Medichecks test results - any advice welcome

[MushroomRisotto]

I've been on levothyroxine since June this year after my GP health check found TSH level of 16.1. Started on 25mcg as I'm over 65, increased to 50mcg in August and have my next NHS blood test next week. I've done an advanced thyroid function test with Medichecks (many thanks for the tips on here that helped me successfully get a finger prick sample on my second attempt!), results as follows (tested at 9am after overnight fasting and 24 hours since last levo dose):

TSH 4.4 (range 0.27 - 4.2) - baseline at first test was 16.1

T4 16.3 (12 - 22) - baseline 11.4

T3 3.3 (3.1 - 6.8) - no baseline

Thyroid peroxide antibodies 369 (range 0 - 34) - so clearly autoimmune

Ferritin 27.3 (range 30 - 332)

Folate 8.6 (7 - 35)

Vitamin B12 44.3 (37.5 - 187.5)

Vitamin D 148 (50 - 250) - have been supplementing 1000 IU for several years, which has clearly paid off

So TSH has dropped quite a bit but still well above 2 which I want to aim for as my GP test also identified high cholesterol. I can see that T3 is at the very low end of the range - I have no baseline as the NHS test didn't include it.

The Medichecks report unsurprisingly recommended supplementing iron, and that I should discuss this with my GP, as well as asking for a full blood count. Also that I should consider taking a B12 supplement for 3 months, and to increase my intake of folate-rich foods. And to consider a blood test for serum MMA.

I can see why I frequently feel tired! Thanks to this forum for all the recommendations to get iron and vitamin levels checked, as I wouldn't have thought of doing this otherwise.

I'll be asking my GP to up my levo dose to 75mcg - this would be slightly below the optimum dose for my weight as I'm under 8 st - and will discuss the iron and B12 levels with her and ask about the full blood count (I did have one in June though, with everything pretty well in the mid-range). Any other advice and suggestions would be most welcome, particularly about iron and B12 supplementation.

Thanks in advance.

[Regenallotment Ambassador]

Yes as you say due an increase.

Before supplementing B12 ask GP to test for Pernicious Anaemia as it’s common to have this with Hashimoto’s, some are also coeliac so why not ask for all at once. The MMA test would be part of that as would a test for intrinsic factor and a gastro investigation too.

Low ferritin will make you feel dreadful, read up on IDWA, (Iron Deficiency Without Anaemia) it’s when stores are used up but you don’t present as classically anaemic. Similar symptoms. Popular supplement that works well is Three Arrows heme iron repair, heme doesn’t have the dietary absorption foibles of iron biglycinate or symptoms of ferrous fumarate. You can also look at dietary iron but with ferritin as low as yours that’ll be too much liver and kale to be healthy.

Actually, are you or have you been veggie or vegan?

When you do start B12 look for methylated versions and follow this with an L methyl folate not a folic acid (there is a cracking video knocking around that explains this, I’ll try to edit it in when I find it again).

Hope the appointment goes well! 🌱

[MushroomRisotto in reply to Regenallotment]

Thanks - that's very helpful especially the advice about IDWA, which I'll certainly read up on. I had a full blood test in June which didn't flag up any issues. Yes, I am veggie and have been for many years, which would make it even more impractical to add enough dietary iron.

[Regenallotment Ambassador in reply to MushroomRisotto]

Aha and so you’ve depleted the B12 reserves that recycle in the body… bear with video even more relevant, will edit and post link 🏃‍♀️

Edit:

vimeo.com/891099138/4150efa06b

There you go, so much in this, I need to watch again and take notes 📝

[MushroomRisotto in reply to Regenallotment]

Thanks - I'll find a quiet hour and also make some notes. I want as clear as possible understanding of what I need from my GP before I speak to her, and also to try and have a face to face consultation rather than the usual telephone call offered after test results.

[SlowDragon Administrator]

as a vegetarian you should ALWAYS supplement B12 daily

But your B12 is extremely low

Recommend you insist on testing for PA first

[MushroomRisotto in reply to SlowDragon]

Thanks - this reinforces the advice from Medichecks - I will

[SlowDragon Administrator in reply to MushroomRisotto]

once GP has tested for PA …..assuming it’s ruled out and low because of your diet

GP may offer B12 injections

If not you need B12 daily

academic.oup.com/nutritionr...

The present review of the literature regarding B12 status among vegetarians shows that the rates of B12 depletion and deficiency are high. It is, therefore, recommended that health professionals alert vegetarians about the risk of developing subnormal B12 status. Vegetarians should also take preventive measures to ensure adequate intake of this vitamin, including the regular intake of B12 supplements to prevent deficiency.

Considering the low absorption rate of B12 from supplements, a dose of at least 250 μg should be ingested for the best results.3

NICE guidelines on B12 and testing

healthunlocked.com/redirect...

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 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

Post discussing how biotin can affect test results

healthunlocked.com/thyroidu...

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

[MushroomRisotto]

Thanks so much for all that info - I'll read carefully and also summarise for vegetarian friends and relatives