New bloodwork - not sure which problem to address first

[Cecilouward]

Hello!

I've been reading this board since moving to the UK in 2017 and appreciate all I've learned here! After lurking for so long, I thought it time to ask for help.

I've had a bunch of labs done recently and know there are many things that need improvement. I'd like to tackle one thing at a time unless there is an easy way to address multiple things and still know what is helping.

I have Hashimoto's - diagnosed in the US in 2008.

I am currently taking levothyroixine 125mcg and liothyronine 10mcg daily 30-60 minutes before breakfast. T4 through NHS with no brand consistency. T3 through private hormone consultant - 20mcg Thybon tablets cut in half.

I am strictly dairy free. Have been gluten free in the past but am not currently.

In January 2025 I upped T4 from 100mcg to 125 per NHS doctor recommendation. I do feel better on this dose and numbers seem to support.

Thyroid tests through thriva - I know the advice here is to test first thing in the morning with 24 hours since last thyroid dose, but my consultant requests tests done 4-5 hours after morning thyroid pills so that's when I do them.

7 Apr 2025

TSH 2.37 (.27-4.2)

Free T3 5.6 (3.1-6.8)

Free T4 18.8 (12-22)

1 Jan 2025 (on previous dose of T4 100mcg)

TSH 6.32 (.27-4.2)

Free T3 4.5 (3.1-6.8)

Free T4 12.8 (12-22)

9 Oct 2024

TSH 10.5 (.27-4.2)

Free T3 5.6 (3.1-6.8)

Free T4 13.9 (12-22)

Vitamin D

since January 2025 - taking Bare Biology D3/K2 spray - 2 sprays per day (4,000IU D3 and 100ug K2 per 3 sprays)

11 Apr 2025

85 (50-250)

11 Jan 2025 - had a different spray was perhaps a better dosage?

100 (50-250)

9 Oct 2024 - no supplementation

59 (50-250)

B vitamins

I do have the MTHFR mutation and have had a hard time taking b vitamins often feeling very shaky and agitated after taking. This test result is with no supplementation

7 Apr 2025

Folate 14.7 (10-45)

Active B12 70.4 (70-150)

Iron

not currently supplementing

7 Apr 2025

TIBC 62 (45-81)

Transferrin saturation 41% (25-45)

Ferritin 30 (30-200)

Serum Iron 25.2 (10-30)

UIBC 36.8 (13-56)

22 Oct 2025

TIBC 63.2 (45-81)

Transferrin saturation 26.4% (25-45)

Ferritin 41.5 (30-200)

Serum Iron 16.7 (10-30)

UIBC 46.5 (13-56)

And lastly - my cholesterol has been rising and I will address this with diet and exercise.

To add to this fun I am definitely Peri-menopausal with very frequent but light periods (every 2.5 weeks, with occasional long gaps between), migraine headaches, night sweats, occasional hot flashes, and some palpitations. I take Utrogestan 100 mg nightly but no estrogen currently per consultant at London Hormone Clinic. It definitely helps with sleep and anxiety but I am not certain this is the best regime for me,. My hormone levels have been tested and this is what the consultant has prescribed for me currently. I am considering trying a different menopause consultant with the complication that my current one prescribes the thybon...

I find it very difficult to wade through the perimenopause vs thyroid vs other vitamin problems and would appreciate some advice. Clearly I need to make some changes, and I'm very happy to! I just need help to know what to tackle first.

Thank you!

[helvella]

Afraid you might not have noticed, but you cannot be strictly dairy free without brand consistency for levothyroxine. Simply because the majority contain lactose which is, I believe, obtained entirely from cows' milk. Four out of seven.

(Glenmark is not currently available so that is realistically four out of six contain lactose.)

helvella - Thyroid Hormone Medicines - UK

The UK document contains:

Up-to-date versions of the Summary Matrixes for levothyroxine tablets, oral solutions and liothyronine available in the UK. These include declared ingredients for all UK-licensed products.

Details of every dosage of each medicine include PL numbers, PIP numbers, tablet markings, product history and links to:

● Patient Information Leaflets

● Summary of Product Characteristics

● Product Assessment Reports

● Dictionary of Medicines and Devices (dm+d) entry and current prices

Document has links to:

● British National Formulary

● NHS Drug Tariff, etc.

PLUS how to write prescriptions in Appendix F.

Also includes links for anti-thyroid medicines (but not product details).

Direct link to PDF:

📄 dropbox.com/scl/fi/l56qrgj2...

Blog last updated 08/04/2025 - documents are regularly updated

Link to blog:

helvella.blogspot.com/p/hel...

Screenshot of helvella's UK levothyroxine matrix

[helvella in reply to helvella]

Appendix F explains how to write prescriptions - including specifically for Aristo Vencamil!

[greygoose]

Hi Cecilouward, welcome to the forum.

my consultant requests tests done 4-5 hours after morning thyroid pills so that's when I do them.

So you have false 'high' Frees, there. Your normal circulating levels will be quite a bit lower than that. Which is why your cholesterol is high. Cholesterol levels have nothing to do with diet or exercise, high levels are caused by low T3.

So, to my mind, the first thing you should do is get full thyroid testing using the protocol recommended on here. Then you'll know where you really stand.

And after that, I would say you should tackle your low ferritin by first getting an iron panel done.

[Cecilouward in reply to greygoose]

Thank you for the quick reply! I will do as you suggest and get a new set of labs done with the suggested protocol.

Can you please clarify regarding a full iron panel? The results I posted were from the thriva "advanced iron panel" which looks similar to the medichecks panel I've seen recommended on this forum. Is it the inflammation marker I'm missing? That was tested a year ago and was very low, but I can re-do. Or do I need to get a different test altogether?

Regarding dairy-free T4 I have asked my GP to specify Aristo as I've tried Teva and not got on with it. They have told me more than once that this is not possible, as has my pharmacy. Could you please advise what exactly I should say to the GP to be more successful with this request?The brands I currently have are Accord 100mcg and Mercury 25mcg. This seems to vary each time I pick up the prescription and again, pharmacy says they can't control that. I do not have adverse gut symptoms from the lactose in the rx but I'd love to eliminate that if it is possible!

Thanks again!

[SlowDragon Administrator in reply to Cecilouward]

Regarding dairy-free T4 I have asked my GP to specify Aristo as I've tried Teva and not got on with it. They have told me more than once that this is not possible, as has my pharmacy. Could you please advise what exactly I should say to the GP to be more successful with this request?

That’s totally incorrect

Government guidelines for GP in support of patients if you find it difficult/impossible to change brands

gov.uk/drug-safety-update/l...

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.

Loads of patients have to have brand specified on their prescription

Prior to March 2023 Vencamil was called Aristo

Vencamil often very well tolerated/best option for many people

How to get prescription written for Vencamil

healthunlocked.com/thyroidu...

How to get Vencamil stocked at your local pharmacy

healthunlocked.com/thyroidu...

Posts discussing Vencamil

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu....

If your local pharmacy is disinterested in helping you, suggest you ask Springfield pharmacy

They supply Vencamil for lots of patients

Your GP surgery can send prescription electronically to them. They post Vencamil to you. You have to pay the postage

thyroiduk.org/get-support/t...

[Cecilouward in reply to SlowDragon]

Thank you for the specifics - I knew this was incorrect but was unclear how or how hard to push. I will try again.

[SlowDragon Administrator in reply to Cecilouward]

Many, many people can’t tolerate Teva Levo as it contains mannitol

[SlowDragon Administrator]

as helvella has pointed out you will need LACTOSE FREE specified on your prescription

Suggest you trial Vencamil as it’s lactose free and mannitol free

my consultant requests tests done 4-5 hours after morning thyroid pills so that's when I do them.

I suggest

A) you retest for yourself testing as recommended on here 6-8 weeks after being on Vencamil 6-8 weeks

test 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 or 3 smaller doses spread through the day, with last dose approximately 8-12 hours before test

Considering you are on T3 your TSH is very high….most people when adequately treated will have TSH below 1 or more frequently below range

high cholesterol is directly linked to being on inadequate replacement thyroid hormones

Your ferritin is deficient

Again strongly linked to being on inadequate dose

Are you vegetarian or vegan

Your iron is reasonable so you can really only improve ferritin by increasing iron rich foods in your diet

[Cecilouward in reply to SlowDragon]

I am not vegetarian or vegan.

I will attempt to get the Vencamil and will do as you suggest once I've obtained the new rx. Is there any point in retesting before that? (anticipating that the change in rx will happen quickly)

Thank you

[SlowDragon Administrator in reply to Cecilouward]

you could test just TSH, Ft4 and Ft3 now with correct timings

Then retest full thyroid and vitamin levels 2-3 months after getting Vencamil

If gluten free helped before, I would also look at going back to it

[SlowDragon Administrator]

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...

Look at increasing iron rich foods in diet

Eating iron rich foods like liver or liver pate once a week. Increase the amount of red meat you eat, other foods include 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.

Post discussing just how long it can take to raise low ferritin

healthunlocked.com/thyroidu...

Iron and thyroid link

healthunlocked.com/thyroidu...

excellent info from Seasidesusie (much missed) explaining why iron panel is necessary

Good iron but low ferritin

-healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Chicken livers if iron is good, but ferritin low

healthunlocked.com/thyroidu...

Shellfish and Mussels are excellent source of iron

healthline.com/nutrition/he...

Iron deficiency without anaemia

healthunlocked.com/thyroidu...

Ferritin over 100 to alleviate symptoms

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

Great research article discussing similar…..ferritin over 100 often necessary

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

Low Iron implicated in hypothyroidism

healthunlocked.com/thyroidu...