Test results back.What do I do next?

[Sunflower1-]

I will just type as they appear as there are quite a few...Active B12 85 range 37.5-150pmol/l

TSH 12.10 range 0.27-4.20 mlu/l

Free T4 13.7 range 12.0-22.0 pmol/l

Free T3 2.6 range 3.1-6.8 pmol/l

T4 total 97.8 range 66-181 nmol/l

Anti thyroglobulin abs 1029 range <115

Anti thyroid peroxidase abs >600 range <34

Cortisol 593.0 range 73.0-507.0 nmol/l

Reverse T3 23.0 range 10.0-24.0 ng/dl

Reverse T3 ratio 0.11

Vitamin d 80 range 50-200nmol/l

HbA1c 35 range 20-42 nmol/mol

Magnesium 0.9 range 0.7-1.0mmol/l

CRP 2.0 range <5.0 mg/l

Iron 12.6 range 5.8-34.5 umol/l

UIBC 36.3 range 24.2-70.1 umol//

TIBC 49 range 45-81 umol/l

Transferrin saturation 25.8 range 20-50

Ferritin 39 range 13-150 uh/l

Serum folate 5.61 range 8.83-60.8 nmol/l

Vitamin B12 395 range 245-569 pmol/l

Thank you everyone that has taken the time to read through and help me with my ongoing journey.I am very confused by everything thyroid related and I'm trying my best to learn from the wise folk in this group.

My post a few days ago explains that I have had constant diarrhea from the levothyroxine,none more than with my last month of mercury pharma,so even though when on 75mg my TSH dropped to 4.82 on my increase of 100mg to bring it down further it has risen ,I believe due to not being absorbed.I have now been given Teva (which I have constantly asked for)but I start that tomorrow,so I'm hoping my TSH will go down without tummy troubles being an issue(no problems with Teva ,just every brand that contains lactose).Do you think I should now do this next month or 6-8 of Teva and then have my bloods done to see if my results improve?or should I ask for an increase right now based on these results?I'm 57/58kg so realistically 100mg of levothyroxine should be enough,or is that not how it works?I was told it's by the weight of the person.

Again thank you so so much for all your help and support,I truly appreciate it-without your support I'm also at a complete loss as to what to say to the doctor /pharmacist to get my points across.

[SlowDragon Administrator]

So these results were taken after 6-8 weeks on 100mcg Mercury Pharma brand of Levo

Now about to start on Teva 100mcg per day

Is that correct?

If yes, ask GP for 25mcg dose increase per day

The other option that is lactose free is Vencamil levothyroxine

All future prescriptions should specify LACTOSE FREE levothyroxine

Or specify the brand

Have you had coeliac blood test

If not get GP to do this BEFORE trialing strictly gluten free diet

Exactly what vitamin supplements are you taking

Ferritin 39 range 13-150 uh/l

Too low

Serum folate 5.61 range 8.83-60.8 nmol/l

Deficient

Vitamin B12 395 range 245-569 pmol/l

Inadequate

[Sunflower1- in reply to SlowDragon]

Thank you for helping me yet again.So just before I started taking the Mercury Pharma my TSH had dropped to 4.82 from about 13 ,then I took mercury pharma for a month and that whole month I had diarrhea (really bad) the month before I had accord and again constant diarrhea.I felt like I did before I even started Levothyroxine.I told the pharmacist at my doctor's that I can no longer take the brands with lactose as they are making me very unwell (I have told them this before)anyway this time they said they would put Teva only on my prescription,so I've just got the Teva today.I did the blue horizon test about two weeks ago-so taken a lot quicker than I expected to come back.Im just assuming that the constant diarrhea for the 6-8 weeks caused my body not to absorb the levothyroxine because of it didn't cause it the the 100mg should have brought the TSH down again not up,if you see what I mean.So if I now do 6-8 weeks on Teva with no tummy troubles my TSH should drop,at least that's what I'm thinking.So I should wait to increase or ask for increase now based on these results?

[Sunflower1- in reply to SlowDragon]

I'm not taking any supplements as I wanted to see what I needed,I need to write down what you have been for supplements so I can order them.Do of I get the b vitamins all in one fo I just need ferritin?

[SlowDragon Administrator]

B12 and folate

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 3-5 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

[Sunflower1- in reply to SlowDragon]

My active B12 is 85 but vitamin B12 is 395 so I still need the supplement?

[SlowDragon Administrator in reply to Sunflower1-]

Yes ….probably only for a month or two

Then continue with just vitamin B complex

[SlowDragon Administrator]

Ferritin

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...

monitormyhealth.org.uk/anae...

10% off code here

thyroiduk.org/testing/priva...

Look at increasing iron rich foods in diet

Eating iron rich foods like liver or liver pate once a week. ideally some red meat daily, 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.

[Sunflower1- in reply to SlowDragon]

Chicken liver pate every day for lunch(family history of anemia so I'm just making sure).I have pumpkin seeds and sunflower seeds every day in my oats.I eat dark chocolate every night(good for the heart,I have hypertension).I do not drink orange juice at all,so I need to add that to my diet.Im a very boring person,I eat the same things every single day-oats with nuts,seeds and fruit.Toast with pate and an apple.Either chicken or steak with veg and potatoes.Thats really how I knew it's the levothyroxine causing me issues.I'm having a couple of other issues that are really concerning me which I need to go to the doctors for,but I put things off as I really don't think I'm going to be listened to(has happened in the past).So I think if I can make a start on my thyroid problems first and try and get my vitamins right then I'm onto a good start.

[SlowDragon Administrator in reply to Sunflower1-]

Well you do need dose increase in Levo as the FIRST step

Low vitamin levels, especially low ferritin linked to inadequate dose Levo

Aiming for TSH always below 2

[Sunflower1- in reply to SlowDragon]

Ok so contact the doctor and ask for an increase -the only problem is is that I don't think they are going to take the blue horizon test results seriously,but I will try.

[SlowDragon Administrator in reply to Sunflower1-]

Give them copy of results

They may want to run their own tests

[Sunflower1- in reply to SlowDragon]

Yes I will drop a copy off at the surgery with a note asking for an increase and go from there,I will let you know what happens,I just want to feel a little bit better because I feel absolutely terrible right now.

[SlowDragon Administrator in reply to Sunflower1-]

Do a short covering letter re endless diarrhoea

How you now (finally) have lactose levothyroxine to trial

Are you on absolutely strictly dairy free diet?

[Sunflower1- in reply to SlowDragon]

Well the last few days I have been testing myself(testing my body) obviously still on the Mercury Pharma but I usually make my oats with water or oat milk,so switched to semi skimmed normal and yes much much worse toilet situation -so that had me thinking am I now allergic to all dairy(I eat cheddar and never noticed any issues)so after my milk trial for a couple of days I did a cheddar couple of days and I had no issues at all(again apart from the Mercury Pharma)but still when I had the milk it ramped up the amount of times on the toilet but not with cheese,so I can't be all dairy intolerant, although I've not put myself through yogurt or soft cheese yet-as I said my diet is simple and the same so I know when there is an issue with food or medication.

[Sunflower1- in reply to SlowDragon]

Can I just ask,does levothyroxine dosage not always go with the weight of the person of you know what I mean?

[SlowDragon Administrator in reply to Sunflower1-]

Some people need more than guidelines

Some less

Different brands give different results - they aren’t “bio equivalent “

Personally I have seen better results and reduced symptoms on Vencamil (never tried Teva Levo)

[Sunflower1- in reply to SlowDragon]

Yes when taking accord or mercury I just didn't feel right(apart from the toilet situation)I feel more tired,less motivated,colder,weaker but the few times Ive been given Teva,number one no toilet issues but also less tired,a bit more motivated,like I feel a bit more alive if that makes sense.I did look mercury pharma up after experiencing much worse problems and I did find a few pages stating or saying it wasn't bioequivalent,then tried to work out what that actually meant and couldn't really find a straight answer,but I noticed it didn't say that about other brands oh and another article saying do not start new patients on this brand and do not change people to this brand if on another brand which I found odd-so when on earth would someone be on mercury pharma.

[SlowDragon Administrator in reply to Sunflower1-]

Not Bio equivalent means different brands give different results at same dose in one person

So if someone is prescribed 100mcg Levo - different brands of levothyroxine will give different results for that one person

academic.oup.com/jcem/artic...

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).

Many people find different brands are not the same

Many people can’t tolerate Teva at all - probably because it contains mannitol

But some people, especially if lactose intolerant find Teva the best

Vencamil is the NEW lactose free levothyroxine and also is free of mannitol

Mercury Pharma contains acacia and lactose

Helpful post about different brands

healthunlocked.com/thyroidu...

List of different brands available in U.K.

thyroiduk.org/if-you-are-hy...

[Sunflower1- in reply to SlowDragon]

I have hair loss-is that due to my ferritin being 39?