Hi,
I have been diagnosed with hashimotos since 2017, just looking at my latest blood test results and wondering what to do supplement wise for Vit D, Folate and B12, as I'm feeling really really tired again, let me know what you think
Thanks
B12 55.1 pmol/L
Vit D 69.7 nmol/L
Folate 8.3 nmol/L
Haemaglobin 114 g/L
Red blood cells 3.86
Ferretin, 55 ng/ml
Haematocrit 0.349
TSH was .58 15/6/23 now 1.19 26/7/23
Free T3 404
Free T4 16.8
I'm on 50mg levothyroxine
welcome to the forum
Please add ranges on Ft4 and Ft3, B12, folate, vitamin D and ferritin results
Was test done early morning and last dose levothyroxine 24 hours before test
50mcg is only the standard STARTER dose
Make an appointment with GP and request 25mcg dose increase to 75mcg daily
Bloods should be retested 6-8 weeks later
Likely to need further increases over coming months
Which brand of levothyroxine are you currently taking
What vitamin supplements are you currently taking
Test done early morning and fasting, no Levo for 24+ hours
T3 Range 3.1 - 6.8 T4 Range 12-22, B12 Range 37.5-188
Vit D Range 50-250, Folate Range 8.83-60.8, Ferretin Range 30-150
Current levo is MA Holder Teva UK, but it does seem to vary
Currently not on any supplements for 6 weeks or so
Thanks for your help
Nic67
B12 55.1 pmol/L (37.5-188)
This is low. For Active B12 we suggest 100 plus, and below 70 it's suggested to test for B12 deficiency according to Viapath at St Thomas' Hospital:
viapath.co.uk/our-tests/act...
Reference range:>70. *Between 25-70 referred for MMA
There is a link at the bottom of the page to print off the pdf to show your GP to support your request for further testing.
Do you have any signs of B12 deficiency – check here:
b12deficiency.info/signs-an...
b12d.org/submit/document?id=46
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.
Folate 8.3 nmol/L (8.83-60.8)
As you can see this is below range and should be discussed with your GP. Folate and B12 work together. Your GP might prescribe a course of folic acid, come back and let us know what he says, but whatever is suggested further testing of B12 needs to be done before starting anything for your folate level as mentioned above.
Vit D 69.7 nmol/L
You might want to check out a recent post that I wrote about Vit D and supplementing:
healthunlocked.com/thyroidu...
and you can check out the link to how to work out the dose you need to increase your current level to the recommended level.
Your current level of 69.7nmol/L = 34.85ng/ml
On the Vit D Council's website
web.archive.org/web/2019070...
You will see that they suggest supplementing with 2,500iu to achieve their recommended level. 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).
My preference is for Doctor's Best D3 oil based softgels.
Retest after 3 months to check levels and adjust if necessary.
When taking D3 there are important cofactors - magnesium (which helps the body convert D3 into it's usable form) and Vit K2-MK7 which directs the extra uptake of calcium aided by D3 to bones and teeth where it's needed and away from soft tissues and arteries where it can be deposited and cause problems.
For Vit K2-MK7 my preferences are (depending what's available):
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.
There are many types of magnesium so we have to check to see which one is most suitable for our own needs:
naturalnews.com/046401_magn...
explore.globalhealing.com/t...
and ignore the fact that this is a supplement company, the information is relevant:
swansonvitamins.com/blog/ar...
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.
Currently not on any supplements for 6 weeks or so
What supplements do you normally take and why have you stopped taking them?
Haemaglobin 114 g/L
You haven't given a range for this but it looks low, my GP range is 115-165, this could suggest anaemia which could be the source of your fatigue.
Ferretin, 55 ng/ml (30-150)
This is low. Some experts say the optimal ferritin level for thyroid function is 90-110ug/L. However, don't consider taking an iron supplement unless you do an iron panel, if you already have a decent level of serum iron and a good saturation percentage then taking iron tablets can push your iron level even higher, too much iron is as bad as too little.
You can help raise your level by eating liver regularly, maximum 200g per week due to it's high Vit A content, also liver pate, black pudding, and including lots of iron rich foods in your diet
bda.uk.com/resource/iron-ri...
everydayhealth.com/pictures...
Red blood cells 3.86
Haematocrit 0.349
You haven't given ranges for the above two tests so the results can't be interpreted.
TSH was .58 15/6/23 now 1.19 26/7/23
So TSH has risen.
Free T3 404 (3.1-6.8)
Presumably you mean the result is 4.04 which would make that 25.41% through range.
Free T4 16.8 (12-22) - 48% through range. However, you say your last dose of Levo was 24+ hours before test. Exactly when was it taken. It should be 24 hours, longer can cause a false low FT4 result.
Your thyroid results show undermedication and you could ask your GP for an increase in your Levo to 75mcg and retest in 6-8 weeks. Also work on optimising nutrient levels. Your tiredness could be a combination of everything thyroid and nutrient wise.
Thanks for all your help.
I stopped taking the supplements as I had my tonsils out and couldn't swallow them for a few weeks and never went back as I wasn't really sure that I was taking the right things so wanted blood tests done when they weren't in my sytem so I had a true baseline to work with
The ranges for Haematocrit are .36-.44, mine was .33
Red Blood Count range 4 - 5.5, mine 3.8
Nic67
OK, so you now know what you need to do regarding nutrients.
As for Haematocrit and RBC, those ranges show that they are low so again suggest anaemia if the haemoglobin is also low.
FT4: 16 pmol/l (Range 12 - 22)
Ft4 is only 40.00% through range
FT3: 4.04 pmol/l (Range 3.1 - 6.8)
Ft3 only 25.41% through range
So not on high enough dose levothyroxine and currently poor conversion rate
Next step
Improving all four vitamins to optimal as well as dose increase
Ft4 (levothyroxine) should be at least 60-70% through range
request/ politely insist on next dose increase to 75mcg
Retest in another 8 weeks
Approximately how much do you weigh in kilo
pathlabs.rlbuht.nhs.uk/tft_...
Guiding Treatment with Thyroxine:
In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months.
The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).
The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range.
……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.
The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.
Many Thanks for all your help and guidance, I will book a GP appointment and get them to look for PA and increase my levo as a start before introducing supplements, I'll let you know how I get on.
Hi, just an update on what has happened and how I'm feeling. The GP finally put up my thyroxin to 75mg 5 weeks ago and I then added in the supplements about 3 weeks ago. I won't have any more blood test results for another 8 weeks or so.
I have seen a lot of improvement in my daily energy levels, however I am still falling asleep (feels almost like I pass out, I am not able to force myself to stay awake) by 9pm in the evening and wondered if you had any thoughts on this.
Many Thanks
Unless extremely petite, you are likely to need further increase (s) in levothyroxine over coming months
approximately how much do you weigh in kilo
90kg
See my reply above from 3 months ago re dose and weight
90kg x 1.6mcg per kilo = 144mcg levo as possible daily dose you might eventually need
However …..if you base it on BMI of 24 …..it would be less
How tall are you?
BMI calculator here
nhs.uk/live-well/healthy-we...
Added information on dose by weight/BMI
healthunlocked.com/thyroidu...
See reply by roukounasGK
Just a quick note: i have read somewhere that the initial dosing per weight is not for your current weight. It is for the weight you would have for a BMI 23-24. So even if overweight, the initial dosing is roughly the same. So if for example you have a height of 175 cm, the target weight based on a bmi of 23 should be 72 kg. And the dosing should be 1.6x72=116 mcg. Which is much more logical as an initial dose than the very large numbers resulting from this function using our actual weight.
BMI 31, I'm 170cm
So BMI of 24 for your height and age = 70kg
70kg x 1.6mcg = 112mcg
Be interesting wether that’s enough Levo
I guess I need to wait and see what the next TSH reading is before I can convince them to up it! Do you think that's probably why I'm falling asleep?
Vitamin levels
Vitamin D aiming for at least 80nmol minimum
B12 at least over 70 minimum
Folate near 60
Ferritin at least over 70
Only add one supplement at a time and wait to assess before adding another
B12 first, then vitamin B complex, then vitamin D
Meanwhile working on improving low ferritin by increasing iron rich foods in your diet
Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels
Low vitamin levels affect Thyroid hormone working
Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common.
A trial of strictly gluten free diet is always worth doing
Only 5% of Hashimoto’s patients test positive for coeliac but a further 81% of Hashimoto’s patients who try gluten free diet find noticeable or significant improvement or find it’s essential
A strictly gluten free diet helps or is essential due to gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)
Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and may slowly lower TPO antibodies
While still eating high gluten diet ask GP for coeliac blood test first or buy test online for under £20, just to rule it out first
Assuming test is negative you can immediately go on strictly gluten free diet
(If test is positive you will need to remain on high gluten diet until endoscopy, maximum 6 weeks wait officially)
Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse
chriskresser.com/the-gluten...
amymyersmd.com/2018/04/3-re...
thyroidpharmacist.com/artic...
drknews.com/changing-your-d...
Non Coeliac Gluten sensitivity (NCGS) and autoimmune disease
pubmed.ncbi.nlm.nih.gov/296...
The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported
nuclmed.gr/wp/wp-content/up...
In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned
restartmed.com/hashimotos-g...
Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.
Similarly few months later consider trying dairy free too. Approx 50-60% find dairy free beneficial
Hashimoto’s and leaky gut often occur together
Low B12 symptoms
b12deficiency.info/signs-an...
methyl-life.com/blogs/defic...
With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a separate B12 supplement and add a separate vitamin B Complex after a week
Then once your serum B12 is over 500 (or Active B12 level has reached 70), you may be able to reduce then stop the B12 and just carry on with the B Complex.
If Vegetarian or vegan likely to need ongoing separate B12 few times a week
B12 drops
natureprovides.com/products...
Or
B12 sublingual lozenges
uk.iherb.com/pr/jarrow-form...
cytoplan.co.uk/shop-by-prod...
B12 range in U.K. is too wide
Interesting that in this research B12 below 400 is considered inadequate
healthunlocked.com/thyroidu...
Low folate
supplementing a good quality daily vitamin B complex, one with folate in (not folic acid)
This can help keep all B vitamins in balance and will help improve B12 levels too
Difference between folate and folic acid
healthline.com/nutrition/fo...
Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid.
thyroidpharmacist.com/artic...
B vitamins best taken after breakfast
Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule)
Thorne currently difficult to find at reasonable price, should be around £20-£25. iherb.com often have in stock. Or try ebay
Other options
healthunlocked.com/thyroidu....
IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results
endo.confex.com/endo/2016en...
endocrinenews.endocrine.org...
In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate folate supplement (eg Jarrow methyl folate 400mcg) and continue separate B12
Post discussing how biotin can affect test results
Why am I still feeling tired after taking Levo
Further bloods and advice on supplements 
Can any one help with my results? Plus am unsure if I am posting in the right place?
