So we can offer better advice, it would be useful to share blood test results (with ranges in brackets) for:
TSH
FT3
FT4
Plus any antibody and key vitamin tests (ferritin, folate, vitamins D and B12)
In the first instance, do ask your GP for the above tests. We don’t recommend supplementing key vitamins without testing first (and sharing results with us).
If your GP is unable to complete all the above (eg if TSH is within range, some surgeries may not be able to access FT4 and FT3 tests), you could look to do this privately, as many forum members do, for a better picture of your thyroid health:
Personally, I wouldn’t consider seeing a specialist before having results of a full thyroid blood test/ key vitamins. You likely need a dose adjustment, but it is difficult to advise without seeing these results.
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
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.
Taking 100mg Levothyroxine daily and 25mg Monday and Thursday this is since February 2024
Which brand of Levo
Do you always get same brand
What vitamin supplements are you taking …if any
Bloods should be retested 6-8 weeks after each dose change or brand change in levothyroxine
For full Thyroid evaluation you need 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
Is your hypothyroidism autoimmune?
Low vitamin levels are extremely common when hypothyroid, especially with autoimmune thyroid disease
About 90% of primary hypothyroidism is autoimmune thyroid disease, usually diagnosed by high TPO and/or high TG thyroid antibodies
Autoimmune thyroid disease with goitre is Hashimoto’s
Autoimmune thyroid disease without goitre is Ord’s thyroiditis.
Both are autoimmune and generally called Hashimoto’s.
Significant minority of Hashimoto’s patients only have high TG antibodies (thyroglobulin)
NHS only tests TG antibodies if TPO are high
20% of autoimmune thyroid patients never have high thyroid antibodies and ultrasound scan of thyroid can get diagnosis
In U.K. medics hardly ever refer to autoimmune thyroid disease as Hashimoto’s (or Ord’s thyroiditis)
Lower vitamin levels more common as we get older
For good conversion of Ft4 (levothyroxine) to Ft3 (active hormone) we must maintain GOOD vitamin levels
VERY important to test TSH, Ft4 and Ft3 together
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
Thank you 😊 I don't know if I'm autoimmune? Also I don't know what TG and TPO means?My GP will only test TSH but I will ask for the other blood tests you've mentioned to be done.
I'll also keep an eye on if I get different brands when I collect medication as that could possibly be why I'm always up and down?
TG stands for Thyroglobulin which is a protein found within the thyroid gland.
TPO stands for Thyroid peroxidase which is an enzyme found within the thyroid gland.
If the thyroid is damaged, these substances can be released into the bloodstream. When they are there, our immune systems create antibodies to help in cleaning them out of our systems. These are called Thyroglobulin antibodies (TGab) and Thyroid Peroxidase antibodies (TPOab).
But TG and TPO pretty much only occur within the thyroid. If the immune system is creating antibodies to them, it means that the thyroid has been damaged.
You could have TGab, TPOab or both types.
You could have lots of other antibodies but these two are very specific to the thyroid so act as markers for thyroid damage.
If you test positive, it is often taking as meaning you have autoimmune thyroid diseases. But, technically, other causes of damage (e.g. from a seatbelt in a car accident) can damage the thyroid and see these antibodies appear for a while.
My document might help with other abbreviations and acronyms.
helvella - Abbreviations, Acronyms, Latin
A document containing a list of many of the abbreviations, acronyms and Latin terms you are likely to find when reading documents about thyroid. This is very frequently updated. Don't assume an old copy is up to date!
Many patients do NOT get on well with Teva brand of Levothyroxine.
Teva is lactose free, but contains mannitol as a filler instead of lactose, which seems to be possible cause of problems. Mannitol seems to upset many people, it changes gut biome
If a patient reports persistent symptoms when switching between different levothyroxine tablet formulations, consider consistently prescribing a specific product known to be well tolerated by the patient.
Physicians should: 1) alert patients that preparations may be switched at the pharmacy; 2) encourage patients to ask to remain on the same preparation at every pharmacy refill; and 3) make sure patients understand the need to have their TSH retested and the potential for dosing readjusted every time their LT4 preparation is switched (18).
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Never delay seeking advice or dialling emergency services because of something that you have read on HealthUnlocked.
Blood Test Results
Blood test
Blood test results - confused!
