Latest Bloods on Trialing T3. Thoughts please

[helenshubby]

Apols for the length of this but these are 3 recent blood tests Helen had between August and November. The August dated result was taken before Helen started treatment with B Complexes, VitD & K2 and T3. I will summarise my thoughts at the end and would welcome comments from those who have become acquainted with my previous entries. Thanks.

Blue Horizon Gold Well Woman Test August

Sex: Female

Sample Dated: 13-08-2024 09:05 AM

Sample Received: 15-08-2024 12:45 PM

Result Reported: 21-08-2024 01:20 PM

Sample Type: EDTA Blood (Venous), Serum (Venous), Serum trace

elements (Venous)

TEST RESULT NORMAL RANGE UNITS COMMENT

HAEMATOLOGY

Full Blood count

Red Blood Cells 4.22 (3.80 - 5.80) x10^12/L

Haemoglobin 126 (120 - 160) g/L

Haematocrit L/L 0.444 (0.350 - 0.470)

H Mean Cell Volume 105.2 (81 - 98) fL Above Range

Mean Cell Hb 29.9 (7.0 - 33.0) pg

L MCHC g/L 284 (300 - 350) Below Range

H Red Cell Distribution 14.8 (11.5 - 14.4) % Above Range

White Blood Cells 3.8 (3.0 - 10.0) x10^9/L

L Neutrophils 1.9 (2.0 - 7.5) x10^9/L Below Range

Lymphocytes 1.53 (1.2 - 3.65) x10^9/L

Monocytes 0.3 (0.2 - 1.0) x10^9/L

Eosinophils 0.08 (0 - 0.4) x10^9/L

Basophils 0.0 (0 - 0.1) x10^9/L

Platelets 241 (150 - 400) x10^9/L

MPV 9.80 (7.00 - 13.00) fL

Comments: Sample received between 48-72 hours. Please interpret red cell indices with caution due to sample age.

Sodium 143 (133 - 146) mmol/L

Urea 5.00 (2.5 - 7.8) mmol/L

Creatinine 81 (45 - 84) µmol/L

eGFR 67* mL/min/1.73 m2 (> 60 unless evidence of CKD)

ALP 113 (30 - 130) IU/L

ALT 18 (<35U)

Total Bilirubin 8 (<21) µmol/L

GGT 15 (5 - 36) U/L

Albumin 44 (35 - 50) g/L

Total Protein 73 (60 - 80) g/L

Globulin 29* (19 - 35) g/L

Calcium 2.29 (2.2 - 2.55) mmol/L

Corrected Calcium 2.22* (2.2 - 2.55) mmol/L

Vitamin D (25 OH) 78 (50 - 200) nmol/L

Optimal 75-200 Adequate 50-<75 Insufficient 25 -<50 Deficient <25

Uric Acid 242 (140 - 360) µmol/L

H Cholesterol 6.89 (0 - 5.0) mmol/L Above Range

Desirable:

HDL 1.7 (>1.2mmol/L)

H* LDL 4.4 (<3.0) mmol/L Above Range

Triglycerides 1.7 (<1.7(Fasting)) mmol/L

Experts advise a non-fasting triglyceride level below 2.3mmol/L. Fasting triglyceride (10-14 hours) should be below 1.7mmol/L.

H* Non HDL Cholesterol 5.18 (<4) mmol/L Above Range

H* Chol:HDL ratio 4.03 (<4.0) Above Range

CK 95 (26 - 192) U/L

HbA1c 39* (20 - 42) mmol/mol

20 - = 48 Diabetes 48 - 59 Good control

H Magnesium 1.1 (0.7 - 1.0) mmol/L Above Range

CRP (High Sensitivity) 1.23 (0 - 5) mg/L

Iron 16.4 (5.8 - 34.5) µmol/L

UIBC 37.3 (24.2 - 70.1) µmol/L

TIBC 54* (45 - 81) µmol/L

Transferrin Saturation 30.5* (20 - 50) %

H Ferritin µg/L 365.00 (13 - 150) Above Range

Ferritin is the most useful indicator of iron deficiency, but also an acute phase reactant and may be elevated in malignancy, chronic inflammation, liver damage and iron overload

Serum Folate 58.60 (8.83 - 60.8) nmol/L

H Active B12 >150 (37.5 - 150) pmol/L Above Range

TSH 1.53 (0.27 - 4.20) mIU/L

Free T4 20.2 (12.0 - 22.0) pmol/L

Free T3 4.4 (3.1 - 6.8) pmol/L

T4 Total 133.0 (66 - 181) nmol/L

H Anti-Thyroglobulin Abs 123 (<115) IU/mL Above Range

H Anti-Thyroidperoxidase abs 434.0 (<34) IU/mL Above Range

Cortisol (Random) 320.0* (73.8 - 507.0) nmol/L

6am - 10am (166 - 507) 4pm - 8pm (73.8 - 291)

CA 125 15.0 (<35) U/mL

Zinc 15.66 (10.7 - 17.5) µmol/L

Copper 18.10 (12.24 - 23.72) µmol/L

R/H Selenium µmol/L 2.61 (0.75 - 1.46) µmol/L Above Range

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- - - - - - - - - - - -- - - - - - -

GP Requested NHS test November 2024 (having to be retested as TSH/T4 not done.

Tests Full blood count

Result Borderline

What you need to do Need to repeat test

Specimen Type: EDTA whole blood

Collected: 12 Nov 2024

Received: 12 Nov 2024

EDTA

Full blood count

Total white blood count 3.4 10*9/L [4.0 - 10.0] Below low reference limit

Red blood cell count 4.16 10*12/L [3.8 - 4.8]

Haemoglobin concentration 125 g/L [120.0 - 150.0] Low normal range

Haematocrit 0.379 [0.36 - 0.46] Borderline

Mean cell volume 91 fL [83.0 - 101.0]

Mean cell haemoglobin level 29.9 pg [27.0 - 32.0]

Platelet count - observation 215 10*9/L [150.0 - 410.0]

Neutrophil count 1.49 10*9/L [2.0 - 7.0]; Below low reference limit

Lymphocyte count 1.62 10*9/L [1.0 - 3.0]

Monocyte count - observation 0.19 10*9/L [0.2 - 1.0] Below low reference limit

Eosinophil count - observation 0.07 10*9/L [0.02 - 0.5]

Basophil count 0.03 10*9/L [0.0 - 0.1]

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Blue Horizon Gold Well Woman Test November

Sample Dated: 03-12-2024 09:15 AM

Sample Received: 05-12-2024 12:24 PM

Result Reported: 09-12-2024 07:42 PM

Sample Type: EDTA Blood (Venous), Serum (Venous), Serum trace

elements (Venous)

TEST RESULT NORMAL RANGE UNITS COMMENT

HAEMATOLOGY

Full Blood count

Red Blood Cells 4.02 (3.80 - 5.80) x10^12/L

Haemoglobin 121 (120 - 160) g/L

Haematocrit L/L 0.368 (0.350 - 0.470)

Mean Cell Volume 91.5 (81 - 98) fL Above Range in August

Mean Cell Hb 30.1 (7.0 - 33.0) pg

MCHC g/L 329 (300 - 350)

Red Cell Distribution 12.8 (11.5 - 14.4) % Above Range in August

L White Blood Cells 2.7 (3.0 - 10.0) x10^9/L Below Range

L Neutrophils 0.8 (.0 - 7.5) x10^9/L Below Range

Lymphocytes 1.64 (1.2 - 3.65) x10^9/L

Monocytes 0.2 (0.2 - 1.0) x10^9/L

Eosinophils 0.08 (0 - 0.4) x10^9/L

Basophils 0.0 (0 - 0.1) x10^9/L

Platelets 206 (150 - 400) x10^9/L Low end of Range

MPV 10.10 (7.00 - 13.00) fL

Comments: Sample received between 48-72 hours. Please interpret red cell indices with caution due to sample age.

Sodium 140 (133 - 146) mmol/L

Urea 4.6 (2.5 - 7.8) mmol/L

Creatinine 83 (45 - 84) µmol/L

eGFR 65* mL/min/1.73 m2 (> 60 unless evidence of CKD)

ALP 99 (30 - 130) IU/L

ALT 16 (<35U)

Total Bilirubin 10 (<21) µmol/L

GGT 12 (5 - 36) U/L

Albumin 38 (35 - 50) g/L Borderline Low Range

Total Protein 65 (60 - 80) g/L Borderline Low Range

Globulin 27* (19 - 35) g/L

Calcium 2.38 (2.2 - 2.55) mmol/L

Corrected Calcium 2.41* (2.2 - 2.55) mmol/L

Vitamin D (25 OH) 101 (50 - 200) nmol/L

Optimal 75-200 Adequate 50-<75 Insufficient 25 -<50 Deficient <25

Uric Acid 277 (140 - 360) µmol/L

H Cholesterol 6.03 (0 - 5.0) mmol/L Above Range

Desirable:

HDL 1.3 (>1.2mmol/L)

H* LDL 4.1 (<3.0) mmol/L Above Range

Triglycerides 1.4 (<1.7(Fasting)) mmol/L

Experts advise a non-fasting triglyceride level below 2.3mmol/L. Fasting triglyceride (10-14 hours) should be below 1.7mmol/L.

H* Non HDL Cholesterol 4.69 (<4) mmol/L Above Range

H* Chol:HDL ratio 4.5 (<4.0) Above Range

CK 102 (26 - 192) U/L

HbA1c 40* (20 - 42) mmol/mol

20 - = 48 Diabetes 48 - 59 Good control

Magnesium 1.0 (0.7 - 1.0) mmol/L

CRP (High Sensitivity) 0.96 (0 - 5) mg/L

Iron 18.1 (5.8 - 34.5) µmol/L

UIBC 31.0 (24.2 - 70.1) µmol/L

TIBC 49* (45 - 81) µmol/L Low Normal Range

Transferrin Saturation 36.8* (20 - 50) %

H Ferritin µg/L 316.00 (13 - 150) Above Range

Ferritin is the most useful indicator of iron deficiency, but also an acute phase reactant and may be elevated in malignancy, chronic inflammation, liver damage and iron overload

H Serum Folate 73.8 (8.83 - 60.8) nmol/L Above Range

H Active B12 >150 (37.5 - 150) pmol/L Above Range

TSH 0.39 (0.27 - 4.20) mIU/L reduced from 1.59 in August

Free T4 20.1 (12.0 - 22.0) pmol/L

Free T3 5.1 (3.1 - 6.8) pmol/L

T4 Total 132.0 (66 - 181) nmol/L Stable since August

H Anti-Thyroglobulin Abs 125 (<115) IU/mL Above Range Stable

H Anti-Thyroidperoxidase abs 472.0 (<34) IU/mL Above Range increased since August

H Cortisol (Random) 493.0* (73.8 - 507.0) nmol/L Significant increase

6am - 10am (166 - 507) 4pm - 8pm (73.8 - 291)

CA 125 12.1 (<35) U/mL

Zinc 13.27 (10.7 - 17.5) µmol/L

Copper 15.70 (12.24 - 23.72) µmol/L

R/H Selenium µmol/L 2.45 (0.75 - 1.46) µmol/L Above Range

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The 1st test in August was drawn when Helen was on 100 mcg Levo solely. Supplementation was solely Zinc and Selenium. As Selenium was above Range at the August test we reduced her dosage to one every other day. For some reason we decided to revert back to one every day but in view of continued raised selenium we will be reverting to one every other day or perhaps every 3 days. In early October we started a regime including Vitamin B Complex, Selenium, zinc and after Consulting Roseway got a script for 2.5 mcg T3.

The November results show some interesting changes including an increase in FT3, stable FT4, suppressed but normal TSH, substantially improved cortisol. Nearly 170 points!, increased Anti-Thyroidperoxidase abs. B12 still up and a marked increase in folate. Ferritin is down and Transferrin Sat has gone up a bit. CRP is under 1 too. Minerals appear OK and MCV has improved but note RBC are Below Range as are the WBC. Notably her Neutrophils are at well down compared to August and despite taking 4-5K Vit D sprays a dayits only just scraped over 100 but has increased 22 points. Is it worth splitting the sprays as Helen is doing the Vit D all at once and I think we need to increase it by another 1000 iu?

I'm also a bit concerned at her low RBC & WBC but pleased with the response to T3 which seems to be having some effect on her TFTs, Ferritin, and Cholesterol as they are all related to Hashi's.

Would some of the more knowledgeable folks on here have a scan through the results and offer their thoughts.

I'm thinking that if we increase the T3 to 2.5 mcg twice a day ie 5 mcg it will be necessary to reduce her T4 to 75 mcg to ensure her TSH doesn't fall through the floor. Any other tweaks necessary?

Any thoughts and advice will be greatfully accepted.

[Regenallotment Ambassador]

Only commenting on one thing that jumped out at me. I’d recommend stopping Selenium completely for 3 months. I was less over range than Helen is and it took over 3 months to fall into range with no supplements and no Brazil nuts.

Ok one more, I’d suggest you stick with 2.5mcg T3 while you make other adjustments, go slowly with these changes. Allow 12 weeks more to settle. That cholesterol should start to come down too with the added T3 will be interesting to see in another 12 weeks.

[TiggerMe Ambassador in reply to Regenallotment]

I agree with Regen, stick with the current dosing of thyroid hormone and let things really settle in, how is Helen feeling?

You could also cut back on the B complex as both B12 and folate are high and too much folate isn't ideal

[helenshubby in reply to TiggerMe]

We have a prescriber appointment on 18 Dec to discuss dosing and generate a fresh prescription. Helen is sleeping better and she is improving and wonder how we can improve things but one thing at a time. My main issue is ensuring we don't kick off the GP with a totally suppressed TSH and keep TSH/T3/T4 within range. May mean tweaking one of them.

When the NHS started Helen 's T3 Trial the Endo prescribed 10mcg twice a day and reduced her T4 to 75. This has proved it should have been started low & slow.

[TiggerMe Ambassador in reply to helenshubby]

Sleeping better is a huge step forward and will bring lots of benefits (by far the best medicine)... I'd hold off dropping the T4 dose as it will likely continue to fall over the coming weeks and lowering it won't affect TSH levels, which drop due to the inclusion of T3 even in very small doses for most

Yes, it is often the way that if you find a T3 amenable Endo they are a bit gung ho with their starter doses which sets people up to fail more often than not as it is powerful stuff

Helen has responded well to 2.5mcg T3 which has raised her fT3 to mid range which could well be all she needs.... but it does take many months to recover from years of low levels and suddenly overloading the system with too much too soon rarely has a good outcome 😕

I'm sure you will have a worthwhile discussion with Roseway who seem very sensible

[helenshubby in reply to Regenallotment]

OK, we'll think about that. We have a review appt on 18 December with the prescriber.