latest blood results…grateful for any thoughts/... - Thyroid UK

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latest blood results…grateful for any thoughts/advice

JoJoloveschocolate profile image

**** I have posted screen-shots of recent results from Aug 2024 in the comments.

Bit of a cock-up with timings - so it was a non-fasting, blood test taken about 7 hours after I’d had my levo (87.5mcg, been on that dose since April 2024. I’m also on HRT Evorel Sequi patches 50) - doesn’t seem to have affected my TSH as my last NHS tsh not so long ago in July 2024 was around 0.8 too. Interesting to see how high my t4 was at about 7 hours after taking the levo.

Past info below (new results in comments):

Last MMH thyroid results done before this new test done in July 2024 t4 17.3 Last t3 before this = 3.7.

Should I be worried about the high b12? I don’t take any b12 supplements at all or folate. I take a low dose vitd (with zinc, vit c, selenium).

My ferritin has gone up a bit!

(Past info below taken 10 Jan 2024with Medichecks:

ferritin 21.4 (30-264) (nhs test last year, prior to this Medichecks one was 30);CRP 3.6 (7);Active b12 >150 (37.5-188):Vit d 82.3 (50-250) )

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JoJoloveschocolate
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JoJoloveschocolate profile image
JoJoloveschocolate

Bloods Aug 2024

aug 2024
JoJoloveschocolate profile image
JoJoloveschocolate

Aug 2024

Aug 2024
JoJoloveschocolate profile image
JoJoloveschocolate

Aug 2024

Aug 2024
JoJoloveschocolate profile image
JoJoloveschocolate

sorry if it’s too much info - my head is all over the show just lately!

SlowDragon profile image
SlowDragonAdministrator

I don’t take any b12 supplements at all or folate

Your folate is too low

Suggest you start taking daily 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

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 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

healthunlocked.com/thyroidu...

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

JoJoloveschocolate profile image
JoJoloveschocolate in reply toSlowDragon

Thanks SD. Why do I need to improve B12 when my B12 is above the normal range? What should B12 and Folate be?

SlowDragon profile image
SlowDragonAdministrator in reply toJoJoloveschocolate

sorry …I have edited folate reply

B12 likely high because folate low

Starting a daily Vitamin B complex should keep them all in balance

To use B vitamins they all need to be present

humanbean profile image
humanbean in reply toSlowDragon

SlowDragon, You've misread the folate result. It's actually very high. The range is >7 and the result is > 45.

Jojoloveschocolate : Do any of your supplements contain folic acid? What kind of folate are you taking - and in what form and dose? Your high levels suggests that your body might not be metabolising folate very well or that you are taking an overdose.

Folic acid is something that should be avoided because a lot of people can't metabolise it well, and high levels of unmetabolised folic acid in the blood stream are not a good idea. See this paper :

mdpi.com/2072-6643/15/21/4699

Your B12 is fine according to the range provided. Over the range levels are not a problem. The range is very low though, as is so often the case in the UK. Some links on the subject :

perniciousanemia.org/b12/le...

perniciousanemia.org/b12/le...

I read once that the Serum B12 range in Japan was something like 500 - 1300. People with levels below 500 in Japan are treated for deficiency. In the UK we're lucky if the top of the range even reaches 600.

The best form of supplement for B12 for most people is methylcobalamin although some do prefer one of the others. There are four different types in general use either in tablets/capsules or as injections.

perniciousanemia.org/b12/fo...

SlowDragon profile image
SlowDragonAdministrator in reply tohumanbean

Yes…whoops….i did misread that as result being 7

Odd to have high folate if NOT taking any supplements

humanbean profile image
humanbean in reply toSlowDragon

Yes it is. Although supplementing high doses of folic acid would do it.

JoJoloveschocolate profile image
JoJoloveschocolate in reply tohumanbean

I’m not taking any folic acid meds/tablets, HB. Do you mean like a multivitamin or tablet supplement type thing? The only multi i take is one with selenium, vit d, vit c and zinc. Why do you think the folate is high? Could it be something in my diet? Why is it odd - out if interest, please

humanbean profile image
humanbean in reply toJoJoloveschocolate

The range is > 7. Your result is > 45.4 nmol/L. That is high.

Perhaps your result is high because you regularly eat some food which is fortified with folic acid, but I can't tell.

Doctors treat women who are planning pregnancy or are pregnant already or patients with a deficiency with tablets containing 5mg per day folic acid. But not everyone can metabolise folic acid - roughly 50% of the global population can't metabolise it very well, or they metabolise it very slowly, causing it to build up in the blood. Folic acid is artificial and was first developed in 1943. The human body was actually built to make use of folate not folic acid.

The reason I said that your high result is odd is because many people can't maintain a good level of folate because it is water soluble and needs to be eaten in the diet very regularly. The body doesn't have a place to store folate for future use so it must be topped up often.

JoJoloveschocolate profile image
JoJoloveschocolate in reply tohumanbean

Thank you. I eat a fortified breakfast cereal every day - about half a bowl full (ordinary size bowl though … not washing up bowl🤣)

SlowDragon profile image
SlowDragonAdministrator in reply toJoJoloveschocolate

Fortified cereal……That would explain it

JoJoloveschocolate profile image
JoJoloveschocolate in reply toSlowDragon

Ah, ok. Thanks for all the help and advice.Should I change cereal to something else? It’s fortified gf bran flakes. I started it because it was gf and had iron in it too.  SlowDragon  humanbean

humanbean profile image
humanbean in reply toJoJoloveschocolate

What, specifically, is it fortified with?

JoJoloveschocolate profile image
JoJoloveschocolate in reply tohumanbean

iron, niacin, pantothenic acid, vit d3, riboflavin, vit b6, thiamine mononitrate, folic acid, vit b12

SlowDragon profile image
SlowDragonAdministrator

Ferritin still far too low

Likely linked to very low Ft3

Are you vegetarian or vegan

Pre or post menopause

What iron supplements are you taking

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

Medichecks iron panel test

medichecks.com/products/iro...

Look at increasing iron rich foods in diet

Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption

List of iron rich foods

dailyiron.net

Links about iron and ferritin

irondisorders.org/too-littl...

davidg170.sg-host.com/wp-co...

Great in-depth article on low ferritin

oatext.com/iron-deficiency-...

drhedberg.com/ferritin-hypo...

This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.

healthunlocked.com/thyroidu...

Posts discussing Three Arrows as very effective supplement

Great replies from @FallingInReverse

re ferritin and Three arrows

healthunlocked.com/thyroidu......

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Great reply by @fallinginreverse

healthunlocked.com/thyroidu...

Iron patches

healthunlocked.com/thyroidu...

Thyroid disease is as much about optimising vitamins as thyroid hormones

healthunlocked.com/thyroidu...

restartmed.com/hypothyroidi...

Post discussing just how long it can take to raise low ferritin

healthunlocked.com/thyroidu...

Iron and thyroid link

healthunlocked.com/thyroidu...

Posts discussing why important to do full iron panel test

healthunlocked.com/thyroidu...

Good iron but low ferritin

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Chicken livers if iron is good, but ferritin low

healthunlocked.com/thyroidu...

Shellfish and Mussels are excellent source of iron

healthline.com/nutrition/he...

Iron deficiency without anaemia

healthunlocked.com/thyroidu...

Ferritin over 100 to alleviate symptoms

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Great research article discussing similar…..ferritin over 100 often necessary

ncbi.nlm.nih.gov/pmc/articl...

Low Iron implicated in hypothyroidism

healthunlocked.com/thyroidu...

Really interesting talk on YouTube, link in reply by Humanbean discussing both iron deficiency and towards end how inflammation can also be an issue

healthunlocked.com/thyroidu...

Inflammation affecting ferritin

healthunlocked.com/thyroidu...

Updated reference ranges for top of ferritin range depending upon age

healthunlocked.com/thyroidu...

Thank you for your incredible patience while you have been awaiting the outcome of our ferritin reference range review. We conducted this with Inuvi lab, which has now changed the reference ranges to the following:

Females 18 ≤ age < 40. 30 to 180

Females 40 ≤ age < 50. 30 to 207

Females 50 ≤ age < 60. 30 to 264l

Females Age ≥ 60. 30 to 332

Males 18 ≤ age < 40 30 to 442

Males Age ≥ 40 30 to 518

The lower limits of 30 are by the NICE threshold of <30 for iron deficiency. Our review of Medichecks data has determined the upper limits. This retrospective study used a large dataset of blood test results from 25,425 healthy participants aged 18 to 97 over seven years. This is the most extensive study on ferritin reference ranges, and we hope to achieve journal publication so that these ranges can be applied more widely.

JoJoloveschocolate profile image
JoJoloveschocolate in reply toSlowDragon

Thank you, SD. I’m not vegan/vegetarian. I’m not sure where I am in the menopause. I think I might be post meno, but I have withdrawal bleeds from sequential hrt - these have been a lot lighter recently though. I’m not taking any iron supplements and was trying to address it through diet but that seems to have only shifted it up about 9 points from my last medichecks test. Do you think my t3 level is classed as very low then?

SlowDragon profile image
SlowDragonAdministrator in reply toJoJoloveschocolate

Yes Ft3 is very low. Most people find they need Ft3 at least over 5-5.8

Improving B vitamins and improving ferritin to at least around 70 may help improve conversion rate

If not, then likely to need addition of T3 prescription alongside levothyroxine

JoJoloveschocolate profile image
JoJoloveschocolate in reply toSlowDragon

Thanks, SD. I was diagnosed hypo May last year and have been slowly increasing levo. Now up to 87.5mcg which has dropped my tsh to 0.8. I’m seeing a thryoid specialist at the end of the month and was thinking of asking for a poss trial of T3 along with my levo. Do you think it’s too soon to ask to try T3?

SlowDragon profile image
SlowDragonAdministrator in reply toJoJoloveschocolate

I think you need to try to improve iron/ferritin first

Have you had full iron panel test

Are you on gluten free or dairy free diet

JoJoloveschocolate profile image
JoJoloveschocolate in reply toSlowDragon

Thanks. I am gluten free. I haven’t had a full iron test. But would T3 help to improve the ferritin?

SlowDragon profile image
SlowDragonAdministrator in reply toJoJoloveschocolate

Next step get full iron panel

See if iron is low or not

Ideally always get all four vitamins at optimal levels BEFORE considering T3

JoJoloveschocolate profile image
JoJoloveschocolate in reply toSlowDragon

Ok, thank you, SD. Getting the ferritin up is slow going.

SlowDragon profile image
SlowDragonAdministrator in reply toJoJoloveschocolate

Many members do well on Three Arrows iron supplement but you MUST get full iron panel test BEFORE considering iron supplement

Once vitamin levels are good you will probably be able to increase levothyroxine a bit more

Approx how much do you weigh in kilo

JoJoloveschocolate profile image
JoJoloveschocolate in reply toSlowDragon

Ok. Will do. I’ll ask about the iron panel. I weigh 90kg. Lots of things are better with the levo and I do have some “good days” now when my energy is great, but then I seem to just run out of steam again. Also I have developed raynauds and it seems to be getting worse again even though the weather is still fairly warm here. People have said my conversion does not look great.

SlowDragon profile image
SlowDragonAdministrator in reply toJoJoloveschocolate

Yes currently very poor conversion

Low ferritin tends to result in lower TSH making it harder to get dose levothyroxine increase

Would GP allow increase in dose to 100mcg 3 days per week and 87.5mcg 4 days

Guidelines on dose Levo at 1.6mcg per kilo of your weight per day …suggests you likely EVENTUALLY need significantly higher dose at approx 144mcg

Always worth trying dairy free diet too

JoJoloveschocolate profile image
JoJoloveschocolate in reply toSlowDragon

I’m seeing a thyroid gp at the end of the month so I can ask her about an increase. I’ll ask about iron panel re: ferritin level too. I better ask her about my high folate too while I’m at it! Can’t win. 144mcg! lol … probably take me twenty years to get there 🤣

SlowDragon profile image
SlowDragonAdministrator in reply toJoJoloveschocolate

You obviously can ask/discuss adding T3

Have you considered getting Dio2 gene testing done

Regenerus now offer a more general DNA test including Dio1 and Dio2

regeneruslabs.com/products/...

portal-app.inspira-regeneru...

portal-app.inspira-regeneru...

JoJoloveschocolate profile image
JoJoloveschocolate in reply toSlowDragon

Thank you ror all your help, SD. I really appreciate it. I have been thinking about Dio 2 gene testing. I’ll see what hapoens at my appointment and then go from there. It’s sooo hard trying to get everything aligned…tsh, t4, t3, ferritin, vit d, folate, b12, selenium, sex hormones, cortisol, diet, magnesium, iron, conversion, a good gp/endo, the moon and the stars!! 💫

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