Graves advice

[Kari55]

Hi All,

I have posted before on this group but also on another group where I just got a response.

my TRab antibodies are undetectable, below 0.8

I have been on Carbimazole for a year. Currently taking 2.5mg 6 days a week. My endo advised me to stop carbimazole completely. Is this what you think I should do ?

TSH 0.77 (0.465-4.68)

Free T3 - 5.3 (4.3-8.1)

Free T4 - 14.9 (10-28)

Ferritin 14.7 (6-137)

Folate 12.95 (2.76- >20)

B12 328 ( 239-931)

the advise on the other group was that my TSH is still being suppressed by t-rab antibodies that are not being picked up by the t-rab test and my TSH should be somewhere around 1.2 to 1.4 in accordance with your T4 and T3.

My dose is already too low to fight the TRab. They are probably already coming back as it is.

They also said that my T4 and T3 are riding too low to raise the dose.

They recommended the Add Back method which means I take some replacement T4 along with the Carbimazole (no less than 5mg daily) and this would prevent my T3 and T4 from falling more and sending me into a hypOthyroid state.

So now I’m feeling quite confused 😕

I wanted to contact Elaine Moore for advice as she has been great when my husband had Graves but her website is down 😕

What shall I do?

[SlowDragon Ambassador]

Free T4 (fT4) 14.7 pmol/L (10 - 28) 

Ft4 only 26.1% through range

Your TSH is likely low because your vitamin levels are very low

Ferritin 14.7 (6-137)

Folate 12.95 (2.76- >20)

B12 328 ( 239-931)

Ferritin is deficient as below 30

Folate low

B12 very low

What vitamin supplements are you taking

Request full iron panel test for anaemia from GP

And vitamin D tested too

[Kari55 in reply to SlowDragon]

Thank you. I have ongoing issues with iron due to heavy periods and short cycles. It’s related to adenomyosis (after c-section)and most likely hormone changes (I’m 43). 14.7 is actually a great result for me as I’m normally at 5.

I’m taking Floradix every other day and 40mg of byglycinate iron every other day. Perhaps I need to get B complex on top of that.

I had vitamin D checked last year and it was fine but I’m taking 5000iu daily. I also take zinc, selenium and magnesium.

[Kari55 in reply to SlowDragon]

Slow dragon, what strength of B12 and folate I should be taking?

[SlowDragon Ambassador in reply to Kari55]

What vitamin supplements have you been taking up until this test

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...

Great reply by @humanbean on B12 here

healthunlocked.com/thyroidu...

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 two per day and/or 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 if last test result serum B12 was below 500 or active B12 (private test) under 70

[SlowDragon Ambassador in reply to SlowDragon]

cks.nice.org.uk/topics/anae...

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

Never supplement iron without doing full iron panel test for anaemia first and 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 3-5 days before testing

Medichecks iron panel test

medichecks.com/products/iro...

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

List of iron rich foods

dailyiron.net

Links about iron and ferritin

irondisorders.org/too-littl...

davidg170.sg-host.com/wp-co...

Great in-depth article on low ferritin

oatext.com/iron-deficiency-...

drhedberg.com/ferritin-hypo...

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.

Aim to maintain Ferritin around 70 if possible

[Kari55 in reply to SlowDragon]

Thank you so much for your replies!