Test results

[Luna5289]

Could anyone shed light on my latest blood results? Been taking 75mcg levothyroxine since October as my last TSH was 15, took over a year to get back on the medication. Now it looks like I'm over active

[SlowDragon Administrator]

just testing TSH is totally inadequate

Standard starter dose is 50mcg so you might need small dose reduction….but before considering that you need full Thyroid evaluation

TSH, FT4 and FT3 tested

Also both TPO and TG thyroid antibodies tested at least once to see if your hypothyroidism is autoimmune

Very important to test vitamin D, folate, ferritin and B12 at least once year minimum

What vitamin supplements are you taking if any

Recommended that all thyroid blood tests 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)

Private tests are available as NHS currently rarely tests Ft3 or all relevant vitamins

Post all about what time of day to test

healthunlocked.com/thyroidu...

Testing options and includes money off codes for private testing

thyroiduk.org/testing/

Medichecks Thyroid plus BOTH TPO and TG antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes BOTH TPO and TG antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

Medichecks and BH also offer private blood draw at clinic near you, or private nurse to your own home…..for an extra fee

Only do private testing early Monday or Tuesday morning.

Tips on how to do DIY finger prick test

support.medichecks.com/hc/e...

If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal

[Luna5289 in reply to SlowDragon]

T4

Results

[Luna5289 in reply to SlowDragon]

More results

Results

[Luna5289 in reply to SlowDragon]

Sorry for photo dump! I have positive antibodies (I was on thyroxine whilst pregnant but it was stopped when I gave birth, I've been fighting for a year to get back on medication which was restarted in october). I've had my vitamin levels done aswell, I take a b12 supplement that was recommended on here

[SlowDragon Administrator in reply to Luna5289]

was test done early morning and last dose levothyroxine 24 hours before test

please add vitamin results and ranges

You also need TSH, Ft4 and Ft3 tested together

[McPammy]

You are definitely over replaced with your test results. Maybe you could alternate 75 one day and 50 the next and so on. See how you feel in a few weeks. Other way is to request liquid levothyroxine. I take liquid. That way you can tailor the amount you take daily. I take 68mcg liquid which you could never do with tablets. It’s more expensive. Ask your medication manager at the gp practise for a 3 month trial of the liquid.

[SlowDragon Administrator in reply to McPammy]

McPammy

You don’t know for definite that she’s on too much levothyroxine

A) could have taken levothyroxine before test

B) could have very low vitamin levels and poor conversion

C) could have had a Hashimoto’s flare

She needs full thyroid and vitamin testing

GP would never agree to liquid levothyroxine without endocrinologist approval because it’s so expensive

[McPammy in reply to SlowDragon]

Maybe definite was a poor word for me to choose. But I do think if you’re T4 level is above the range you are taking too much. Repeated days of taking too much equals suppressed TSH.

I don’t think you can say a GP would never agree to liquid levothyroxine , surely it’s down to the individual gp practise and their budgets not just on Endo say so. There’s plenty of people on here taking liquid. It’s worth a request to the medication manager firstly, secondly to the gp and thirdly to your Endo if you have one.

[Luna5289 in reply to SlowDragon]

My test was 9.10am, I hadn't taken my thyroxine since 8am the day before.T4 was 18.9 (7.9-14.4)

Serum free triiodothryronine was 6.8 (3.8-6.2)

Last vitamin test was August 24

Ferritin - 34ug/L (11.0- 307.0)

B12- 403 ng/L (180-914)

Folate- 6.0ug/L (3.1-19.9)

I have started taking vitamins since those tests were taken back in August .

I feel much better in myself, the brain fog is much improved, I've got more energy n not so dopey as I felt before I started it again. I have been experiencing a fast heart rate, mainly on a night when I'm in bed.

[SlowDragon Administrator in reply to Luna5289]

So in August ferritin was virtually deficient

B12 and folate were low

Have you had vitamin D tested?

What vitamin supplements are you taking

Did you stop vitamin B complex 5-7 days before test

[Luna5289 in reply to SlowDragon]

These are what I take daily, no I didn't stop them before my recent blood test, I didn't realise I had to.

I'm not taking any iron supplements atm, I've been having some gastro investigations done and was advised to not take any whilst having the procedures done. I haven't actually taken any iron supplements since having my baby

I don't think I've had my Vit D checked, not that I can see on my NHS app anyway 🤔

Vitamins

[SlowDragon Administrator in reply to Luna5289]

So it’s possible that results were affected by biotin in B complex

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 if last test result serum B12 was below 500 or active B12 (private test) under 70:

Perhaps consider getting thyroid and vitamin levels tested privately before starting on dose reduction in Levo

Low iron/ferritin makes it hard to process and convert Levo

Gut issues are common when hypo

Have you had coeliac blood test yet

Very common to develop gluten intolerance and/or dairy intolerance with Hashimoto’s

Testing options and includes money off codes for private testing

thyroiduk.org/testing/

Medichecks Thyroid plus BOTH TPO and TG antibodies and vitamins

medichecks.com/products/adv...

Blue Horizon Thyroid Premium Gold includes BOTH TPO and TG antibodies, cortisol and vitamins

bluehorizonbloodtests.co.uk...

Medichecks and BH also offer private blood draw at clinic near you, or private nurse to your own home…..for an extra fee

Only do private testing early Monday or Tuesday morning.

Tips on how to do DIY finger prick test

support.medichecks.com/hc/e...

If you normally take levothyroxine at bedtime/in night ...adjust timings as follows prior to blood test

If testing Monday morning, delay Saturday evening dose levothyroxine until Sunday morning. Delay Sunday evening dose levothyroxine until after blood test on Monday morning. Take Monday evening dose levothyroxine as per normal

Monitor My Health (NHS private test service) offer thyroid and vitamin testing, plus cholesterol and HBA1C for £65

(Doesn’t include thyroid antibodies)

monitormyhealth.org.uk/full...

10% off code here

thyroiduk.org/testing/priva...

[SlowDragon Administrator in reply to Luna5289]

My test was 9.10am, I hadn't taken my thyroxine since 8am the day before.T4 was 18.9 (7.9-14.4)

Serum free triiodothryronine was 6.8 (3.8-6.2)

So you do appear to be on slightly too high a dose

Are you taking 75mcg tablets or 50mcg and 25mcg tablets

Which brand Levo are they

Suggest you reduce dose at some little

Ideally to 62.5mcg daily (cutting a 25mcg in half to get 12.5mcg)

But obviously that depends on having 25mcg tablets

if you only have 75mcg tablets

Try 75mcg 5 days and cut one tablet in half to take 37.5mcg 2 days a week (not consecutive days)

get a weekly pill dispenser to store cut tablets in

[SlowDragon Administrator]

Ferritin will likely take a while to improve

Are you taking iron supplements

retest 3-4 times a year if self supplementing.

It’s possible to have low ferritin but high iron

Test early morning, only water to drink between waking and test. Avoid high iron rich dinner night before test

If taking any iron supplements stop 5-7 days before testing

Medichecks iron panel test

medichecks.com/products/iro...

[SlowDragon Administrator]

Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels

Low vitamin levels affect Thyroid hormone working

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances.

Most common by far is gluten. Dairy is second most common.

A trial of strictly gluten free diet is always worth doing

Only 5% of Hashimoto’s patients test positive for coeliac but a further 81% of Hashimoto’s patients who try gluten free diet find noticeable or significant improvement or find it’s essential

A strictly gluten free diet helps or is essential due to gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and may slowly lower TPO antibodies

While still eating high gluten diet ask GP for coeliac blood test first as per NICE Guidelines

nice.org.uk/guidance/ng20/c...

Or buy a test online, about £20

Assuming test is negative you can immediately go on strictly gluten free diet 

(If test is positive you will need to remain on high gluten diet until endoscopy, maximum 6 weeks wait officially) 

Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse

chriskresser.com/the-gluten...

amymyersmd.com/2018/04/3-re...

thyroidpharmacist.com/artic...

drknews.com/changing-your-d...

Non Coeliac Gluten sensitivity (NCGS) and autoimmune disease

pubmed.ncbi.nlm.nih.gov/296...

The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported

nuclmed.gr/wp/wp-content/up...

In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned

restartmed.com/hashimotos-g...

Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.

Similarly few months later consider trying dairy free too. Approx 50-60% find dairy free beneficial

With loads of vegan dairy alternatives these days it’s not as difficult as in the past

Post discussing gluten

healthunlocked.com/thyroidu...

Recent research in China into food intolerances with Hashimoto’s

healthunlocked.com/thyroidu...

More interesting Chinese research on Hashimoto’s and leaky gut

nature.com/articles/s41598-...