blood results: good morning, I’ve just received... - Thyroid UK

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blood results

Clare78uk2002 profile image
13 Replies

good morning,

I’ve just received my advanced thyroid panel from medichecks and I hoped someone could interpret them for me please?

A bit of history, I developed an overactive thyroid with graves and t.e.d in 2001, I had radio iodine which obviously knocked me underactive.

I got put straight on levothyroxine and was never well, i trialed armour which I bought myself, and then I was lucky enough to get this prescribed but then it got stopped ! I went on naturethroid and did well but then they stopped making it, so I tried metavive and I’ve tried thyrovanz.

I wasn’t well on any of these and earlier this year I had to return to levothyroxine, again I do not feel well.

I take 100mcg, I didn’t take it for 24 hours before my test, and these results are based on me not taking any vitimins or supplements.I took my blood at 9am.

Tsh 3.49 range 0.27-4.2

Ft3 3.7 range 3.1-6.8

Ft4 17 range 12-22

Thyroglobulin antibodies 42.7 range 0-115

Tpa 41.2 range 0-34

Folate serum 4.8 range 8.83-60.8

B12 active 65.6 range 37.5-188

Vit d 78 range 50-250.

I’m very symptomatic aswell.

I have some Tiromel t3 25mcg ready to take, which I know to start slowly but I need some advice please on what to do with this, my levothyroxine and any other supplements please.

I just don’t have the brain cells at the moment to help myself.

Thank you for any advice xx

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13 Replies
SlowDragon profile image
SlowDragonAdministrator

Before adding T3 you really need next increase in levothyroxine

TSH is too high

Ft4 only 50% through range

Request GP increase dose levothyroxine by 25mcg

Retest again in 6-8 weeks

Approximately how much do you weigh in kilo?

Which brand levothyroxine is 100mcg tablets

Do you always get same brand levothyroxine at each prescription

Vitamin levels

No ferritin result?

So you haven’t been taking any vitamin supplements at all?

B12, folate and Vitamin D are all too low

Only add one supplement at a time, waiting 10 days to assess before adding another

Suggest you start with vitamin D, followed by magnesium

Then Separate B12 followed by vitamin B complex

Clare78uk2002 profile image
Clare78uk2002 in reply toSlowDragon

thank you

He actually prescribed me another 25mcg but when I tried to increase it I kept getting headaches, but I can try again.

I’m 78 kg, the brand I take is teva and yes I normally get the same brand.

I must have missed ferritin off that was 83.9 gangs 30-150.

I was taking ferrous fumerate 322 a day and also magnesium glycinate but I hadn’t take any for about 2 weeks prior.

Thank you so much for the advice it’s very much appreciated, I will look thenyour other answers separately as my brain just isn’t working well at the moment !

SlowDragon profile image
SlowDragonAdministrator in reply toClare78uk2002

Suggest you cut 25mcg in half and initially only increase by 12.5mcg per day

Retest after 6-8 weeks

Assuming room for further increase, increase Levo to the full 25mcg extra per day

Are you dairy intolerant that you are on Teva

You shouldn’t supplement iron without getting full iron panel test

Ferritin is high enough anyway November

Guidelines on dose by weight

78kg x 1.6mcg = 125mcg per day

Clare78uk2002 profile image
Clare78uk2002 in reply toSlowDragon

Thank you, I’ll definitely increase the levothyroxine by half for now and see how I go.

No I’m not dairy intolerant it’s just the one they give me, but on closer inspection that’s only the 25mcg which is teva, the 100mcg are accord.

I shall stop the ferrous then, and I’ll order the other items you have kindly told me about.

Thank you so much xx

SlowDragon profile image
SlowDragonAdministrator in reply toClare78uk2002

Well I would get different brand for the 25mcg

Teva brand upsets many many people - it’s highly likely the Teva brand causing the issue not the dose

Request new prescription for 50mcg and make sure you get Accord brand - cut in 1/2 for 25mcg

If you still want to start on 12.5mcg ….either take 100mcg and 125mcg on alternate days

Or cut 50mcg into 1/4’s

Most easily available (and often most easily tolerated) are Mercury Pharma or Accord

Accord only make 50mcg and 100mcg tablets. Accord is also boxed as Almus via Boots, 

Mercury Pharma make 25mcg, 50mcg and 100mcg tablets 

Mercury Pharma also boxed as Eltroxin. Both often listed by company name on pharmacy database - Advanz

Wockhardt is very well tolerated, but only available in 25mcg tablets. Some people remain on Wockhardt, taking their daily dose as a number of tablets 

Lactose free brands - currently Teva or Vencamil only

Teva makes 25mcg, 50mcg, 75mcg and 100mcg

Many patients do NOT get on well with Teva brand of Levothyroxine.

Teva is lactose free.But Teva contains mannitol as a filler instead of lactose, which seems to be possible cause of problems. Mannitol seems to upset many people, it changes gut biome 

But for some people (usually if lactose intolerant, Teva is by far the best option)

Aristo (currently 100mcg only) is lactose free and mannitol free.

March 2023 - Aristo now called Vencamil

healthunlocked.com/thyroidu...

List of different brands available in U.K.

thyroiduk.org/if-you-are-hy...

Posts that mention Teva

healthunlocked.com/search/p...

Teva poll

healthunlocked.com/thyroidu...

Once you find a brand that suits you, best to make sure to only get that one at each prescription.

Watch out for brand change when dose is increased or at repeat prescription.

Government guidelines for GP in support of patients if you find it difficult/impossible to change brands

gov.uk/drug-safety-update/l...

If a patient reports persistent symptoms when switching between different levothyroxine tablet formulations, consider consistently prescribing a specific product known to be well tolerated by the patient.

academic.oup.com/jcem/artic...

Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).

Discussed here too

healthunlocked.com/thyroidu...

Clare78uk2002 profile image
Clare78uk2002 in reply toSlowDragon

Wow thank you so much your very kind to share all of this information with me !!

I’ll arrange an appointment with the gp and try to get a new script :)

Thank you xx

Beads profile image
Beads in reply toClare78uk2002

For what it’s worth, the adverse effect I get from Teva 25ug is a persistent headache which doesn’t respond to painkillers.

Clare78uk2002 profile image
Clare78uk2002 in reply toBeads

Yes that’s exactly what I get !! I’m trying to get an appointment but I may try and split 100 in to 4 and see how that goes x

SlowDragon profile image
SlowDragonAdministrator

vitamin D

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/...

But 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

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 profile image
SlowDragonAdministrator

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...

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...

SlowDragon profile image
SlowDragonAdministrator

Graph showing median TSH in healthy population is 1-1.5

web.archive.org/web/2004060...

Comprehensive list of references for needing LOW TSH on levothyroxine

healthunlocked.com/thyroidu....

onlinelibrary.wiley.com/doi...

If symptoms of hypothyroidism persist despite normalisation of TSH, the dose of levothyroxine can be titrated further to place the TSH in the lower part of the reference range or even slightly below (i.e., TSH: 0.1–2.0 mU/L), but avoiding TSH < 0.1 mU/L. Use of alternate day dosing of different levothyroxine strengths may be needed to achieve this (e.g., 100 mcg for 4 days; 125 mcg for 3 days weekly).

pennyannie profile image
pennyannie

Hello Claire :

I too had RAI thyroid ablation but back in 2005 and didn't know any different and just trusted the medical profession until around 8 years later when I became more ill and in an ever decreasing circle of wellness and totally get the brain fog and clouded thinking.

I was refused both T3 and NDT by the NHS in 2018 and now self medicate with NDT and am much improved.

I think it deplorable that you had Armour prescribed by the NHS which suited you and that then it was removed from your prescription - what reason was given ?

A fully functioning working thyroid would be supporting you on a daily basis with trace elements of T1. T2 and calcitonin +a measure of T3 at around 10 mcg + a measure of T4 at around 100 mcg.

Some people can get by on T4 monotherapy.

Some people find that T4 seems not to work as well as it once did and that by adding in a little T3 - likely a similar dose to that the thyroid once supported them with - they are able to restore T3/T4 hormonal balance and feel better.

Some can't tolerate T4 and need to take T3 only :

Whilst others find their health restored better taking Natural Desiccated Thyroid which contains all the same known hormones as that of the human gland and derived from pig thyroids dried and ground down into tablets referred to as grains.

As for TED - I have found it's essential to use Preservative Free eye drops :

We do now have some research papers you may like to have :-

pubmed.ncbi.nlm.nih.gov/338...

ncbi.nlm.nih.gov/pubmed/306...

All things Graves Disease - elaine-moore.com -

if you haven't found Elaine yet - she has Graves and went through RAI thyroid ablation - around the turn of the century and finding no help with her continued ill health started researching herself and now has her own Stateside forum and help line- several published books and a leading authority on this poorly understood and badly treated auto immune disease.

No thyroid hormone replacement works optimally until our core strength vitamins and minerals are up and maintained at optimal levels - I now aim for a ferritin at around 100 : folate around 20 : active B12 75 ++ ( serum B12 500 ++ ) and vitamin D at around 100.

Clare78uk2002 profile image
Clare78uk2002 in reply topennyannie

Thank you so much !

Yes I too trusted them as I knew absolutely nothing about thyroid health and just did what they told me too.

My own gp stopped it and gave the reason “it’s not licensed and it’s unsafe”.

He totally ignored the fact that I was really well on it and that my nhs endo had prescribed it for me, my endo then moved to another part of the country and I was unable to go back to him, the other endo I saw was as bad as the gp, he knew nothing at all and actually told me there are no thyroid symptoms whatsoever !!

I was lucky enough to get orbital decompression so that fixed the cosmetic appearance of my eyes, on some days they get dry and itchy but that’s easily fixed by using drops.

I’m going to work on my vitamins and minerals and see how I feel if I can get them optimal.

Thank you ever so much for your response xx

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