advice please

[Scavendi]

Hi

I have graves disease and been treated since I was diagnosed in 2014.

I take low dose of carbimazole alternate days and had a blood test at 9am a couple of days ago. Normally the GP will only ask the lab for TSH, but this was a 'well woman' check up so the lab also did T4 and T3.

I ws a bit concerned as the T4 seemed a bit high, though the TSH is fine, so would be grateful for any advice please.

serum TSH level 0.41 miu/L (0.3 - 5.5)

Serum free T4 level 20.8 pmol/L (12.0 - 22.0)

serum free triiodothyronine level 4.4 pmol/L (3.1 - 6.8)

Should I increase the carbimazole?

thank you

Scavendi

[RedApple Administrator]

Those results do not suggest an increase in carbimazole is needed.

TSH is above bottom of range. FT4 is below top of range. FT3 is well below top of range.

How do you feel, any symtoms worrying you?

[Scavendi in reply to RedApple]

Hi

thanks for your reply. I do feel the cold a lot, and also very tired - constantly fall asleep in the middle of tv films! Maybe due to getting older though!

[RedApple Administrator in reply to Scavendi]

What is your current dose of carbimazole?

[SlowDragon Administrator]

when did you last test vitamin D, folate, B12 and ferritin levels

What vitamin supplements are you taking

[Scavendi in reply to SlowDragon]

Hi

I take zinc ( my hair is thining etc), Calcichew (as I have osteoporosis)

vitamin D July2023 = 73nmol/L (50 -200)

folate Aug 2023 = 5.6 ug/L (3.1 -20)

vitamin B12 Aug 2023 = 360 ng/L (187-883)

ferritin Sep 2024 106 ug/L (30-400)

[SlowDragon Administrator in reply to Scavendi]

vitamin D might be better nearer 100nmol

How much vitamin D are you taking

And adding separate magnesium might be helpful

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...

B vitamins

B12 and folate are both too low

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 you stop vitamin B complex, you might want to consider taking a separate folate supplement (eg Jarrow methyl folate 400mcg) and continue separate B12

Post discussing how biotin can affect test results

healthunlocked.com/thyroidu...

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

[Scavendi in reply to SlowDragon]

Thank you for all the information - Lots to look at