hi everyone, now 8 mths post delivery and feeling tired - cud be ‘normal’ but just needed to check. just wondering if you can help interrupt these blood results for me.
blood results: hi everyone, now 8 mths post... - Thyroid UK
blood results
![Safiktm profile image](https://images.hu-production.be/avatars/06479024071840aab45413df277c8763_small@2x_100x100.jpg)
![](https://images.hu-production.be/post/post_6bac862f-a11c-4577-87c5-34b31e41c665.jpg)
![Safiktm profile image](https://images.hu-production.be/avatars/06479024071840aab45413df277c8763_small@2x_100x100.jpg)
![SlowDragon profile image](https://images.hu-production.be/avatars/27fbbead1f291333f83bad1f31359fe3_small@2x_100x100.jpg)
looking at previous post
healthunlocked.com/thyroidu...
This is your daughter’s results ?
They are absolutely dire
Ferritin is deficient
B12 extremely deficient
Folate deficient
Vitamin D insufficient
What is her GP prescribing
What vitamin supplements is she taking
Low vitamin levels tend to lower TSH
How much levothyroxine is she taking and which brand
Was test early morning and last dose Levo 24 hours before test
Free T4 (fT4) 15.3 pmol/L (12 - 22)
Ft4 only 33.0% through range
Free T3 (fT3) 3.7 pmol/L (3.1 - 6.8)
Ft3 only 16.2% through range
She needs immediate 25mcg dose increase in Levo
Retest in another 8 weeks
Most people when adequately treated on just levothyroxine will have Ft4 (levothyroxine) at least 60-70% through range and Ft3 at least 50-60% through range
Being on inadequate dose levo results in low stomach acid and poor nutrient absorption
Essential to maintain OPTIMAL vitamin levels
Meanwhile she will need full iron panel test via GP for anaemia. Most likely iron supplements
B12 so low she needs testing for pernicious anaemia before starting on B12 injections or daily B12
She must not start on folic acid or folate supplement until 48 hours after first B12 injection
Vitamin D. GP should prescribe 1600iu daily for 6 months
Thank you for such a quick reply 🙂
Yes it’s my daughter, she’s on 125mg Eltroxin and is taking the following supplements:
Symrpove, B12, iodine, ashwagana, vit c, zinc, lions mane,
Iodine not recommended for anyone on levothyroxine.
Levothyroxine contains all the iodine she needs
Iodine use to be used to treat HYPERthyroid patients
So first step is to stop iodine supplements
Retest thyroid levels again in another 8 weeks
Vitamin levels
To still have such extremely low B12 after taking B12 supplements suggests she most likely will need B12 injections
Is she vegetarian or vegan
Exactly what B12 supplement has she been taking
Get her GP to do test for Pernicious Anaemia
Once tested
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...
In-depth article on different forms of B12
perniciousanemia.org/b12/fo...
B12 range in U.K. is too wide
Interesting that in this research B12 below 400 is considered inadequate
healthunlocked.com/thyroidu...
perniciousanemia.org/b12/le...
And why aiming to keep B12 over 500 recommended
perniciousanemia.org/b12/le...
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 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 stop vitamin B complex, might want to consider taking a separate folate supplement (eg Jarrow methyl folate 400mcg) and continue separate B12 until over recommended levels
Post discussing how biotin can affect test results
Does she always get same brand levothyroxine at each prescription
Is she on strictly dairy free diet
If yes, she needs lactose free levothyroxine
Is she also on gluten free diet
Is she taking levothyroxine correctly
Levothyroxine is an extremely fussy hormone and should always be taken on an empty stomach and then nothing apart from water for at least an hour after
Many people take Levothyroxine soon after waking, but it may be more convenient and perhaps more effective taken at bedtime
verywellhealth.com/best-tim...
markvanderpump.co.uk/blog/p...
markvanderpump.co.uk/blog/p...
No other medication or supplements at same as Levothyroxine, leave at least 2 hour gap.
Some like iron, calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away
(Time gap doesn't apply to Vitamin D mouth spray)
If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test
If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal
She’s not on dairy free or gluten free diet. Has always taken Eltroxin as she had a severe reaction to the previous one they gave her after her surgery so was advised to stick to this one.
Was test early morning and last dose levothyroxine 24 hours before test
Approx how much does she weigh in kilo
125mcg is a reasonable dose
But she may simply not be on high enough dose
Or has malabsorption issues
if not vegetarian
Unexplained low folate, B12 or iron/ferritin
She needs coeliac blood test BEFORE trialing strictly gluten free diet
ask GP for coeliac blood test first as per NICE Guidelines
nice.org.uk/guidance/ng20/c...
Assuming test is negative she can immediately go on strictly gluten free diet
(If test is positive will need to remain on high gluten diet until endoscopy, maximum 6 weeks wait officially)
Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse
chriskresser.com/the-gluten...
amymyersmd.com/2018/04/3-re...
thyroidpharmacist.com/artic...
drknews.com/changing-your-d...
Non Coeliac Gluten sensitivity (NCGS) and autoimmune disease
pubmed.ncbi.nlm.nih.gov/296...
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
nuclmed.gr/wp/wp-content/up...
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
restartmed.com/hashimotos-g...
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
Post discussing gluten
![SlowDragon profile image](https://images.hu-production.be/avatars/27fbbead1f291333f83bad1f31359fe3_small@2x_100x100.jpg)
Previous post from 2 years ago with in depth replies from SeasideSusie (RIP) on your daughter’s extremely low B12 and folate
Suggest rereading
![SlowDragon profile image](https://images.hu-production.be/avatars/27fbbead1f291333f83bad1f31359fe3_small@2x_100x100.jpg)
is she breastfeeding?
Even if we frequently start on only 50mcg, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or somewhere near full replacement dose (typically 1.6mcg levothyroxine per kilo of your weight per day)
cks.nice.org.uk/topics/hypo...
bnf.nice.org.uk/drugs/levot...
Some people need a bit less than guidelines, some a bit more
TSH should be under 2 as an absolute maximum when on levothyroxine
gponline.com/endocrinology-...
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).
If she’s on roughly correct dose by weight ….then possibly looking at malabsorption issues
Coeliac
SIBO
H Pylori etc etc
academic.oup.com/edrv/artic...
Thank you for all this information, I will have a good read through it and pass it on. Much appreciated
Thanks for all the info , passed it all on. She is not breastfeeding. Spoke to gp, to incr by 25mg alternate days Repeat bloods for Vit etc in 2/52 ( not sure why waiting for two weeks) as apparently the ranges are very different here and said Vit D levels are ‘normal’ for n Ireland 🤷♀️