advice on new blood test

[PassionFruit-xxx]

TSH 0.9mu/L range 0.27-4.20

Serum B12 457pmol/L range 145-569

Serum folate 57.7nmol/L range 8.8-60.8

Serum ferritin 164ug/L range 13-150 if/L

Serum 25-HO vit D3 134nmol/L…… no range but

25nmol/L - Deficient

25-50 - insufficiency

50 - sufficient for most of population

200 - potentially toxic

No free t’s where tested as the lab refuses to do them unless they see a problem 🙄

This is my recent blood test results, I haven’t been back into see the Doctor yet but she was talking about reducing my Levo from 75 back to 50, I feel better on 75 to how I felt on 50, although I’m still getting afternoon fatigue & feeling cold, she did say I may be over medicated & would look at the test results to see if I need to go back to 50Levo.

Also I see that my vit D is very high, I currently take vit D & K3 4000iu daily, maybe I need to lower the dose, again any advice would be greatly appreciated.

If anyone could offer me some good advice, I would be so grateful.

thank you.

[GlowCoach Administrator]

So you will need to test privately to see where your FT4 & FT3 are and find out if there are reasons there that you still have symptoms. Thousands of members of this group are forced to buy their own tests due to NHS inadequacies. Its the only way to feel well.

Your B12 is not optimal. What are you taking for B12?

Your D3 is not really too too much but you could afford to perhaps miss a day or two a week of your supplement.

With TSH in range your GP should have no reason to reduce your dose now.

[PassionFruit-xxx in reply to GlowCoach]

Thank you jaydee,so I can refuse a reduction in Levo & know that I’m not over medicated, that’s good to know.

I can’t afford to do a private test at the moment but I think I will have to at some point. My vit B12 is 1000ug per day, I also take igennus super B complex as well. Should I maybe take 2 1000ug B12 a day?

Thank you for your quick response

[GlowCoach Administrator in reply to PassionFruit-xxx]

You're definitely not over replaced. Be sure to always book your blood test for 9am or earlier to get highest TSH reading. It varies throughout the day.

You really need to get an active B12 done as the GP usually only offers serum B12. Try adding a few extra 1,000ug B12 a week which should help.

Otherwise you eed to check if you are converting and how high your FT4 is in range which only a private blood test will tell you.

[PassionFruit-xxx in reply to GlowCoach]

Yes my blood test was 8.30am, I didn’t take my Levo at 5 that morning until after the blood test & I also didn’t eat or drink anything until afterwards.

I will take extra vit B12 tab 2/3 times a week to increase my B12 & look into getting a private blood test for ft4,ft3 & active B12, my Doctor has already told me I’m not having any more blood test now for a year, baring in mind I’ve only been hypothyroid for a year & was told at the beginning that I will need blood test every 6/8 weeks for the first year until I’m settled 🤦‍♀️ I just feel like a nuisance every time I rock up to the doctors for yet another blood test because I’m not feeling well.

Hopefully get there in the end, but again thank you for your advice.

[SlowDragon Administrator in reply to PassionFruit-xxx]

Your GP should test TSH, Ft4 and Ft3

Just testing TSH on levothyroxine is completely inadequate

Refuse to reduce dose based just on TSH

Which brand of levothyroxine are you taking

Do you always get same brand at each prescription

Recommended that all thyroid blood tests early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

NHS private test service

Just TSH, Ft4 and Ft3 test - £32

monitormyhealth.org.uk/thyr...

10% off code here

thyroiduk.org/testing/priva...

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).

Approximately how much do you weigh in kilo?

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...

[PassionFruit-xxx]

Thank you SlowDragon, I will refuse to lower the dose if that is what she will say, unfortunately the lab won’t test ft4 or ft3, I asked for them to be tested & the doctor said they won’t do it, I will be looking into a private test.

I take mercury pharma Levothyroxine mainly or accord if they can’t get mercury, I’m good on both & have listed them as my preference.

My blood test was done early, 8.30, with no food or drink before & Levo was taken around 27 hours before.

I weigh around 60kilos & take 75 levo.