Help with new blood results and next steps

[Holidays4]

I have just had bloods completed after four weeks on increase of Levo 75mcg daily plus 10 T3 (from 75/50 alternate days). 24 hours after Levo and 12 hours after T3 as per the protocol and blood test was at 9.00am.

TSH 0.12 mIU/L (0.27 - 4.2) -3.8% February 0.18

Free T4 (fT4) 14.3 pmol/L (12 - 22) 23.0% February 13.7

Free T3 (fT3) 5.6 pmol/L (3.1 - 6.8) 67.6%

T4:T3 Ratio 2.554 

Vitamin D - 65 (I supplement with Vit D/K2 2,000 a day for two years)

Ferritin 27 (13.0 - 150.0) In February Ferritin was 28

Folate 7.6 (3.9 - 20.0) up from 3.6 in February. I'm supplementing with folate in addition to B complex

B12 447 ( (> 180.0) down from 473 in February

Since February I have been supplementing with gentle iron from Holland and Barrett which is obviously doing nothing. Will now buy Three Arrows to see if this will help. B Complex, Folate, Magnesium, L-theanine.

Can you suggest a suitable B12 for me to take in addition to the B Complex please.

Doctor has messaged about my decreased renal function and has requested a urine sample.

April

Creatinine 89 umol/L (45.0 - 84.0)

eGFR 59 mL (normal GFR greater than 90)

February

Creatinine 80 umol/L

eGFR 67 mL

Does Hashimotos affect renal function. I'm surprised it's deteriorated since February.

I'm now confused as had assumed with higher T3 I would be feeling much better.

I would be very grateful for any input.

[GlowCoach Administrator]

4 weeks is too soon to test for accurate results. Suggest you wait at least a further 4 weeks and retest to allow the dose to settle some more.

Most people need a minimum of 3,000iu of vit D + K2 per day to get optimal results.

Nature provides B12 is good: natureprovides.com/products...

2 months may be a little soon to retest vitamins. Once you adjust them allow 3-4 months before retesting.

Being hypo can affect renal function. Hopefully it will improve as your thyroid results get better.

[Holidays4 in reply to GlowCoach]

Hi GlowCoach

Thank you very much for responding. Yes, I know 4 weeks is much too soon after dose increase but the doctors re-booked a blood test for me as they had omitted to test T3 and 4 weeks was the soonest they could do it. I increased the Levo to 75mcg daily as the result in February showed T4 was only 13.7.

Thank you for suggesting I up my Vitamin D to 3,000 daily and for the B12 recommendation which I will get on and order.

That's a relief to hear renal function is related to being hypo. I would have thought increasing my dose would have improved my results but they have got worse since February.

I guess I have to be patient but its so frustrating when I feel worse rather than better.

Thank you again for your help.

[GlowCoach Administrator in reply to Holidays4]

Remember you tested only 4 weeks after dose change. If you had left longer they may well have improved.

I'm sure you just need some more time to feel better. Hope its soon.

[Holidays4 in reply to GlowCoach]

Yes, you're right, 4 weeks isn't long enough for everything to settle. It's the highest dose I have ever been on since being diagnosed in 2018.

Yes, I really hope so, I have forgotten what its like to feel normal.

Thank you so much for your help, its very much appreciated.

[SlowDragon Administrator in reply to Holidays4]

Taking T3 typically shuts your own thyroid output right off ….. as shown by your low TSH

So unless on high enough replacement of thyroid hormones you can become more hypo …..as shown by your drop in kidney function

[Holidays4 in reply to SlowDragon]

No wonder I have been progressively getting worse rather than better.

[SlowDragon Administrator]

suggest you push for next increase in Levo to 75mcg and 100mcg on alternate days

Ft4 has hardly moved

How much levothyroxine were you taking BEFORE T3 was added

Your extremely low ferritin won’t be helping

See how you get on with Three Arrows. Many members find it highly effective

Vitamin D dose also needs increasing

It’s trial and error what dose we need, with thyroid issues we frequently need higher dose than average

which vitamin D are you taking

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.

perhaps try 4000iu daily and retest in 2-4 months

B12

With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a separate B12 supplement as well 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...

[Holidays4 in reply to SlowDragon]

Thank you SlowDragon

I think I must have been on 50mcg Levo when the endo added 5mcg T3. My T4 was 17 at the time but my T3 was at the very bottom of the range. The endo then reduced Levo to 25mcg and increased T3 to 10mcg daily. My GP has since agreed to each of my requests to increase my Levo as she is aware of how ill I have been. I will have to see if she will agree to another increase to 75/100 alternate days.

I'm taking the Better You Vitamin D3/K2 spray, I'll now increase to 4,000 per day. Thank you for the B12 recommendation which I will get to take in addition to the B Complex.

Thank you again for your help, I don't know what I would do without the support of the lovely members of this group.

[SlowDragon Administrator in reply to Holidays4]

Which brand of levothyroxine are you taking

Which brand of T3

Do you always get same brands at each prescription

Many (most?) members on Levo plus T3 seem to find they need BOTH Ft4 and Ft3 at least 50-60% through range

See what levels have settled on at next test in 4-6 weeks before getting next increase

[Holidays4 in reply to SlowDragon]

Levo is Accord and T3 is Roma capsules.

If I increaseT4 again is that likely to push the T3 too high in the range?

Yes, I'll stay at this dose and see how the results are in 4-6 weeks.

[SlowDragon Administrator in reply to Holidays4]

May be ……but unlikely

See how things go

[Holidays4 in reply to SlowDragon]

OK, that's good, so I still have room to increase the Levo dose to 75/100 alternate days.

Yes, will see if things settle in a few more weeks.

[jgelliss in reply to Holidays4]

Most importantly see how your Feeling?

[SlowDragon Administrator]

Poor kidney function should improve once thyroid levels are fine tuned

pmc.ncbi.nlm.nih.gov/articl...

The GFR is reversibly reduced (by about 40%) in more than 55% of adults with hypothyroidism[40] due to several reasons.

[Holidays4 in reply to SlowDragon]

Thank you, that now makes sense.

[SlowDragon Administrator]

Four weeks is too soon to test as  GlowCoach has pointed out

Retest in another 4-6 weeks

Meanwhile working on improving low vitamin levels

Are you on gluten free diet and/or dairy free diet?

If not GF yet get coeliac blood test BEFORE trialing