At GP appointment in March, I asked for full blood test after reading the forum, Doctor agreed, as have been suffering for 3 years (moved house, changed Doctors, etc., relapsed Graves June 2023) still suffering: Fatigue, weak muscles, heavy legs, bones ache down to big toes, back pain, breathless, wheezing, overweight. Doctor said, not to believe all I read on Google, as it has been scientifically proven that testing for T3 is pointless. I managed to convince the nurse in June to add on T3 and T4. I fasted and didn’t take Levo’ before tests. I supplement Vit D3 and K2 and Marine Collagen. Thank you.
11/06/2024 Medication for endocrine
Carbimazole 40mg daily
Levothyroxine (Almus) 100mcg
T3 4.2 pmol/L N range 3.1 to 6.8
T4 21.0 pmol/L N range 10.0 to 22.0 Lab comment: Adequate thyroxine replacement
TSH 0.41mIU/L N range 0.3 to 4.5
Blood Results 05/03/24:
Serum TSH: 3.2 MIU/L Normal range: 0.3 to 4.5
B12 & FOLATE
Serum vitamin B12: 243 ng/L Normal range: 150 to 1000
Serum Folate: 4.1 ug/L Normal range: 2.0 to 18.
Liver Function Test
Bilirubin: 7 umol/L Normal range: 0 to 2110*9/L
Serum alkaline
phosphatase: 113 u/L Normal range: 30 to 130
Serum ALT: 20 u/L Normal range: 0 to 40
Serum total protein: 65 g/L Normal range: 60 to 80
Serum globulin: 24 g/L Normal range: 20 to 35
Haemoglobin(MCH): 29.3 pg Normal range: 27.0 to 32.0
MCHC: 341 g/L Normal range: 320 to 360
Blood Results 10/11/2023
FBC neutrophils normal
TSH 1.6
T3 3.7
T4 19.0
LFTs NAD
Relapsed Graves’ Disease June 2023
TRAb 1.2
T4 86
T3 37.2
Medication for endocrine
Carbimazole 40mg daily
Levothyroxine (Teva) 75mcg
Propanolol 10mg twice daily
Chest Xray: clear
Written by
Doodlebug50
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it's called 'block and replace' . it's a method of stabilising/ controlling hyperthyroidism.
you give a large enough dose of carbimazole to stop thyroid producing any T4/T3 and at the same time , replace the thyroid hormones using levo and adjust the dose of levo as required .
It's called block and replace 😊 Block the hormones secreted by the overactive thyroid gland with the carbimazole, and replace with appropriate amount of exogenous thyroid hormone.
Your T4 looks a little high with your T3 a little too low on this Block & Replace dosing regime.
The Propanolol will be slowing the conversion of T4 into T3 - can you afford to wean yourself off this beta blocker and see if this then increases your T3 and lowers your T4 ?
It's too low a T3 that causes the debilitating symptoms of hypothyroidism just as too high a level of T3 causes the symptoms of hyperthyroid - though it can become confusing as some symptoms can be experienced at both extreme ends of this T3 yardstick.
If its pointless testing T3 I think it's likely pointless listening to this doctor regarding your thyroid health and well being - ask her for a copy of the research papers she is referring to - and I'm not Google - but a Graves forum member.
When metabolism runs too fast as in hyper or too slow as in hypo - both of which you are dealing with - the body struggles to extract key nutrients through food no matter how well and clean you eat and non optimal levels of core strength vitamins and mineral can compromise your ill health further than necessary.
Your serum B12 is very low in range and suggest you aim for at least 500 ++ and folate needs to be in double numbers and suggest aiming for around 20 :
I can't see a ferritin - suggest this should be around 100 and for vitamin D that needs to be around 125.
Graves is a poorly understood and badly treated Auto Immune Disease for which there is no cure and I'm sorry you have relapsed and just hope this time sees you out of the woods for good, since Graves tends to be triggered by stress and anxiety - so - for one - stop moving house !!
We do now have some research you may like to read :-
Hi Pennyannie, thank you for your reply. I weaned off the Propranolol at the end of last year. Yes, Doctor is hopeless, but I bit my tongue (I did tell him the information was from the forum), as I had just had a run in with the vet, who had also told me not to believe Google, after I refused the treatment he offered, that has well known side effects. I feel we can't trust these professionals, we have to research everything ourselves. Fortunately, the nurse was much more sympathetic. Thank you for the information, I will have a read.
Serum vitamin B12: 243 ng/L Normal range: 150 to 1000
Serum Folate: 4.1 ug/L Normal range: 2.0 to 18.
These are far too low
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
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
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
Hi SlowDragon, Thank you so much for all the information. I have been taking Clean Vit D3+K2 10,000IU from British Supplements and will get some B12 and Folate, I can't see the Doctor testing me any for any more things, it was only when I said, everyone on here gets private bloods done, that he said ok, but I will try.
Thank you, yes I will have a test in future, I'm not a sunbather and keep covered up, so really I was just trying it out. My Mother had osteoporosis and was hyperthyroid, she had RAI, which I don't fancy, I am being pressed to have it, due to the relapse, but have managed to avoid up to now.
I agree with pennyannie, please do not be talked into RAI. It’s an absolute disgrace that the NHS is still pushing this treatment. I really wish I had taken more of an active role in my treatment but I didn’t know any better and thought they (lazy NHS Endos) were acting in my best interests. I now know better.
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