blood results

[Safiktm]

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.

[SlowDragon Administrator]

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

[Safiktm in reply to SlowDragon]

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,

[SlowDragon Administrator in reply to Safiktm]

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

healthunlocked.com/thyroidu...

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

[SlowDragon Administrator in reply to Safiktm]

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

[Safiktm in reply to SlowDragon]

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.

[SlowDragon Administrator in reply to Safiktm]

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

healthunlocked.com/thyroidu...

[SlowDragon Administrator]

Previous post from 2 years ago with in depth replies from SeasideSusie (RIP) on your daughter’s extremely low B12 and folate

Suggest rereading

healthunlocked.com/thyroidu...

[SlowDragon Administrator]

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...

[Safiktm in reply to SlowDragon]

Thank you for all this information, I will have a good read through it and pass it on. Much appreciated

[Safiktm in reply to Safiktm]

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 🤷‍♀️