Advice on recent Bloods please

[GratingCarrots]

I would really appreciate your advice on blood results please. I have been taking Levothyroxine for 10 years. When I read ElleMai's post I was tearful, that was me 10 years ago. Once medicated I certainly felt much better but not great. I've been frustrated for years at my low energy levels, crawling out of bed needing a couple of hours in the morning just to heave my heavy, aching body into action. (I'm not overweight). Thanks to this site, since taking my meds at night rather than the morning I feel much lighter on waking. My libido has all but gone and just an hour of dog walking leaves me sitting on the sofa for half an hour just to recoup my strength. I really want to improve my fitness but this is hard when you feel so drained , hard to find the motivation.

I am hoping that supplementing with vitamins will help . But I am looking for advice to be specific with supplementing and to choose the best products.

I am on no other medication, eat a healthy varied diet (mainly vegetarian and avoid processed foods). I tried gluten free for many months but I felt no improvement. I love my cheese so really don't want to go dairy free.

Female Age 58 years Medicated on 100mg levothyroxine daily

Blood Results 7th August 2023 Blue Horizon Medical. (Tested early Monday morning and last dose of levothyroxine 24 hours before the test).

Thanks, in advance

Biochemistry Results Range

TSH 0.57 0.27 - 4.20 mlU/L

Free T4 16.50 12 - 22 pmol/L

Free T3 4.00 3.1 - 6.8 pmol/L

Ferritin 127.00 13 - 150 ug/L

Serum Folate 11.60 3.89 - 26.80 ng/ml

Vitamin B12 542.00 197 - 771 pg/ml

Thyroid Peroxidase antibody 67.00 0 - 24 IU/mL

Selenium 1.16 0.75 - 1.46 umol/ L

Total Vitamin D 55.00 >50 sufficient ?

Magnesium 0.76 0.70 - 1.0 mmol/L

rT3 (by LS/MS/MS) 65.00 8 - 31 ng/dL

[SlowDragon Administrator]

welcome to the forum

FT4: 16.5 pmol/l (Range 12 - 22)

Ft4 only 45.00% through range

FT3: 4 pmol/l (Range 3.1 - 6.8)

Ft3 worse at just 24.32% through range

Results suggest you need dose increase in levothyroxine

Request trial increase to 112.5mcg daily

Which brand of levothyroxine are you currently taking

Do you always get same brand at each prescription

Vitamin levels

Vitamin D far too low

Likely to also benefit from daily vitamin B complex

Only add one vitamin at a time …..then wait 2 weeks to assess before adding another

[GratingCarrots in reply to SlowDragon]

Dear SlowDragon,

thank you for your speedy 3 replies- I am so relieved to read through your advice. When I read my results I thought my lethargy must all be in my head as all (except rT3 and TP antibody) were in range. As to your question which brand - Accord (100mg ). Over the past few months I have been experiencing a racing heart beat and feeling quite anxious (though my BP is fine). So I thought perhaps my dose was too high (especially as I've read as you get older your dose should be lowered to avoid osteoporosis or atrial fibrillation). I am 5ft2" and weigh approx. 58kg. I so hate going to the doctor as it is all guidelines and not how the patient is actually feeling. In 2018 I was referred to the endocrine clinic hoping to trial T3. Instead the consultant advised that I should lower my dose of levothyroxine and that as my T3 was at 4.8 I would not benefit from combination therapy. His exact words.."....in normal circumstances,95% of patients with an underactive thyroid that are on thyroxine replacement do feel well in themselves, but there are 5% group of patients that we do not really know why they still feel underactive despite an adequate thyroxine replacement". Suffice it to say, I ignored his advice and continued on 100mg daily!

I will follow your advice on supplements, increasing my tablets and testing. I will choose the private route (thanks to all the links on this site) - way too stressful to negotiate with the GP

Health Unlocked is an amazing site, providing hope and health advice to allow us in the 5% to feel well again. Thank you from the bottom of my heart.

[SlowDragon Administrator in reply to GratingCarrots]

Been quite a few post’s recently questioning wether some batches of Accord have been not up to strength recently

helvella might have more info on batch numbers

Ever tried different brands ?

[GratingCarrots in reply to SlowDragon]

I've been on Mercury Pharma and Teva. TBH I never paid much attention on the brand before coming to your site. So never thought to log how I felt with a brand change. Now I am better informed by your good selves. Thank you

[SlowDragon Administrator]

GP will often only prescribe to bring vitamin D levels to 50nmol.

Some areas will prescribe to bring levels to 75nmol or even 80nmol

leedsformulary.nhs.uk/docs/...

GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)

mm.wirral.nhs.uk/document_u...

But with Hashimoto’s, improving to around 100nmol by self supplementing may be better

pubmed.ncbi.nlm.nih.gov/218...

vitamindsociety.org/pdf/Vit...

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

Test twice yearly via NHS private testing service when supplementing

vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function.

There’s a version made that also contains vitamin K2 Mk7.

One spray = 1000iu

amazon.co.uk/BetterYou-Dlux...

It’s trial and error what dose we need, with thyroid issues we frequently need higher dose than average

Vitamin D and thyroid disease

grassrootshealth.net/blog/t...

Vitamin D may prevent Autoimmune disease

newscientist.com/article/23...

Web links about taking important cofactors - magnesium and Vit K2-MK7

Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Interesting article by Dr Malcolm Kendrick on magnesium

drmalcolmkendrick.org/categ...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

[SlowDragon Administrator]

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....

Igennus B complex popular option too. Nice small tablets. Most people only find they need one per day. But a few people find it’s not high enough dose

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

healthunlocked.com/thyroidu...

Retest thyroid and vitamin levels 2-3 months after getting dose increase in levothyroxine

[Doris11]

Gosh you sound like me 😞 fortunately I’m a retired nurse so don’t have to get up for work! 🙈 I don’t literally think I could actually drag myself to work 🙈

I’m taking Vitablossom B complex which seemed good at first but I think I’m having a flare up as I am overweight so definitely need a small increase!

I noticed I was getting sleepy in the day and my back started playing up again (it did settle) I’m a vegetarian to and do try and eating healthily 🙈 I have put on over a stone since being diagnosed….. good luck with your journey 🤩 btw I am the same age as you x

I will post my results later as ordering Medichecks

[GratingCarrots in reply to Doris11]

Dear Doris11, thank you for your response. I'm sorry to hear you are struggling too and that your vitamins are not working as they once did. I'm going to introduce vitamins one by one as advised by Slow Dragon - it is such a drag when you think you have a solution to well being only to find it stops working. Hopefully your blood results will help you adjust meds or vitamins so you can feel better. I have found that if I do a 3 day shake 800 calorie every now and then,it keeps my weight in check. I believe that as weight changes, one might need to reassess thyroxine dose.

I am fortunate that I'm not working so I can start the day easy. It is however frustrating to have low energy, it really does limit enjoyment of life. At only 58 I believe we should still have zest for life with energy to get up and go. I had resigned myself to a life of lethargy. However this site and the kindred spirits on this site have given me hope that life can be much,much better. Keep strong, small changes will reap rewards of a more fulfilling life.

[Doris11 in reply to GratingCarrots]

It does ruin your day! If I go out I come back exhausted 😩 My sleep is bad at the best of times! But this heat 🥵🥵🥵❤️

[Banaras]

rT3 (by LS/MS/MS) 65.00 8 - 31 ng/dL !???

If my RT3 was this high I would start taking some T3 and lower the T4. I am not a doctor, only talking from experience.

[radd in reply to Banaras]

Banaras,

Now so much more is known about how the deiodinases function it is old protocol to try reducing RT3 with T3. Today it is more about supplying the essential cofactors to thyroid hormones and healthy lifestyle to promote improved performance and clearance of RT3, eg improving enzyme D1 ramps up conversion but also detoxing RT3.

[Banaras in reply to radd]

You are talking about Iodine protocol I assume. I couldn't function without T3. I have no thyroid to improve, but iodine still seems to do some good.

[radd in reply to Banaras]

Banaras,

No, I am not talking about any iodine protocol. I am referring to the methods used to improve performance of thyroid hormones that reduces the amount of RT3 being converted whilst up regulating clearance of RT3 in the blood stream.

[GratingCarrots in reply to radd]

Thank you Radd for commenting on this thread, I think I will need to research rT3. It cost a lot to have it tested, yet I have no idea what it means 🤔🙄. If you can suggest any sites to research that would be brilliant. TIA

[radd in reply to GratingCarrots]

GratingCarrots,

The body metabolises T4 and T3 into other metabolites and RT3 is an inactive form metabolised from FT3. In general health the body uses RT3 (along with other metabolites) as a way of regulating the amounts of T3, and in acute/chronic stress/illness it is usual for RT3 to raise.

Once raised more than is healthy, if the conditions that caused it aren’t addressed RT3 can remain elevated and risk encouraging further disability of our thyroid meds. Hence RT3 is often viewed with caution by hypo people with common iron/nutrient deficiencies and chronic inflammation caused by autoimmune disease that commonly drives levels of RT3 higher.

This forum generally doesn’t support RT3 testing because the test is expensive, takes a while to turn around, the results can be tricky to interpret, and it offers no indication of the cause. If optimised thyroid meds are failing you, then it is prudent to assume RT3 levels will be raised.

Conventional medicine often regards RT3 testing as controversial. This is because the ramifications of thyroid autoimmune disease are not recognised and it is assumed elevated RT3 levels will be eliminated by the usual methods used by a healthy body. Also many endos can not interpret comprehensive thyroid panels and RT3 results would not usually be used in their thyroid treatment decisions.

The RT3 test result can not be viewed in isolation but alongside TSH, FT4 & FT3. Some practitioners will also use ‘totals’. Tania Smith of Thyroid Patients Canada who has provided a vast wealth of knowledge on the intricate workings of thyroid hormone states about RT3 “In the right hands, it can provide insight into protective and pathological metabolic mechanisms, illnesses, thyroid hormone overdose/underdose, and various types of hyperthyroidism and hypothyroidism’.

There is plenty of reading here ..... thyroidpatients.ca/2020/11/...

[GratingCarrots in reply to radd]

Thank you Radd. I may need to read through your message a few times to wrap my head around the detailed information. Thank you so much, your extensive knowledge is much appreciated. I will look into the link . Hopefully then I can understand my rT3 result whilst also considering T4 & T3 results plus increasing my vitamins for optimal health. Thanks again 😁

[GratingCarrots in reply to Banaras]

Thank you Banaras, I think I will need to do lots of research on rT3. It cost a lot to have it tested, yes you are correct that mine is very high - but I have no idea what it means 🤔🙄

[Banaras in reply to GratingCarrots]

Better conversion of T4 to T3, and if needed, extra T3 while lowering T4. Read up on it here: stopthethyroidmadness.com/reverse-t3/

[GratingCarrots in reply to Banaras]

Thank you Banaras. Some bed time reading 😄