I've been reporting to the GP for the last 8 years are a tick list for hypothyroid, however that certainly does not rule out that other factors are at play.
I'd also like to thank you for your advice on supplements which I will consider carefully alongside the other advice.
Tagging SeasideSusie for you just in case she didn't get an alert to your reply . (we somtimes have gremlins in the works)
So TSH is naturally higher at 7 am than it will be at 9.30 am .... and having some breakfast has also been shown to lower TSH a bit in some people .
So the 1.1 from GP is not a surprise. eg On the day you did the 7 am test , if you'd then had a smoothie and tested again at 9.30 am~ you might have got 1.1
You won't usually be able t get GP test any earlier than 8/ 9 am ish, so it's best to do any fingerprick test at that time too in future so results are properly comparable to GP ones .
Also the ref . ranges for TSH are made from 'day time' blood samples the NHS gets , which will usually be taken no earlier then 8/9 am anyway .. so technically , a 7 am result can't be interpreted correctly against the 'daytime sample' ref. ranges.
p.s time of last dose levo will only affect fT4 result , not TSH result .
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