Blood results

[Blodders2]

Results backTsh 1.1

Ft4 21

I know these results are good but I am feeling very breathhless and my legs feel very achy and weak any idea what it could be. Thanks

[Jaydee1507 Administrator]

Can you add the reference range for the FT4? This is important as ranges vary between labs.

How long before the test did you take your last dose of Levo?

Do you do tests as per the protocol recommended here?

Recommended blood test protocol: Test at 9am (or as close as possible), fasting, last levo dose 24hrs before the blood draw & no biotin containing supplements for 3-7 days (Biotin can interfere with thyroid blood results as it is used in the testing process).

Testing like this gives consistency in your results and will show stable blood levels of hormone and highest TSH which varies throughout the day. Taking Levo/T3 just prior to blood draw can show a falsely elevated result and your GP/Endo might change your dose incorrectly as a result.

Really you need an FT3 test run which the NHS rarely if ever will do. Suggest you buy a private test to see whats happening with a full thyroid panel and testing as per protocol.

See link for companies offering private blood tests & discount codes, some offer a blood draw service at an extra cost. thyroiduk.org/testing/priva...

There is also a new company offering walk in& mail order blood tests in London, Kent, Sussex & Surrey areas. Check to see if there is a blood test company near you. onedaytests.com/products/ul...

Only do private tests on a Monday or Tuesday to avoid postal delays.

You posted some vitamin levels which looked quite low. We need OPTIMAL levels of vitamins for our thyroid hormone to work well.

Your folate was very low and B12 strangely high. High B12 can be a paradoxical high meaning its actually quite low. A B complex would raise your levels and then thyroid hormone would work better.

B complex suggestions: Slightly cheaper options with inactive B6:

amazon.co.uk/Liposomal-Soft...

Contains B6 as P5P an active form:

bigvits.co.uk/thorne-resear...

healf.com/products/basic-b-...

Explanation about the different forms of B6:

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

B complex comparison spreadsheet:

healthunlocked.com/thyroidu...

What supplements are you taking?

Vitamin D should be around 100 - 150. Buy one that includes vit K2 to help it go to your bones. Some are available in oil or you can take it with an oily meal for better absorption. Many members like the ‘Better You’ range of mouth sprays that contain both bit D & K2. Use this calculator to work out how much to take to get your level to 100-150. Most people need a minimum of 3,000iu per day.grassrootshealth.net/projec...

What was your ferritin level?

[Blodders2 in reply to Jaydee1507]

Hi Jaydee, The Reference range for FT4 11-23

Ferritin level 150.4 RANGE 20-260

I have not taken any supplements for a while but I do have some BetterYou Vitamin D 3000iu spray also Vitamin B12 Boost 1,200ug spray.

I did follow protocol for blood tests.

Thanks again for reply and information.

[Jaydee1507 Administrator in reply to Blodders2]

Next step is to get FT3 tested privately along with TSH & FT4 to check conversion. Link above for testing companies. Cheapest is Randox or Monitor My Health.

Essential to get all vitamin levels to optimal for thyroid hormone to work well.

So time to restart the supplements, likely you will need a B complex too otherwise you wont be getting any folate.

B complex suggestions: Slightly cheaper options with inactive B6:

amazon.co.uk/Liposomal-Soft...

Contains B6 as P5P an active form:

bigvits.co.uk/thorne-resear...

healf.com/products/basic-b-...

Explanation about the different forms of B6:

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

B complex comparison spreadsheet:

healthunlocked.com/thyroidu...

[Blodders2 in reply to Jaydee1507]

I asked for FT3 to be tested but no result obviously they do not test FT3.

Antibodies result - Serum thyroid peroxidase antibody concentration 14 Uml ( range less than 34) passed as "Normal".

[Jaydee1507 Administrator in reply to Blodders2]

Its rare for the NHS to test FT3, so many thousands of members here have topay for their own tests to feel well.

Privately you can also get Tg antibodies tested.

[DippyDame]

breathless and my legs feel very achy and weak

Various possibilities....

To be accurate, thyroid hormone evaluation must include both FT4 and FT3

Your results are not necessarily good!

I guess you are baseing "good" on your TSH result....TSH is not a reliable marker and it fluctuates during the day.

thyroidpatients.ca/2021/07/...

Doctor's focus on TSH often results in poor diagnosis and medication

FT4 21 (11 - 23) is high and could indicate poor T4 to T3 conversion which would result in relatively low FT3

You need an FT3 test together with FT4

High FT4 with low FT3 indicates poor T4 to T3 conversion

For good health every cell in the body must be flooded with T3 by way of an adequate and constant supply

Your symptoms could very likely be caused by low FT3

Vitamin B12 deficiency is another possibility

Are you also fatigued?

T3 supports metabolism and if deficient metabolism runs low causing a number of symptoms including fatigue and weakness.

Another role of T3 is to promote oxygen delivery to tissues. So, if you have low T3 levels your tissues may have low oxygen levels causing breathlessness

I suggest you need a full thyroid test to include...

TSH, FT4, FT3, vit D, vit B12, folate and ferritin and if not previously tested then thyroid antibodies TPOand Tg

thyroiduk.org/testing/priva...

FT3 results are inevitably key!

Good luck...we're here to help. Just ask.

[Blodders2 in reply to DippyDame]

I asked for FT3 to be tested was told that they did not think it would be but asked for it anyway, obviously it wasn't done.

Serum thyroid peroxidase antibody concentration 14 IU/mL (range less than 34.0)

Vitamin D 60nmol/L MAY 2024

Vitamin B12 909 ng/L (197 -771) May

Ferritin 150.4 ng/ml (20-260) May

Folate 4.4 ng/ml (2-18.7) May

Thank you.

[SlowDragon Administrator in reply to Blodders2]

So in May Folate and vitamin D were too low

Restart daily vitamin D and daily B complex

Retest vitamin levels in another 6-8 weeks

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

Difference between folate and folic acid

healthline.com/nutrition/fo...

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 you could take a separate folate supplement twice a week instead of B complex

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...

GP will often only prescribe to bring vitamin D levels to 50nmol.

Some areas will prescribe to bring levels to 75nmol or even 80nmol

leedsformulary.nhs.uk/docs/...

GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)

mm.wirral.nhs.uk/document_u...

But with Hashimoto’s, improving to around 80nmol or 100nmol by self supplementing may be better

pubmed.ncbi.nlm.nih.gov/218...

vitamindsociety.org/pdf/Vit...

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

Test twice yearly when supplementing

Can test via NHS private testing service

vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function.

There’s a version made that also contains vitamin K2 Mk7.

One spray = 1000iu

amazon.co.uk/BetterYou-Dlux...

It’s trial and error what dose we need, with thyroid issues we frequently need higher dose than average

Vitamin D may prevent Autoimmune disease

newscientist.com/article/23...

Web links about taking important cofactors - magnesium and Vit K2-MK7

Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Recipe ideas

bbc.co.uk/food/articles/mag...

Interesting article by Dr Malcolm Kendrick on magnesium

drmalcolmkendrick.org/categ...

Vitamin K2 mk7

betterbones.com/bone-nutrit...

healthline.com/nutrition/vi...

[Blodders2 in reply to SlowDragon]

You are so helpful. Have taken everything you said on board, started my Vitamin B and D Sprays today, will look in to adding other vitamins. Reference FT3 if I am diagnosed low would my GP be able to prescribe medication seeing as I couldnt have the FT3 blood test. I did send off to have bloods through Blue Horizon but on receipt of test read through instructions and it stated not to use if taking steroids so I had to return the kit as I am taking Prednisolone as was diagnosed with Polymialgia Rheumatica Arteritis in June. I am so fed up at the moment its the breathing problems and not being able to walk properly because of calf muscle aches and weakness. Hey Ho on we go.

[SlowDragon Administrator in reply to Blodders2]

You can test TSH, Ft4 and Ft3 when on prednisolone

TSH likely to be low or suppressed on steroids, but Ft4 and Ft3 should be reliable

GP frequently unable to test Ft3 even if they request it lab refuse

GP can not initiate T3 has to be via endo

[Blodders2 in reply to SlowDragon]

I wonder why Blue Horizon put that in the instructions, I may give them a ring. So if I am tested low for FT3 I will have to wait for an appointment with an Endocrinologist, I have never seen one since I was diagnosed in the 90s.

[SlowDragon Administrator in reply to Blodders2]

To some extent low TSH will reduce conversion rate

For good conversion of Ft4 (levothyroxine) to Ft3 (active hormone) we must maintain GOOD vitamin levels …so first step is to improve low Vitamin D and Folate

Then retest thyroid and vitamin levels in 6-8 weeks

Testing early morning, before 9am only drinking water between waking and test and last dose levothyroxine 24 hours before test

You also need to test TG antibodies

You will have to test privately

Significant minority of Hashimoto’s patients only have high TG antibodies (thyroglobulin)

Any other autoimmune diseases yourself or in your close family

20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis

thyroiduk.org/?s=Ultrasound+

Do you always get same brand levothyroxine at each prescription

Are you pre or post menopause

Conversion often gets worse after menopause

So if I am tested low for FT3 I will have to wait for an appointment with an Endocrinologist, I have never seen one since I was diagnosed in the 90s.

Waiting time for an NHS endocrinologist is over a year and if TSH and Ft4 are “normal “ referral often refused

Some ICB health areas it’s much more difficult to get T3 prescribed on NHS

See here

openprescribing.net/analyse...

Here’s link for how to request Thyroid U.K.list of private Doctors emailed to you, but within the email a link to download list of recommended thyroid specialist endocrinologists who will prescribe T3

Ideally choose an endocrinologist to see privately initially and who also does NHS consultations

thyroiduk.org/contact-us/ge...

[DippyDame in reply to Blodders2]

How do they expect us to get well if they won't do the investigative tests....madness rules in thyroid towers.

Nearly 25 years ago when I was diagnosed, FT3 was routinely tested

I'm guessing we both think FT3 is too low!!

Suggest you test privately

Basic TSH, FT4 and FT3 testing available here for £32, and get a 10% discount using the code THYROIDUK10

monitormyhealth.org.uk/thyr...

Vitamin D :low.

The Vit D Council, the Vit D Society and Grassroots Health all recommend a level of 100-150nmol/L (40-60ng/ml), with a recent blog post on Grassroots Health mentioning a study which recommends over 125nmol/L (50ng/ml).

Vit K2 should be taken with vit this directs calcium in the body to hard tissues ( bones and teeth) rather to soft tissues (arteries) where it can cause problems

Folate: low

Folate is recommended to be at least half way through range so you're looking at 35 plus with that range.

Low TPO ...thyroid autoimmune disease not suggested

[Blodders2 in reply to DippyDame]

Thank you. I am working on increasing vitamins. TPO 14 (less than34.5) Result stated normal, Thyroid autoimmune disease not suggested.

[jgelliss in reply to DippyDame]

❤👏👏👏👏

[Brightness14]

I only experience these when my FT3 is low. Weak legs and breathlessness both.

[jgelliss in reply to Brightness14]

👏👏👏👏