Latest blood results - any ideas?

[Sneedle]

Hello Everyone,

Here are my most recent BH results obtained as per the forum guidelines - the last test I did was about 3 months ago.

Cortisol

Following my very low Regenerus cortisol results, I've been on Adrenavive 2 for about 4 weeks now, no digestive or other problems. I've been working upwards and am now on 600mg daily. No perceived change in my symptoms, but I understand it can take several months so I was planning to continue...BUT the random Cortisol sample shows as high. I definintely didn't take Adrenavive the day of the test, I think the last dose would have been about 22 hours before.

Should I reduce? It seems strange to reduce without having had any noticeable benefit. I'm very confused.

THYROID

I've been on Accord 100mcg for about two months and tomorrow have a GP appointment to discuss. I would like to ask for a further raise - is this the right thing to do? No improvement in fatigue so far.

FT4 is 18.2 or 60% of range

FT3 is 4.55 or 39.2% of range

My TSH is just below range. I am guessing the GP will baulk at an increase - what should I counter with? I have read the 'Lore' so many times here but can't bring it to mind.

B12/Folate

I have had one B12 injection and have been supplementing about 6000-8000mcg B12 drops and sublingual daily. Should I reduce this now? Again, no particular improvement.

After the injection I could feel 'runs of energy' moving downwards in my limbs for a few hours. It felt good then faded. No other changes.

Folate is 28.70 or 38.2% of the range. It was bottom of range in June and I've been supplementing 1400mcg daily. Should I continue with this?

Thank you for your input.

PS I'm on 200mg HRT patches and Wellsprings Progesterone cream. And undergoing ultrasound on Thursday for possible fibroids and Mirena coil gone MIA😯

[SlowDragon Administrator]

if B12 injection gave improvement, suggest you try getting another injection

Many members self inject B12 regularly

Folate is 28.70 or 38.2% of the range. It was bottom of range in June and I've been supplementing 1400mcg daily. Should I continue with this?

Rather than just supplementing folate….we always recommend taking a good quality vitamin B complex

supplementing a good quality daily vitamin B complex, one with folate in (not folic acid) This can help keep all B vitamins in balance

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)

Post discussing how biotin can affect test results

healthunlocked.com/thyroidu...

Post discussing B12 injections

healthunlocked.com/thyroidu...

[Sneedle in reply to SlowDragon]

Hi SlowDragon, thanks for your reply.

I should have said I take YipMai B complex which includes 400mcg methylfolate then an extra 1000mcg.

I'll look into B12 injections probably self-injecting, to give it a go. It's worth a punt as you suggest.

Re Thyroid, do you think I have room for an increase to 125mg? According to my weight I can go up to 140ish. But think GP (appt this morning) will not want to.

Looking at T4 and T3, are they in a good ratio now? But just need to both go higher?

Cheers.

[SlowDragon Administrator in reply to Sneedle]

I should have said I take YipMai B complex which includes 400mcg methylfolate then an extra 1000mcg.

Did you stop this 5-7 days before test as contains biotin

Re dose levothyroxine

Approx how much do you weigh in kilo?

[Sneedle in reply to SlowDragon]

Yes I did stop the supplement beforehand.I weigh about 88kg.

[SlowDragon Administrator in reply to Sneedle]

So yes likely to need further increases in dose over coming months

What were most recent NHS test results

Request small increase to 125mcg daily

You might initially increase to 112.5mcg (cutting 25mcg tablet in half)

guidelines on dose levothyroxine by weight

Even if we frequently start on only 50mcg, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose

NICE guidelines on full replacement dose

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

Also here

cks.nice.org.uk/topics/hypo...

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.

[Sneedle]

My results

NHS

TSH FEB .65 AUG .17 (0.55-4.78)

T3 FEB not tested AUG 5.5 (3.50-6.50) 66.7%

Can't find t4 for some reason!

Edit: checked and t4 was not tested.

Edited again for SlowDragon

Update following Gp appointment this morning - he agreed to go up to 125mcg but said that if my TSH becomes suppressed he won't agree to go higher.

He wasn't going to increase at all but thanks to your link I found on another post to an academic paper (which I printed out) finding low TSH did not increase risk of bone and cardio problems, I managed to convince him to try👍😀.

I have to stay on 125 for three months then go back.

I'm very pleased I'm getting to try!