Help with results please: Have now got my... - Thyroid UK

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Help with results please

GiaRose profile image
7 Replies

Have now got my latest blood test results, as follows;

TSH. 0.66 mluL range 0.35 - 4.94

Serum Free T4. 13.5 pmol/L range 9.0 - 19.10 pmol/L

Serum Free T3. 4.2 pmol/L range 2.40 - 6.00 pmol/L

Serum Ferritin 108 ug/L range 30 - 250 ug/L

Serum Vitamin B12 292 ng/L Range 200 - 900 ng/L

Vitamin D serum total. 117 nmol/L range 50 - 200 nmol/L

Liver Function Test

Serum Albumin 42 g/L

Serum total Billiruben 7umo/L

Serum Alkaline Phosphatase 64u/L

Serum ALT level 11u/L

B12, Ferritin, Folate - (ABAB) Serum folate. 3.9 ug/L range 3.00 - 20.50 ug/L

I’m 68, weight is 156lbs (70.76kg)

My current dosage of Levothyroxine is

4 x 75mg and 3 x 100mg weekly.

I’m still struggling with my weight despite consulting a nutritionist, have joint pain and am always very cold.

Can anyone help me with these results ? please, do I need my dosage increased.

Also, some advice please on what vitamin supplements I may need. I’m seeing my Dr this week to discuss these results so any advise would be greatly appreciated

Many thanks Gia

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GiaRose
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SlowDragon profile image
SlowDragonAdministrator

can you please add ranges on Ft4 and Ft3, B12, folate

Was test done early morning, ideally before 9am, only drinking water between waking and test and last dose levothyroxine 24 hours before test

what vitamin supplements are you taking

GiaRose profile image
GiaRose in reply toSlowDragon

Hi, SlowDragon I’ve added ranges to my post. Tests were done before 9am, only drinking water and previous dosage taken 24hrs before. Not currently taking any vitamin supplements as I wanted to check my levels first.

SlowDragon profile image
SlowDragonAdministrator in reply toGiaRose

So

FT4: 13.5 pmol/l (Range 9 - 19.1)

Ft4 only 44.55% through range

FT3: 4.2 pmol/l (Range 2.4 - 6)

Ft3 50.00% through range

Request increase to 100mcg daily

Which brand of levothyroxine are you taking

Serum Vitamin B12 292 ng/L Range 200 - 900 ng/L

Serum folate. 3.9 ug/L range 3.00 - 20.50 ug/L

are you vegetarian or vegan

B12 and folate both very low

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 a week later add a separate vitamin B Complex 

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...

retest 8-10 weeks after increase in levothyroxine

GiaRose profile image
GiaRose in reply toGiaRose

Thank you for your reply, in answer to your questions, I’m not vegan or vegetarian.

Levothyroxine is ;

25mg is Mecury

50mg is Almus

100 mg is Almus.

Will now thoroughly review all your advise on supplements, and will request with my Dr that he increases my dosage to 100mg daily.

Much appreciated

Gia

SlowDragon profile image
SlowDragonAdministrator

I’m 68, weight is 156lbs (70.76kg)

70kg x 1.6mcg = 112mcg as likely daily dose levothyroxine required

So you may need small further increase in levothyroxine in 2-4 months

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.

GiaRose profile image
GiaRose in reply toSlowDragon

Thank-you for all your advice, Dr has increased my dosage to 100 and have I just ordered the B12.

SlowDragon profile image
SlowDragonAdministrator in reply toGiaRose

Brilliant news

Well done 👏👏👏

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