I have been on Levothyroxine now for about 6 weeks. My results are as follows: I got tested at 8.50 am and hadn't taken any medication from the morning before at 6am. I ate nothing before test. I felt good for a few days but feel as bad as ever again - just low mood and tired and no energy. I was someone who was always full of energy and just seem to drop down to the point now where life is not enjoyable anymore. The doctor thinks I am depressed. I have been blaming my thyroid as it has been borderline since 2012 but all they ever did was re-test until recently when I just got so tired I rang again and because my antibodies were more than 500 they referred me to Endo who didn't see me but just told them to put me on 50 mg of Levo - brand name Mercury Pharma.
These are the tests from last week
TSH - 2.36 (0.27 - 4.2)
T4 - 21.5 (12-22)
They won't test T3
Cholesterol 5.9 - they want to put me on a low fat diet. I am 8 stone 9 and 5 feet 4, I can't loose any more weight.
Old tests from February that I asked for in paper format are the following - what do you think - do I need any supplements.
Serum B12 - 522 (191-663)
Serum Folate 8 (3.9 - 26.8)
Serum Iron - 20 (13-30)
Serum Ferritin 184 (13-300)
Serum Transferrin 1.8 (1.8 - 3.8)
Transferrin Saturation Index - 44 (20 - 45)
These tests don't mean anything to me - can you advise is anything not at optimal level and if there is how can I help. I take 5000 international units of Vitamin D and K2 and take Flaxseed Oil for dry eyes and have started 20 mg of B12 in liquid form (it has Ashagawanda in it) again. I had been taking it a good while back but not before test.
I can't afford to get any other tests done privately and they won't test Vitamin D - said that the laboratory have to have a really good reason to test and by the sounds of it my reason is not good enough.
Just really want to know are these tests ok - is there anything I can do or take to help me get back to normal. Or does normal ever happen again!
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Sunflower535
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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
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
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
I have been on Levothyroxine now for about 6 weeks. ...... I felt good for a few days but feel as bad as ever again
This is typical. When starting Levo it switches off your body's production of it's own thyroxine, so it's job is to replace what you are no longer making yourself and add enough extra that you need to make you "euthyroid". This all takes time, it can be months before you reach the right dose to make you feel well, this is why retesting should be done every 6-8 weeks after starting Levo or an increase, this will check your levels and show if you need more. This process unfortunately can't be rushed, we have to build up gradually with hormones.
So your new TSH of 2.36 (0.27 - 4.2) is telling us that you need an increase. The aim of a treated hypo patient on Levo only, generally, is for TSH to be 1 or below if that is where you feel well.
Your FT4 of 21.5 (12-22) doesn't suggest undermedication BUT you have Hashi's and this can make things difficult sometimes and give unexpected results.
Not testing T3 is typical but misses out a very important part of understanding our thyroid status. T3 is the active hormone that every cell in our bodies need and is therefore the most important result. If FT3 is over range then we are over medicated.
For now, because you have only just been diagnosed and are on a starter dose, you really need to have a 25mcg increase and retest in 6-8 weeks. If they wont do the full panel - TSH, FT4 and FT3, then it would be worth you doing a private test and I'd suggest using Monitor My Health which is an NHS lab which offers this test to the general public to do at home. As it's an NHS lab then it's difficult for doctors to dismiss the results but it's valuable for you to have the full picture.
Serum B12 - 522 (191-663)
I'm guessing the unit of measurement is pmol/L but can you confirm? The other units of measurement are ng/L or pg/ml (which are both the same) and their upper limit of range goes up to around 900.
If this is pmol/L then this is a good result and you don't need to take a separate B12 supplement. Even if it is ng/L or pg/ml it's not low enough to need a separate B12 supplement but a B Complex would help improve the level.
Serum Folate 8 (3.9 - 26.8)
This is low, it's recommended that folate is at least half way through it's range which would be at least 15-16 with that range. A good quality B Complex will help raise your level. Popular brands here to consider are
Thorne Basic B (sometimes hard to find and can be expensive)
Vitablossom Liposomal B Complex (from hempoutlet.co.ut)
Yipmai Liposomal B Complex (same as Vitablossom but from Amazon)
Serum iron: 55 to 70% of the range, higher end for men - yours is 41.18% so a little bit low.
Saturation: optimal is 35 to 45%, higher end for men - yours is 44% so at the high end.
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 - yours is at the bottom of the range so doesn't show the need for supplementing.
Ferritin: Some say the recommended level is half way through range and yours is 59.58% through it's range. Some experts say the optimal ferritin level for thyroid function is 90-110ug/L.
Ferritin can be false raised when inflammation is present so it's always a good idea to test CRP (an inflammation marker) when testing ferritin to know whether the result is a true level.
With your current iron panel it doesn't show any real need too supplement.
I take 5000 international units of Vitamin D and K2 .... I can't afford to get any other tests done privately and they won't test Vitamin D
Vit D is one of the tests that's important to keep a regular check on, this is because excess can't be excreted as it's a fat soluble vitamin, excess is stored and can lead to toxicity. Ideally Vit D would be tested 3 months after starting to supplement and once the recommended level of 100-150nmol/L is reached then check twice yearly to see if seasonal adjustment to dose is needed (many people make a good amount of Vit D naturally from the sun during the summer months).
5,000iu is a fairly high dose, needed if your level is very low or deficient, but not often needed as a maintenance dose. If you can manage to budget for a test then the NHS lab here offers a dried blood spot test to the general public for £32:
I would urge you to check your Vit D level as soon as you can then you will be able to work out what dose you need by checking out a recent post of mine which links to the Vit D Council website:
As well as Vit K2-MK7 being an important cofactor of D3, so is magnesium as this helps the body convert D3 into it's usable form, so you should be considering adding magnesium to your supplement regime.
There are many types of magnesium so we have to check to see which one is most suitable for our own needs:
the printout from the doctor says B12 522 ng/L - does that help Seaside Susie. Also they don't want to see me for 3 months - as they say my readings are normal
According to an extract from the book, "Could it be B12?" by Sally M. Pacholok:
"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml or ng/L because deficiencies begin to appear in the cerebrospinal fluid below 550".
"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml or ng/L".
So no need for the separate B12, the B Complex should be enough to improve both your B12 and your folate levels.
Also they don't want to see me for 3 months - as they say my readings are normal
Of course, they will say everything is normal because your results fall within range but that's not the same as optimal or where you need them to be well. This is where we have to take the information gained from ThyroidUK and advocate for ourselves.
Supplements for low nutrients you'll have to buy yourself because you don't have any deficiencies which they are obliged to treat, you just have low levels.
Here is a post about TSH being kept low in range, take what you need from it, print it out and give links, discuss with your GP and push for an increase in Levo:
If GP refuses due to FT4 result then ask for FT3 to be tested quoting what Dr Toft has to say (information in the post linked to).
If you have any symptoms then list them and emphasise them, telling your GP that they are affecting your every day life, that you are still on a small starter dose of Levo, and that Hashimoto's makes hormone levels fluctuate which is why your FT4 may seem high in relation to your TSH.
Okay - so I will get myself a good B Complex and start it. I will read all this info this evening when I get a minute. Thank you so much. This is so much appreciated. I will look into private testing of T3 at some point soon.
As you have Hashimoto’s you should have coeliac blood test via GP BEFORE trialing strictly gluten free 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
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
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
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
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