Views on my blood results?

[Ktlc]

*I have now received my FT3 results

TSH 0.02 mIU/L (0.35 - 5.50) -6.4%

Free T4 (fT4) 14.4 pmol/L (7.86 - 14.41) 99.8%

Free T3 (fT3) 5.70 pmol/L (3.5 - 6.5) 73.3%

T4:T3 Ratio 2.526

So looks like the correct dose, but I do need to work on my vitamin levels - thanks guys.

The endocrinologist has offered NAD, so worth looking at?

Hello and thanks in advance for your guidance on my recent blood tests. I am fortunate enough (although the secretary hates it) to have the email of my endocrinologist who is quite positive about me contributing towards finding the best dosage for me. Before I email back to discuss I'm interested in your thoughts. I am still waiting on FT3 and Ferritin, which were taken but no one seems to have a record. I will continue to chase.

I generally feel better on 75mg and just wondering if it's right or marginally high dosage? I'm 60kg, but hoping I will get back to my normal weight of 55kg which I've been for over 20 years. Only increased weight since around 2022.

April 2024 (10 weeks on 75mg Levothyroxine). Gluten Free Diet. No other supplements

TSH 0.02 mIU/L (0.35 - 5.50) -6.4%

Free T4 (fT4) 14.4 pmol/L (7.86 - 14.41) 99.8%

Thyroid Peroxidase Antibodies (TPO) 150 IU/mL (≤ 10)

Folate - Serum 11.9 ug/L (4 - 50) 17.2%

Vitamin B12 330 nmol/L (150 - 750) 30.0%

Vitamin D 53.7 nmol/L (no reference range)

Prior History

22 August 2023 - 4 months on 50mg Levothyroxine (took until January for them to get in touch and finally put my levo to 75) Bloods at Hospital). Upped to 75mg

TSH 3.37 mIU/L (0.35 - 5.50)

Free T4 (fT4) 10.4 pmol/L (7.86 - 14.41)

17 May 2023 - preseribed 50mg Levo (bloods at hospital)

April/May 2023 finally diagnosed after several private blood tests. GP was waiting for TSH to go over 10. Lucky for me my cortisol was rock-bottom so I was referred for Addisons. Endo immediately diagnosed AI thyroiditis.

TSH 7.52 mIU/L (0.35 - 5.50)

Free T4 (fT4) 9.90 pmol/L (7.86 - 14.41)

Folate - Serum 11.5 ug/L (4 - 50) 

Vitamin B12 354 nmol/L (150 - 750)

February 2023 (Bloods at GP)

TSH 4.33 mIU/L (0.35 - 5.50)

Free T4 (fT4) 11.30 pmol/L (7.86 - 14.41)

Thyroid Peroxidase Antibodies (TPO) 152 IU/mL (≤ 10)

Vitamin B12 421 nmol/L (150 - 750) 30.0% (I was on a multivitamin)

Ferritin 52.6 (previously 35 with GP who wasn't concerned. I started a multivitamin)

May 2021 - Told nothing wrong, but the start of my complaints and heading down private blood tests to monitor myself.

TSH 2.65 mIU/L (0.35 - 5.50)

Free T4 (fT4) 9.1pmol/L (7.86 - 14.41)

Thyroid Peroxidase Antibodies (TPO) 152 IU/mL (≤ 10)

Thyroid Globulin Antibodies (TgAB) 350

Vitamin B12 260 nmol/L (150 - 750)

Ferritin 35.1

[SlowDragon Administrator]

Would suggest you stay on current dose and work on improving low vitamin levels

Folate - Serum 11.9 ug/L (4 - 50) 17.2%

Vitamin B12 330 nmol/L (150 - 750) 30.0%

Vitamin D 53.7 nmol/L (no reference range)

These are all too low

No ferritin result?

[Ktlc in reply to SlowDragon]

No - they didn't do ferritin. I did ask. However, I know it's always been between 35-50 and GP doesn't say anything about it

[SlowDragon Administrator in reply to Ktlc]

So ferritin is too low

cks.nice.org.uk/topics/anae...

Serum ferritin level is the biochemical test, which most reliably correlates with relative total body iron stores. In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency.

Never supplement iron without doing full iron panel test for anaemia first and retest 3-4 times a year if self supplementing.

It’s possible to have low ferritin but high iron

Test early morning, only water to drink between waking and test. Avoid high iron rich dinner night before test

Stop iron supplements 5-7 days before testing

Medichecks iron panel test

medichecks.com/products/iro...

Aiming for at least over 70 minimum

Look at increasing iron rich foods in diet

Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption

List of iron rich foods

dailyiron.net

Links about iron and ferritin

irondisorders.org/too-littl...

davidg170.sg-host.com/wp-co...

Great in-depth article on low ferritin

oatext.com/iron-deficiency-...

drhedberg.com/ferritin-hypo...

This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.

healthunlocked.com/thyroidu...

Posts discussing Three Arrows as very effective supplement

Great replies from @FallingInReverse

re ferritin and Three arrows

healthunlocked.com/thyroidu......

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Great reply by @fallinginreverse

healthunlocked.com/thyroidu...

Iron patches

healthunlocked.com/thyroidu...

Thyroid disease is as much about optimising vitamins as thyroid hormones

healthunlocked.com/thyroidu...

restartmed.com/hypothyroidi...

Post discussing just how long it can take to raise low ferritin

healthunlocked.com/thyroidu...

Iron and thyroid link

healthunlocked.com/thyroidu...

Posts discussing why important to do full iron panel test

healthunlocked.com/thyroidu...

Good iron but low ferritin

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Chicken livers if iron is good, but ferritin low

healthunlocked.com/thyroidu...

Shellfish and Mussels are excellent source of iron

healthline.com/nutrition/he...

Iron deficiency without anaemia

healthunlocked.com/thyroidu...

Ferritin over 100 to alleviate symptoms

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Great research article discussing similar…..ferritin over 100 often necessary

ncbi.nlm.nih.gov/pmc/articl...

Low Iron implicated in hypothyroidism

healthunlocked.com/thyroidu...

Really interesting talk on YouTube, link in reply by Humanbean discussing both iron deficiency and towards end how inflammation can also be an issue

healthunlocked.com/thyroidu...

Inflammation affecting ferritin

healthunlocked.com/thyroidu...

Updated reference ranges for top of ferritin range depending upon age

healthunlocked.com/thyroidu...

Thank you for your incredible patience while you have been awaiting the outcome of our ferritin reference range review. We conducted this with Inuvi lab, which has now changed the reference ranges to the following:

Females 18 ≤ age < 40. 30 to 180

Females 40 ≤ age < 50. 30 to 207

Females 50 ≤ age < 60. 30 to 264l

Females Age ≥ 60. 30 to 332

Males 18 ≤ age < 40 30 to 442

Males Age ≥ 40 30 to 518

The lower limits of 30 are by the NICE threshold of <30 for iron deficiency. Our review of Medichecks data has determined the upper limits. This retrospective study used a large dataset of blood test results from 25,425 healthy participants aged 18 to 97 over seven years. This is the most extensive study on ferritin reference ranges, and we hope to achieve journal publication so that these ranges can be applied more widely.

[SlowDragon Administrator]

Low B12 symptoms

b12deficiency.info/signs-an...

methyl-life.com/blogs/defic...

NICE guidelines on B12 and testing

healthunlocked.com/redirect...

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...

[Ktlc in reply to SlowDragon]

Thanks I'll get onto it

[SlowDragon Administrator]

Only add one supplement at a time, then wait 10-14 days to assess before adding another

Low 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/...

GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)

mm.wirral.nhs.uk/document_u...

But with Hashimoto’s, improving to around 80nmol or 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 when supplementing

Can test via NHS private testing service

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

Vitamin D and thyroid disease

grassrootshealth.net/blog/t...

Vitamin D may prevent Autoimmune disease

newscientist.com/article/23...

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...

Recipe ideas

bbc.co.uk/food/articles/mag...

Interesting article by Dr Malcolm Kendrick on magnesium

drmalcolmkendrick.org/categ...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

[GlowCoach Administrator]

Without FT3 its not possible to say if you are taking enough replacement hormone.

What time of day was the test and when did you last take Levo before the test? Recommended timing is 24hrs to show stable blood levels.

We need OPTIMAL levels of all key vitamins for our thyroid hormone to work well.

If you are already taking vit D then you need to increase your dose. Vitamin D should be around 100 - 150. Buy one that includes vit K2 to help it go to your bones. Some are available in oil or you can take it with an oily meal for better absorption. Many members like the ‘Better You’ range of mouth sprays that contain both bit D & K2. Use this calculator to work out how much to take to get your level to 100-150.grassrootshealth.net/projec...

B12 - do you have symptoms of B12 deficiency? The reference range for B12 is very wide and cut off point too low. theb12society.com/signs-and...

If you do then you should discuss this with your doctor for further tests for Pernicious Anaemia.

If not, then start with a methyl B12 sublingual spray or lozenge for a week, then add a good B complex. Once you run out of the separate B12 just continue with the B complex.

cytoplan.co.uk/vitamin-b12-...

amazon.co.uk/Better-You-Boo...

Folate should be 50%+ of range. A B complex contains both B12 & folate amongst the other B vitamins. Some suggestions:

Slightly cheaper options with inactive B6:

amazon.co.uk/Liposomal-Soft...

Contains B6 as P5P an active form:

bigvits.co.uk/thorne-resear...

healf.com/products/basic-b-...

Explanation about the different forms of B6:

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

B complex comparison spreadsheet:

healthunlocked.com/thyroidu...

[Ktlc]

Thank you. I asked for FT3, but they'll only test what they're willing to test. Ill look at all the vitamins... thank you.

[Ktlc]

Thanks everyone. The T3 results are now back and the endocrinologist has said stay on same dose, but has also said he's open to NDA- anyone else prefer NDA to levothyroxine?

I generally feel ok now on 75, but am very much in menopause and haven't had a cycle for 3 years despite being only 48. However, I think overexercising in lockdown is what trigged both thyroid and menopause decline.