Could you support me in understanding next steps following the below test results? In particular, my iron panel results seem to be very low, and I am not sure how to correct that. How should I start to supplement?
I was diagnosed with hashimotos in 2018. On 50mg of T4 since then. GP reckoned everything was normal. Since January this year I have been struggling very badly. No energy at all. Hard to get out of bed. 39yo male.
I am three weeks into starting on thybon henning t3 treatment, and a supplement called seriphos for phase 1 HPA dysregulation. My conversion from t4 to t3 was found to be poor.
I was feeling awful. I have felt a little bit better each week for the last three weeks.
I had some additional blood tests completed to get a better picture of where my bloods are at.
Coeliac test = negative.
Pernicious anemia = negative.
Vitamin B12: 357 (range 206-1000)
Serum ferratin: 49.6 (range 23-393)
Folate Immunoassay: 20.3 (range 4.5-20)
Would I be correct in saying that the folate is high because I am deficient in B12?
I will start taking a B12 supplement (methylcobalamin), to increase B12 levels.
Iron studies -
Iron: 13 (range 14-31)
UIBC: 42 (range 20-66)
TIBC: 55 (range 50-80)
Transferrin sat: 24% (range 30-40%)
All results seem to be quite low.....
I am not sure what to do with the iron study results......any advice would be most welcome.
Thank you,
Luke
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LukeFitz
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Here are ferritin results over last couple of years.
I requested a full iron panel recently, the results I shared in the first post are are the full results of that test.
I went mostly veggie, with occasional fish/meat, earlier in the year. My LDL cholesterol was extremely high, so doctor advised a meat-free diet. I am assuming my LDL is high because my thyroid hasn't been properly supported. Going vegetarian has probably made things worse...
Your TIBC is low in range which indicates capacity to be able to supplement with iron.
Serum iron below range.
Has GP seen these results as they may offer a supplement.
Even if coeliac test is negative its s till worth trialling a strictly gluten free diet to see if it helps symptoms.
You will need a high dose methylcobalmin supplement so choose carefully. I have some suggestions here.
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.
Only 5% of Hashimoto’s patients test positive for coeliac but a further 81% of Hashimoto’s patients who try gluten free diet find noticeable or significant improvement or find it’s essential
A strictly gluten free diet helps or is essential due to gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)
Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and may slowly lower TPO antibodies
While still eating high gluten diet ask GP for coeliac blood test first as per NICE Guidelines
The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported
In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned
Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.
Similarly few months later consider trying dairy free too. Approx 50-60% find dairy free beneficial
With loads of vegan dairy alternatives these days it’s not as difficult as in the past
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
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
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 until serum B12 over 500
Post discussing how biotin can affect test results
How long did you not eat meat, and how long before this current panel did you start again?
Your numbers are low, but I’m not sure if they are dire enough to supplement - depending on what you tell us about the iron in your diet.
You need to include CRP-hs - a measure of inflammation - in all future iron panels as ferritin reacts to inflammation and can make interpretation of results tricky.
If indeed your ferritin dropped at the same time as you cutting meat out, then your first step should be a commitment to eating more iron-rich meats. You might even want to track how much you eat - as this will tell us a lot about how you absorb and if at some point in the future you would think about supplementing.
Note - re your numbers. Your iron is low, but iron is volatile and can move up or down quickly - even with an iron-rich meal within a day of taking the test.
Saturation is also on the low side - but we would only target + 10% max so it’s not dire and we want to take care to not get close to the top of the range for that one.
Your ferritin has been dropping - but the way to treat that is by bringing your iron to 55-70% through range, and saturation percent to mid range, and then the ferritin will rise as a result. We don’t supplement based on ferritin alone.
For the next 2-3 months I would increase iron rich foods, preferably meat.
Retest the whole iron panel (including ferritin and CRP-hs at the same time) and take it from there.
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