I am seeing GP tomorrow regarding latest blood tests. Currently take 125mg levothyroxine.
TSH 0.32 (-65%) 0.35-4.94
T4 15.3 (62.38%) 9-19.1
T3 4.3 (52.78%) 2.4-6.0
TSH was flagged as Abnormal so GP will mention that - it was 1.08 in Feb and 1.25 last October (same ranges) but no T4 or T3 tested.
They did not test B12, folate or Vitamin D but when tested in Feb 24 B12 was 508 (200-900).
Folate was 14.9 (3-20.5) up from 2.3 in December 23 after 3 months of prescribed folate. Always low otherwise.
Vitamin D was 83 (50-200) - I take Better You spray daily 3000+K2.
I will restart a B complex again as I feel folate and B12 are low again.
I have been on HRT for two years. Have had to adjust amount and GP receptive to me not reducing down from 125g of levothyroxine when I started HRT and TSH was 0.22 (0.35-4.78). TSH had risen in subsequent tests and this is first time it has been flagged since.
I am coeliac and strictly gluten free and drink lactose free milk/avoid high lactose.
I need to restart taking magnesium as I am getting leg and feet cramps.
Basically, I hope I will be correct in saying to GP that I would like to stay on same dose as apart from the slightly out of range TSH, the other results are within range.
The only other thing that was flagged as abnormal was Haematocrit 0.369 (0.37-0.47) and Mean corpus. Hb conc (MCHC) 352 (290-350) but I'm not familiar with what that may mean.
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Pooky1
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High MCHC can be low iron, ferritin or B12 or folate
Many many members find they need to take daily vitamin B complex indefinitely
Some of us find we might need extra folate 1-2 days a week as well
And magnesium daily as well. Best taken at bedtime (or early evening if you take levothyroxine at bedtime)
Refuse to reduce dose levothyroxine ….if anything you might need dose increase
Rather than only cutting lactose, you may need to be dairy free.
Which brand levothyroxine are you taking
On dairy free diet you likely do better on lactose free Levo
Lactose free brands - currently Teva or Vencamil only
Teva makes 25mcg, 50mcg, 75mcg and 100mcg
Many patients do NOT get on well with Teva brand of Levothyroxine.
Teva is lactose free.But Teva contains mannitol as a filler instead of lactose, which seems to be possible cause of problems. Mannitol seems to upset many people, it changes gut biome
Teva is the only brand that makes 75mcg tablet.
So if avoiding Teva for 75mcg dose ask for 25mcg to add to 50mcg or just extra 50mcg tablets to cut in half
But for some people (usually if lactose intolerant, Teva is by far the best option)
Vencamil (currently 100mcg only) is lactose free and mannitol free. 25mcg and 50mcg tablets hopefully available from summer 2024
If a patient reports persistent symptoms when switching between different levothyroxine tablet formulations, consider consistently prescribing a specific product known to be well tolerated by the patient.
Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).
I had iron study done in May (and February). I take 210 ferrous fumerate every other day Ferritin reads high but I think this is due to inflammation.
May -
Serum iron 14 (9-30)
Transferrin 2.72 (1.80-3.82)
Transferrin Sat Index 20% (15-50)
Ferritin 116 (30-250)
Feb -
Serum iron 10
Transferrin 2.67
TSI 14% (Abnormal)
Ferritin 105
There is a condition call anemia of chronic disease. I wonder if I could have that as I have at least 3 autoimmune diseases.
The 100 levo is Mercury, the 25 is Wockhardt. I will mention the lactose to go. At present, I feel it is amount of lactose that causes me problems but appreciate I may have to cut it out completely (but already feel better just using lactose free milk etc and avoiding high lactose foods).
I will restart B complex (I stopped as I thought it was making my rosacea prone face even more red - which I think is one of the Bs?) Will get one with methyl folate in. Will also restart magnesium. I stopped all above as was hoping they would be tested this time)
Am off to my appointment soon armed with all your helpful knowledge. Will say I would like to stay on current dose. Thanks again.
If GP says " I have to reduce your dose because the guidelines say i can't let you have a below range TSH" .....
The first paragraph in the NICE (NHS) Thyroid Disease, Assessment and Management guidelines says :
nice.org.uk/guidance/ng145
"Your responsibility
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with themand their families and carers or guardian. "
Request GP test full iron panel including ferritin
"Anaemia is defined as a haemoglobin (Hb) level two standard deviations below the normal for age and sex.
In men aged over 15 years — Hb below 130 g/L.
In non-pregnant women aged over 15 years — Hb below 120 g/L.
In children aged 12–14 years — Hb below 120 g/L.
In pregnant women — Hb below 110 g/L throughout pregnancy. An Hb level of 110 g/L or more appears adequate in the first trimester, and a level of 105 g/L appears adequate in the second and third trimesters.
Postpartum — below 100 g/L."
diagnosis is confirmed (following the Hb result) by a ferritin<30.
Serum ferritin level is the biochemical test, which most reliably correlates with relative total body iron stores. In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency
The reason is says "in all people" is because the hb levels are differentiated for sex and pregnancy status, but ferritin is not.
NHS follows Nice guidance, The cks are from NICE, and NICE guides NHS practice.
.
Never supplement iron without doing full iron panel test for anaemia first and retest 3-4 times a year if self supplementing.
It’s possible to have low ferritin but high iron
Test early morning, only water to drink between waking and test. Avoid high iron rich dinner night before test
If taking any iron supplements stop 5-7 days before testing
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)
Post discussing how biotin can affect test results
I always test before 9am and make sure to not take my levothyroxine. I have been making adjustments with HRT patch (50 not enough and 75 too much so settled on 62.5) so maybe that has affected it.
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