pre blood test dosing advice please?

[Helbo123]

hi all. I’m booked for a blood test next week. I currently take 2 grains and 1 1/2 grains alternating daily and was advised to take full dose in the am, which I have been doing. How would you advise I take my dosage the day before my blood test? Should I split the dose through the day? Many thanks

[pennyannie]

Hello Helbo :

When taking any form of thyroid hormone replacement containing T3 - it is suggested that you take the same dose every day.

With NDT it does not present in the same way in blood tests as synthetic T3/T4 thyroid hormone replacement -

We track on the T3 -

Your TSH will likely be low/suppressed with your T3 higher and your T4 likely lower than your bench mark results if you were previously on T4 monotherapy prior to switching to NDT.

We generally suggest a fasting blood test around 10-12 hours from your last main dose of NDT - so to see the ' height ' of your T3 levels -

We suggest blood tests after you have been on the same dose for 6-8 weeks -

No thyroid hormone replacement works well until ferritin, folate, B12 and vitamin D are up and maintained at optimal levels within the ranges and we can advise where ' best ' these essential bio markers need to ' sit ' for optimal thyroid hormone conversion.

[Helbo123 in reply to pennyannie]

Thank you for your reply. My blood test is at 9am so by that point it will have been 24 hours since taking any thyroid meds, is that acceptable?

I will do a new post after my results but I’m currently really struggling. My TSH is really suppressed but my t4 and t3 are at the bottom of the range. I also have low b12 which has been ignored, due to see GP tomorrow about that.

[pennyannie in reply to Helbo123]

I thought you were splitting your dose of NDT ?

A test after 24 hours will show low levels in both T3 and T4 -

if that is what you are aiming for -

Your TSH will not necessarily move irrespective of the timing of the blood test as taking any form of T3 suppresses the TSH anyway.

Obviously low B12 needs working on :

Were you taking synthetic thyroid hormone replacements - if so what were you taking and your bench mark results and ranges before switching to NDT ?

[Helbo123 in reply to pennyannie]

No I don’t split my dose, my endo told me I didn’t need to. I was taking levo and lio a few years ago until the GP kept trying to take me off the lio, I was fed up of the monthly battle so switched to NDT through a private endo. I’m not sure what my results were pre NDT but am interested to know. I was thinking of asking the GP for my results from 20 years ago when I was first diagnosed but then within weeks was able to come off meds and felt great (I’ve suffered with my thyroid after all three of my babies, but since my last baby 14 years ago I have been unable to come off the meds)

[pennyannie in reply to Helbo123]

Oh, sorry, my mistake - I misread how you were dosing NDT :

Well if you have results / ranges from when feeling good and well on synthetics at least we know whereabouts your T3 needs to sit - in order to try and replicate same on NDT.

Do you remember if you were initially diagnosed with a thyroid AI disease and had positive TPO or Tg antibodies and dealing with Hashimoto's ?

[pennyannie in reply to Helbo123]

If you have access to your medical records held at your surgery maybe log in and scroll back to see if you can find any details of your diagnosis and the dose of T3/T4 that gave you back your wellness - and then we have a focus rather than guessing where you may feel better on NDT.

Are you now self mediating or with a doctor - for the NDT -

is this your first set of results on NDT - and after around 6-8 weeks the same dose ?

[Helbo123 in reply to pennyannie]

I have hasimotos, positive for antibodies. Unfortunately my health record online does not go back more than a year for some reason. I will ask the GP tomorrow.

I see a private endo for my NDT but she relies a lot on TSH. I have been seeing her for about a year. Previously I saw another private endo for a couple of years but my results were pretty similar.

[pennyannie in reply to Helbo123]

Ok - so you do not medicate any thyroid hormone replacement on a TSH reading -

For NDT you track on the T3 - and the T4 may well be low in range but if you feel well - this does not matter :

You might like to read around on the research and advice of Dr Izabella Wentz who write as thyroidpharmacist.com and whom many forum members follow :

With Hashimoto's there are generally some gut and food intolerance issues to consider - have you been checked out for celiac - do you have any actual current readings for ferritin, folate, B12 and vitamin D -

I think you already mentioned issues with your B12 - do you have a diagnosis already of pernicious anemia and on a treatment plan?

With Hashimoto's you can experience transient hyper type symptoms as this AI systematically attacks and disables your thyroid and longer term you will need full spectrum thyroid hormone replacement as this AI fully dismantles your own thyroid function.

If your eyes are dry, gritty, light sensitive, with pain and or watering in excessively please ensure all drops, sprays and lotions and potions are all Preservative Free.

I read the NDT with the least fillers is that of Efra - is this brand prescribed for you?

[Helbo123 in reply to pennyannie]

Funnily enough I was on Erfa but changed to Armour because I’d read Armour seemed to be the best but I was going to ask to go back on Erfa. I started with some symptoms about 3 months after starting Armour but, my ferritin was 22 (18-150), I’ve managed to get that up to 69. B12 was 295. Vit D not tested. These results are from last summer when the GP told me all was fine! I didn’t look into the B12 issue until just recently and thought I ought to go back to the GP to discuss. I’m 44 years old so bound to be perimenopausal too! Where to start!!

I will read up on the Dr you mention, thanks.

[pennyannie in reply to Helbo123]

Ok - so a ferritin at 22 is officially classed as iron deficient anemia - were further investigations organised - colonscopy / endoscopy / iron panel before being prescribed iron tablets ?

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

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

Everywhere I researched when my ferritin came in at 22 - suggested that no thyroid hormone replacement works well until ferritin is at least over 70 :

I know now I need to maintain my ferritin at around 100 - folate at around 20 - active B12 at around 125 ( serum B12 up at 500++ ) and vitamin D up at around 125:

[Helbo123 in reply to pennyannie]

Do you continue to take iron supplements. I’m assuming mine dipped so low due to heavy periods which I’ve addressed now, now on the mini pill. Ferritin on the last test in Jan came back at 69. Do you think I should continue supplementing daily? I’m worried about my levels going too high

[pennyannie in reply to Helbo123]

Well I've already shared with you where I've found I need my core strength vitamins and minerals to be -

The ranges detailed on the NHS are generaly wide, too wide in some categories - I doubt ou will be finding yourself over dosing - and if you are you just drop down on your supplements a little.

With a ferritin at 69 and with a body metabolising well you could probably build a little higher by increasing your intake of meat, especially liver, and green leafy vegetables.

[pennyannie in reply to Helbo123]

Stateside Armout and Canadian Efra are the 2 leading brands meant to be available on the NHS - though now Black Listed as a ' New Patient ' Prescription :

Armour is declared as providing 9 mcg T3 + 38 mg T4 per 1 grain tablet :

Efra is said to have the least fillers with a declared content of 8 mcg T3 + 35mcg T4 per 1 grain tablet.

[Helbo123 in reply to pennyannie]

Thank you for replying and offering all your advice, I really appreciate it. The GP said she wouldn’t treat a ferrritin level of 22 as it was still in range 🙄. So I bought some ferrous sulphate tablets. I had been having really heavy periods and I suspect that was the cause. There were iron tests done at the same time that all came back as normal. No other investigations were done, as I say the Gp seemed very dismissive and was happy for me to continue with a ferritin of 22. I see a different GP tomorrow so hoping this one will listen and be more helpful 🤞

[pennyannie in reply to Helbo123]

Yes I couldn't tolerate the NHS iron tablets though did have a colonoscopy and endoscopy -probably due to my age -

It takes ages to build up ferritin - my stomach couldn't tolerate the NHS tablets, I wasn't offered an alternative so started buying my own which were much kinder -

Just for reference I purchased Gentle Iron - the clues in the name - but there are other brands - just make sure you are buying an iron bisglycinate - if this your problem too.