Help with blood results please

[Littlebuddha]

I've recently received my results from Medicheck and I wondered if someone would be kind enough to decipher them for me please?! I am currently taking 25mcg levothyroxine daily, have been for some years now! TIA

[SlowDragon Administrator]

was test done early morning, ideally just before 9am, only drink water between waking and test and last dose levothyroxine 24 hours before test

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

What is your TSH

You need immediate 25mcg dose increase in levothyroxine and retest in another 6-8 weeks

Which brand levothyroxine are you taking

ESSENTIAL to test vitamin D, folate, ferritin and B12

What vitamin supplements are you taking

When were vitamins last tested

Low vitamin levels likely as direct result of being left on inadequate dose levothyroxine

Low vitamin levels tend to lower TSH

How old are you

Standard STARTER dose levothyroxine is 50mcg

Guidelines of dose Levo by weight

approx how much do you weigh in kilo

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...

nhs.uk/medicines/levothyrox...

Adults usually start with a dose between 50 micrograms and 100 micrograms taken once a day. This may be increased gradually over a few weeks to between 100 micrograms and 200 micrograms taken once a day.

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).

[Littlebuddha in reply to SlowDragon]

Thank you so much for prompt reply. Yes test was done before 9am and only a glass of water taken before test. My TSH is 6.09. Don't take any vitamins, very first time I've had them tested. Vit D is 45.9, Folate serum is 8.7 and B12 is 52.8. I'm 67.5 years old. I weigh too much!! Approx 90 kilos! The brand of levothyroxine I take is Wockhardt. My GP was having none of it when I questioned my results, told me everything was normal !!!

[SlowDragon Administrator in reply to Littlebuddha]

see different GP with these results

On Levo TSH should ALWAYS be low in range…..ideally around one, definitely below 2

Appalling lack of care from your current GP

Politely but firmly INSIST on increase in dose Levo to 50mcg daily

Vitamin levels

No ferritin result?

Vitamin levels are poor as direct result of being left on inadequate dose levothyroxine

Only add one supplement at a time

Then wait 10-14 days to assess any changes before adding another

Start improving vitamin D first

Then magnesium

Then B12

Then vitamin B complex

[Littlebuddha in reply to SlowDragon]

I didn't get to see a GP! It was a telephone consultation, I asked him to go through my results, he just more or less said there is nothing to discuss as the results are normal, you need to be more bothered about being borderline type 2 diabetic and put the phone down on me! I havent seen or heard from a GP since, just keep re ordering my levothyroxine and venlafaxine and I get them with no questions asked! I'm sure there was a ferritin result, il get back to you on that one.

[SlowDragon Administrator in reply to Littlebuddha]

So can you make an appointment with different GP

Email or post copy of results in

Explain that you are still only on 25mcg dose Levo

Tgat you have of hypothyroid symptoms

List all that apply (but don’t mention weight as main issue)

Symptoms of hypothyroidism

thyroiduk.org/signs-and-sym...

Blood sugar issues likely to improve significantly once you are on higher dose levothyroxine

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

Baseline HbA1c levels were found to be significantly higher in hypothyroid patients, which reduced significantly after achievement of euthyroidism without any change in glucose levels

Print out guidelines on dose Levo

cks.nice.org.uk/topics/hypo...

The NICE clinical guideline recommends:

Consider starting LT4 at a dosage of 1.6 micrograms per kilogram of bodyweight per day (rounded to the nearest 25 micrograms) for adults under 65 years of age with primary hypothyroidism and no history of cardiovascular disease.

Consider starting LT4 at a dosage of 25–50 micrograms per day with titration for adults aged 65 years and over, and adults with a history of cardiovascular disease.

The British National Formulary (BNF) recommends:

For adults aged 18–49 years — initially 50–100 micrograms once daily; adjusted in steps of 25–50 micrograms every 3–4 weeks, adjusted according to response; maintenance 100–200 micrograms once daily.

For adults aged 50 years and over, with cardiovascular disease, or severe hypothyroidism — initially 25 micrograms once daily; adjusted in steps of 25 micrograms every 4 weeks, adjusted according to response; maintenance 50–200 micrograms once daily.

Request “trial” increase to 50mcg

As you currently take Wockhardt, they only make 25mcg tablets so request prescription is increased to 2 x 25mcg tablets per day

If you still can’t get dose increase from new GP

See endocrinologist or thyroid specialist doctor

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

Ideally choose an endocrinologist to see privately initially and who also does NHS consultations so that might eventually transfer to getting T3 on NHS

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

[SlowDragon Administrator in reply to Littlebuddha]

Vitamin D 45.9nmol

GP should prescribe 1600iu everyday for 6 months, but you’re better off just taking supplements yourself

NHS Guidelines on dose vitamin D required

panmerseyapc.nhs.uk/media/2...

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 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

Suggest you start on 2 or 3 sprays per day - that’s 2000-3000iu daily

Retest in 3-4 months

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...

[SlowDragon Administrator]

Suggest you reread previous post of yours from 4 years ago

With very similar results

healthunlocked.com/thyroidu...

Utterly outrageous that dose wasn’t increased to 50mcg after testing 4 years ago

Most people on levothyroxine, when adequately treated will have Ft4 (levothyroxine) at least 60-70% through range

Currently your Ft4 is BELOW RANGE confirming you need dose increase to 50mcg now

Retest in 2-3 months

Likely to need several further increases in levothyroxine over coming months

[SlowDragon Administrator]

Folate serum is 8.7 and

Active B12 is 52.8.

With active B12 below 70 (or serum B12 result below 500) recommended to be taking a separate B12 supplement

Then

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...

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 and may need separate methyl folate couple times a week

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 until Active B12 at least over 70 minimum

Post discussing how biotin can affect test results

healthunlocked.com/thyroidu...

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

[Littlebuddha in reply to SlowDragon]

Ferritin is 233.

[SlowDragon Administrator in reply to Littlebuddha]

So ferritin is fine

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.

[Littlebuddha in reply to SlowDragon]

Thank you so much again, for taking the time out to respond to me so quickly. I've sat here and had a good cry!!!! Ive certainly got a lot of reading and homework to do, thank you. I will be sending my results of to the practice, with the hope that it leads to a face to face appointment. Enjoy the rest of your weekend.

[SlowDragon Administrator in reply to Littlebuddha]

Make sure to include

A) that you have been left on only 25mcg levothyroxine for years

B) list of your symptoms

C) copy of recent test results

Request trial increase in dose of levothyroxine to 50mcg daily as per NHS guidelines

[Jazzw]

You’ve been on 25mcg for years? For goodness sake!

I’m so sorry. You’ve been horribly let down by your miserable excuse for a GP. They’ve made you ill. It’s unforgivable.

[Littlebuddha in reply to Jazzw]

Thank you for your response. I've actually been saving up to have a private blood test done, it's taken me over two years to do this, I'm a pensioner and a widow and sometimes other things have taken priority. I'm now armed with all the tools I need, with the blood test and Snapdragons' incredible information, the battle starts !!!!

[Littlebuddha in reply to Littlebuddha]

#SlowDragon# sorry

[fairgo45]

Given these results, it might suggest subclinical hypothyroidism due to the low Free T4, especially if symptoms align, but antibody levels do not point toward autoimmune thyroiditis like Hashimoto's.

[SlowDragon Administrator in reply to fairgo45]

She’s already diagnosed as hypothyroid, but been left inappropriately on just 25mcg levothyroxine for years

20% of Hashimoto's patients never have raised antibodies

So an ultrasound might be useful eventually

healthunlocked.com/thyroidu...

Paul Robson on atrophied thyroid - especially if no TPO antibodies

paulrobinsonthyroid.com/cou...

[Maggiet]

I could have cried reading your post. Your treatment has been non-existent and you have been left to get ill- unforgivable. If you feel up to it, you could also contact the practice manager and the local health authority to complain. Good luck - you have been given excellent advice on here xx

[Littlebuddha in reply to Maggiet]

Thank you Maggiet, in some respects it's my own fault! I havent felt well for a long time but just kept pushing through. It's impossible to get through to our GP's and after my last experience, I was totally put off and tbh just don't trust them xx I have been given excellent advice, it's a fantastic site. My battle starts today!!! Xx

[Maggiet in reply to Littlebuddha]

Good for you! I’m afraid that these days you have to shout from the rooftops and push for what you need. Good luck x

[Littlebuddha in reply to Maggiet]

Thank you, think I'm going to need all the luck I'm given!!! Its sods law, the GP system is down for the whole of the country!!!!! Not going to deter me though, I'm taking my dog to the groomers, then I'm going into the practice xx

[Maggiet in reply to Littlebuddha]

Great stuff - you may have to push quite a bit so be prepared for that which I think you are now that you’re armed with all the information from here!