help with results please

[Bollieforme]

I’d be grateful if anyone could help with results please. I’m on combined therapy 50mg T4 and 35mg T3

TFT 0.02 (0.35-4.94)

FT3 4.5 (2.4-6.00)

FT4 8.1 (9.00-19.00)

B12 433 (187-883)

Vit D 126.1 >50

Thank you

[TiggerMe Ambassador]

How are you feeling?

[FallingInReverse]

Most important as Tigger noted - how are you feeling?

Also noting your post from 4 months ago - healthunlocked.com/thyroidu...

That it looks like you dropped from 75 to 50 Levo with what appears to be predictable results.

B12 is not terrible but it is too low.

[Bollieforme in reply to FallingInReverse]

I’m seeing a new Endo on Wednesday so wanted to be fully armed! I’m feeling okish I would say but not great. Previous Endo wanted me to drop T4 but don’t think I’m on enough T3 to warrant dropping it. I do sort of feel better on higher T4 meds but trying to find my sweet spot is proving elusive!

[FallingInReverse in reply to Bollieforme]

You had a reply 4 months ago that recommended increasing T4 to 75.

Regards to how you feel, we say that you want both T4 and T3 to be at least 50% but more reaching towards 75% through range.

Convincing your endo is a completely different challenge.

But no doubt you should be increasing your Levo to bring up you T4, and continue to monitor tsh, ft4 and ft3 along the way.

You’re at a decent lio dose. But as noted 4 months ago, we would not have recco ended dropping Levo at that point, and your t4 now reflects that.

[Bollieforme in reply to FallingInReverse]

It’s a private Endo appointment I’ve waited 3 months to see this one! It’s a lottery isn’t it!

[SlowDragon Administrator]

T3 ….day before test did you split T3 as 2 or 3 smaller doses spread through the day, with last dose approximately 8-12 hours before test

which brand is T3

Which brand levothyroxine

Personally I would try increasing levothyroxine back to 75mcg

What vitamin supplements are you taking

Vitamin D good

B12 a bit low

No folate or ferritin

[Bollieforme in reply to SlowDragon]

Hi SD hope you are well

My folate is 8.5 (3.1-20.5)

Ferritin 100 (10-204)

T3 Roma

T4 Teva (liquid)

I did not take meds for 24 hours prior to the blood test. So I only took the one dose day before test so I’d in fact missed two doses of T3.

[SlowDragon Administrator in reply to Bollieforme]

So Last dose Levo was 8am day before test is correct 👍

I did not take meds for 24 hours prior to the blood test. So I only took the one dose day before test so I’d in fact missed two doses of T3.

So ignore Ft3 result

Next test make sure you take T3 as per normal, 3 doses spread through the day and last dose 8pm - assuming test is 8am following morning

You may find you need to reduce T3 by 5mcg AFTER next test

Quite a few people don’t get on with Roma

Have you only ever taken Roma

Ferritin is good

B12 and folate

What B vitamins are you taking

With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a separate B12 supplement

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

Highly effective 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...

Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid supplements

thyroidpharmacist.com/artic...

B vitamins best taken after breakfast

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

Post discussing different B complex

healthunlocked.com/thyroidu...

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 can be difficult to find at reasonable price, should be around £20-£25. iherb.com often have in stock. Or try ebay

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...

helvella.blogspot.com/p/hel...

[Bollieforme in reply to SlowDragon]

Thank you so much for the in depth reply I will have a good read. I’ve only ever been given Roma, is there another brand NHS offer? I can always ask if there is. I will source a good vit b complex as I just take boots own brand.

[helvella Administrator in reply to Bollieforme]

Information about ALL thyroid hormones medicines licensed in the UK is in my UK medicines document.

Most, possibly all, other makes that you could be prescribed/have dispensed will likely work out more expensive. Hence you might have some resistance if you ask for a change.

helvella - Thyroid Hormone Medicines

helvella has created, and tries to maintain, documents containing details of all thyroid hormone medicines in the UK and, in less detail, many others around the world. There is now a specific world desiccated thyroid document.

I highly recommend viewing on a computer screen, or a decent sized tablet, rather than a phone. Even I find it less than satisfactory trying to view them on my phone.

helvella - Thyroid Hormone Medicines - UK

The UK document contains up-to-date versions of the Summary Matrixes for levothyroxine tablets, oral solutions and also liothyronine available in the UK. Includes descriptions of tablet markings which allow identification. Latest updates include all declared ingredients for all UK products and links to Patient Information Leaflets, etc.

helvella - World Desiccated Thyroid

Contains details of all known desiccated thyroid products.

helvella - Thyroid Hormone Medicines - RotW

Contains details of all levothyroxine, liothyronine and combination products - excluding desiccated thyroid products. Details available vary by country and manufacturer.

The link below takes you to a blog page which has direct links to the documents from Dropbox and QR codes to make it easy to access from phones. You will have to scroll down or up to find the link to the document you want.

helvella.blogspot.com/p/hel...

Current NHS Drug Tariff Liothyronine Prices

Link to a blog post of Monthly NHS Drug Tariff prices for Liothyronine products from January 2023 onwards.

Also includes link to information for Northern Ireland and Scotland. (Wales' data is based on England.)

helvella.blogspot.com/p/cur...

Last updated 28th February 2024

[SlowDragon Administrator in reply to Bollieforme]

20mcg tablets currently £40 per 28 tablets

Brands

Teva - lactose free. Generally well tolerated.. Loose in a pot. Unlike Teva levothyroxine, Teva T3 doesn’t contain mannitol

Mercury Pharma - loose in a pot. Contains lactose

Morningside Healthcare - blister packed. Contains lactose.

Morningside also available as 5mcg and 10mcg tablets…..but vastly more expensive

Prices of tablets v capsules

Capsules much more expensive than 20mcg tablets

healthunlocked.com/thyroidu...