Recent blood test – Why do I feel so tired?

[Zazbag]

Hello,

Please could you have a look at my recent blood test results and tell me what could be the cause of my constant tiredness? I find it hard to get out of bed in the morning and often wake up with brain fog. I often wake up during the night to pee. I often feel the need to fall asleep in the afternoon or early evening.

It looks like my folate might be the reason, but I'm not sure. I've been supplementing high-dose vitamin D, methyl-B12, iron and methyl-folate. My folate level doesn't seem to go up even though I'm taking 15,000 mcg tablets. I've had folate deficiency anaemia in the past. For context, diet is healthy (gluten, dairy, egg free, high protein, lots of fruits and vegetables and healthy fats, low sugar, moderate complex carbs).

Sometimes I feel like I might be over-medicated as if I get stressed out or angry or suddenly run up the stairs, my heart beats quite fast and hard and I can get a bit shaky. I was over-medicated for about a year and a half but lowered my dose in November last year and don't seem to be anymore according to my blood test results. Not sure whether I might have high reverse T3 causing me to feel tired even though my bloods look okay. I've noticed my hands and feet are often icy cold as well which hasn't been a problem for a long time.

Many thanks in advance!

Dose:

162.5mcg levo (before bed, 2 hours after food)

25mcg T3 (first half first thing in morning, half an hour before food or caffeine, second half mid-afternoon/early evening)

I've been stable on this dose since November last year

Blood test protocol: (I always follow this)

9am, fasted, no caffeine, water only

Last dose of levothyroxine: 24 hours before

Last dose of T3: 12 hours before

Blood test results:

TSH: 0.01 mu/L (0.3–4.2) [HAS BEEN SUPPRESSED SINCE I STARTED T3 IN 2021]

T4: 19.0 pmol/L (12–22) [HAS TESTED AT AROUND 19 SINCE OCT 2023]

T3: 6.0 pmol/L (3.1–6.8) [LAST TESTED AT 6.7 ON SAME DOSE (JAN 24)]

Vitamin D: 140 nmol/L (50–250)

Ferritin: 70 ug/L (13–150)

Folate: 10.5 ug/L (2.99–26.8)

Vitamin B12: 550 ng/L (197–771)

Red blood cell count: 3.91 x 10^12/L (3.8–5.8) [NEVER GOES ABOVE 4.17, USUALLY VERY LOW IN RANGE OR ABNORMAL]

Haemoglobin estimation: 120 g/L (115–165) [NEVER GOES ABOVE 131, USUALLY AT THE BOTTOM OF THE RANGE]

Mean corpuscular volume: 93.6 fL (78–98)

Haematocrit: 0.37 L/L (0.37–0.5) [SOME PREVIOUS RESULTS HAVE BEEN ABNORMALLY LOW, OTHERS HAVE BEEN NORMAL]

SHBG: 163 nmol/L (191–145), ABNORMAL [PREVIOUS RESULTS: 172 in October 2023, 199 in August 2023]

Prolactin: 414 mu/L (102–496) [PREVIOUS RESULT: 635 mu/L, ABNORMAL]

HbA1c: 31 mmol/mol (20–41)

[SlowDragon Administrator]

That’s a massive dose folate

Suggest instead you take a daily vitamin B complex

Do you continue folate supplements until day before test

Difference between folate and folic acid

healthline.com/nutrition/fo...

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 5-7 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)