Hi I've had my vitamins checked at last results..
Serum folate ...3.9 ug/L (3.8 - 26.8 )
Serum hydroxy vit D ...43 ( 50.0 - 144.0 )
B12 ...472 ng/L (197.0 - 771.0 )
TSH - 4.71 MIU/L - (0.3 - 5.5 )
FREE T4 - 12.1 PMOL ( 12.0 - 22.0 )
FREE T3 - 3.7 PMOL ( 3.1 - 6.8 )
Currently taking 125 mcg levo and 12.5 mcg T3 (self medicating T3 )
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)
T3 ….day before test split T3 as 2 smaller doses spread through the day, with last dose approximately 8-12 hours before test
is this how you did your test
Which brand of Levo are you taking
Do you always get same brand at each prescription
Ft4 far too low and TSH too high
Request GP increase dose Levo to 150mcg
What vitamin supplements are you taking
No ferritin result?
Vitamin D needs improving to at least 80nmol minimum
Folate is virtually deficient and B12 borderline
Hi my test was at 7pm due to work so i always get to the evening surgery..i have never split doses either sadly so no sorry...Levo brand is accord..and t3 is Tiromel .No supplements yet ...was hoping for some reccomendations.... Last Ferretin check Dec 24.... 73 ug/L (15.0 - 150.0 )
So if you had tested TSH early morning it would likely have been higher
Accord don’t make 25mcg …..are you currently cutting 25mcg in half for 25mcg
Request 25mcg increase in Levo from GP up to 150mcg daily
Retest again at correct timings in 2-3 months
Are you now on strictly gluten free diet and dairy free diet to see if this improves your lipodema
If not, get coeliac blood test Before cutting gluten out
Then trial dairy free in 2-3 months time
Oooo sorry the 25mcg is Wockhardt
accord make 50mcg so you can get 150mcg per day as Accord
Also 50mcg and 100mcg Accord available boxed as Almus via Boots or boxed as Hillcross brand
Immunoglobulin A level - 3.50 g/L (0.8 - 4.0 )
Quite high ……it’s ALWAYS worth trying strictly gluten free diet with autoimmune thyroid disease
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
As test is negative you can immediately go on strictly gluten free diet
Trying gluten free diet for 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-...
Personally my lipodema has slowly reduced and now have virtually none….after going strictly dairy free in 2022. (Been strictly gluten free since 2016) And lost 15kg since 2016
I'm also trying 25mcg Tiromel now as I feel the half dose is pointless...do you recommend taking 150 mcg levo with that?
Do you normally take Levo waking or bedtime
Day before testing T3 ALWAYS split T3…..even if you don’t normally
Ferritin looks reasonable
i did try bedtime ....but my last results were horrendous ...so ive switched to mid-morning as i cant not have an early coffee for survival purposes
You can always take Levo in middle of night ….
.helps if have weekly pill dispenser to see if you have taken it
In what way were results horrendous
You were extremely under treated on 100mcg
Slightly better on 125mcg
But still in need of next dose increase to 150mcg
Dec 24...TSH - 10.2 MIU/L -(0.3 - 5.5 )
T4 - 14.6 PMOL/L (12.0 - 22.0 )
They didnt believe i was taking medication right so have kept me on 125mcg ...then i have these latest results ...they didnt test T3 last time either
No need to test Ft3 at this stage
It’s OBVIOUS you need dose increase in Levo
TSH should always be below 2 on levothyroxine
gponline.com/endocrinology-...
Graph showing median TSH in healthy population is 1-1.5
web.archive.org/web/2004060...
Comprehensive list of references for needing LOW TSH on levothyroxine
healthunlocked.com/thyroidu....
onlinelibrary.wiley.com/doi...
If symptoms of hypothyroidism persist despite normalisation of TSH, the dose of levothyroxine can be titrated further to place the TSH in the lower part of the reference range or even slightly below (i.e., TSH: 0.1–2.0 mU/L), but avoiding TSH < 0.1 mU/L. Use of alternate day dosing of different levothyroxine strengths may be needed to achieve this (e.g., 100 mcg for 4 days; 125 mcg for 3 days weekly).
Coffee will be preventing you absorb the Levo. Levo is extremely fussy and needs to be taken on its own, on an empty tomach, with only water and nothing else for an hour afterwards.
Hi i make sure theres at least a couple of hours before taking levo after my coffee anyway ...i also eat after that .
Don’t eat for at least an hour after taking Levo
If you are having anything with high calcium in it (like milk) this can also reduce absorption
black coffee for me ...
When did you take last dose of Levo & T3 before the test?
Your results are looking very lwo for the amount of hormone you are taking.
Recommended blood test protocol: Test at 9am (or as close as possible), fasting, last levo dose 24hrs before the blood draw, last T3 dose 8-12 hours before blood draw & no biotin containing supplements for 3-7 days (Biotin can interfere with thyroid blood results as it is used in the testing process).
Testing like this gives consistency in your results and will show stable blood levels of hormone and highest TSH which varies throughout the day. Taking Levo/T3 just prior to blood draw can show a falsely elevated result and your GP/Endo might change your dose incorrectly as a result.
No ferritin result.
All vitamins are far too low.
Vitamin D should be around 100 - 150. Buy one that includes vit K2 to help it go to your bones. Some are available in oil or you can take it with an oily meal for better absorption. Many members like the ‘Better You’ range of mouth sprays that contain both bit D & K2. Use this calculator to work out how much to take to get your level to 100-150. Most people need a minimum of 3,000iu per day.grassrootshealth.net/projec...
B complex suggestions: Slightly cheaper options with inactive B6:
amazon.co.uk/Liposomal-Soft...
Contains B6 as P5P an active form:
bigvits.co.uk/thorne-resear...
healf.com/products/basic-b-...
Explanation about the different forms of B6:
helvella.blogspot.com/p/hel...
B complex comparison spreadsheet:
You will need to supplement vitamin D continuously all year, likely higher dose in winter than summer
Test twice year …..once in Jan and once in Aug
Can test via NHS private testing service
GP will often only prescribe to bring vitamin D levels to 50nmol.
Some areas will prescribe to bring levels to 75nmol or even 80nmol
leedsformulary.nhs.uk/docs/...
GP should advise on self supplementing if over 50nmol, but under 75nmol (but they rarely do)
mm.wirral.nhs.uk/document_u...
But, improving to around 80nmol or 100nmol by self supplementing may be better
pubmed.ncbi.nlm.nih.gov/218...
vitamindsociety.org/pdf/Vit...
Once you Improve level, very likely you will need on going maintenance dose to keep it there.
Vitamin D mouth spray by Better You is very effective as it avoids poor gut function.
There’s a version made that also contains vitamin K2 Mk7.
One spray = 1000iu
amazon.co.uk/BetterYou-Dlux...
It’s trial and error what dose we need, with thyroid issues we frequently need higher dose than average
Web links about taking important cofactors - magnesium and Vit K2-MK7
Magnesium best taken in the afternoon or evening, but must be four hours away from levothyroxine
betterbones.com/bone-nutrit...
medicalnewstoday.com/articl...
livescience.com/61866-magne...
sciencedaily.com/releases/2...
Vitamin K2 mk7
betterbones.com/bone-nutrit...
healthline.com/nutrition/vi...
Essential to maintain GOOD B12 and folate as well
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...
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 2 per day and/or 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 5-6 days before ALL BLOOD TESTS , as biotin can falsely affect test results
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
Are you now on gluten and dairy free diet to see if it helps improve your lipodema
Test results
Recieved new test results. Opinions please.
My test results
thyroid function test results 
