Hi I am still waiting for my appointment with an Endocrinologist, I have just got my latest blood test results as requested by my gp. I am feeling a little better mentally but still fatigued and low motivation. I am not sure if I need some T3 as it is within range but is my body converting it to my cells? I had a thyroidectomy 10 years ago.
I would welcome your thoughts on the levels 24/1/25
TSH 1.96 mlU/L (0.2 - 4.3)
FT4 12.4 pmol/L (7.8 - 18.0)
FT3 4.4 pmol/L (3.5 -6.8)
VIT D 75.0 nmol/L (50 +)
Folate 20 ng/ml (5.4-24.0)
Ferritin 15.50 ugL (30-337)
B12 190 ng/L (110/914)
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Herdy2024
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Serum ferritin level is the biochemical test, which most reliably correlates with relative total body iron stores. In all people, a serum ferritin level of less than 30 micrograms/L confirms the diagnosis of iron deficiency
Insist GP does full iron panel for anaemia
Look at increasing iron rich foods in diet
Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption
This is interesting because I have noticed that many patients with Hashimoto’s disease and hypothyroidism, start to feel worse when their ferritin drops below 80 and usually there is hair loss when it drops below 50.
The Levothyroxine brand is Accord, I take 100mcg daily and 25mg on alternate days. The test was done as you said. I take vitaminD3 1000 IU daily and Vit C. I regularly eat red meat, 2/3 times a week plus liver pate. I also eat spinach every week and other green veg. I have to take Omeprazole twice a day due to Gerd diagnosed a few years ago and wonder if that is part of the problem with vitamin levels. I was only told not to drink or eat oranges. I have had a lot more blood results as my gp is really trying to get to the bottom of this, and has referred me to an endocrinologist (still waiting for appointment.) The results suggest liver function may be amiss and possibly kidneys so I think this will be followed up. I have an appointment to speak to the practices Pharmacist tomorrow so may be able to ask him about the PPI interaction. I will also book an appointment with gp.
I will explore the links you have sent, thanks again
If you have an underactive thyroid (hypothyroidism), treatment may be delayed until this problem is treated. This is because having an underactive thyroid can lead to an increased cholesterol level, and treating hypothyroidism may cause your cholesterol level to decrease, without the need for statins. Statins are also more likely to cause muscle damage in people with an underactive thyroid.
If B12 low due to vegetarian diet or PPI then supplements should help improve
If these don’t apply definitely get tested for Pernicious Anaemia first
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
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
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
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
We generally feel best when the T4 is up in the top quadrant of its range at around 80% with the T3 tracking just behind at around 70% through its range.
Currently your T4 is coming in at around 45% with your T3 at around 27% :
The accepted conversion ratio of T4 into T3 is said to be 1 / 3.50 - 4.50 T3/T4 with most people feeling at their best when they come is this little ratio at 4 or under -
So, if I divide your T4 result by your T3 result - I'm getting your conversion coming in at around - 2.80 - showing you struggling, under stress and running with a faster than ' normal ' metabolism.
SlowDragon has as always picked up and extensively covered your vitamins and mineral deficiencies - so there is little point saying much more -
Just that everywhere I researched suggested that no thyroid hormone replacement works well until ferritin is up and maintained at least - over 70 .
As a first step you need to increase your Levothyroxine and build back your T4 into the top quadrant of its range and this should ease some of the strain you are feeling -
as you haven't enough T4 circulating in your body in order to convert to enough T3 -
The body needs a good level of T4 circulating in the blood to enable a good level of conversion into T3 - which is the active hormone that actually runs the body and gives you the energy to function -
currently your T4 is too low causing your T3 to be too low and not allowing you enough energy to metabolise and extract key nutrients from your food which in turn has caused these vitamin and mineral health issues.
P.S. Since you have had a thyroidectomy - you may well need to take full spectrum thyroid hormone replacement - and some form of T3 to replace that lost when you lost your own thyroid hormone production - but we can't know that until your T4 is built back up into the top quadrant of its range.
And even so. no thyroid hormone replacement works well until these 4 cornerstones and foundations of good base health - feritin, folate, B12 and vitamin D are strong and solid - just like the foundations of a building - which is in this case. your brain and body.
Hi again, thanks for your reply it confirms what I have been thinking but my gp has just reported my results and has totally missed the Ferritin saying “abnormal but expected” despite the test saying below low reference level. everything else tested is normal? except for cholesterol, which I understand there can be a connection to thyroid issues. The pharmacist at our surgery has just rung me to discuss cholesterol levels but I explained about my thyroid issues and also the fact I have been on PPI omeprazole for a few years and he said I need to speak to a gp. He did also acknowledge the below reference ferritin and has noted it on my records. The first appointment I can get with a gp is a telephone one on the 11th February. Not ideal as I am struggling with it all.
My gp has referred my to an endocrinologist back in late October with an expected 9week wait so hopefully not too long now.
Ok then - let's hope 9 weeks is actually 9 weeks -
Just keep notes of everything you want to discuss as my experience was that my records couldn't be found when my appointment with the endocrinologist came around !!
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Latest Blood results. 
latest blood results
Latest blood results. Need advice
