Hi, can anybody offer any guidance on my blood tests. I have paid to have them done by blue horizon. My blood was done at 8.45 before taking any medication. I take levo 175 one day followed by 150 the next. B12 supplement. I have been suffering from a feeling of being on a boat with weak legs. Bad brain fog. Blood sugar dips. Bloating, diarrhea. Night sweats. Sensitive to light.Iron 28.2 (5.8_34.5)
Ferritin 331 (30_400)
Transferrin saturation 52% (20_50)
TiBC 52.2 (45_81)
UiBC 24 (22.3_61.7)
CRP 35 (5)
Vitamin D 42 (50_200)
TSH 4.88 (0.27_4.20)
Free T3 5.3 (3.1_6.8)
T4 total 115 (66_181)
Reverse T3 22 (10_24)
Reverse T3 ratio .24
Free T4 21.8 (12_22)
Cortisol 457 (73_507)
Serum folate 8.79 (8.83_60.8)
Vitamin b12 472 (145_569)
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Not surprised you don't feel good with those results!
TSH 4.88 (0.27_4.20)
This is much too high for someone on thyroid hormone replacement - especially a dose as high as yours. So, something is not right.
Free T4 21.8 (12_22)
This is rather high, and is probably the reason for your high rT3. But don't worry about the rT3, it's a red herring. You need your FT4 high to get the level of FT3 you have because you are a poor converter. It's not a good thing to have it that high, but unless you can get onto T3, it's the best you can do.
Free T3 5.3 (3.1_6.8)
Could be higher - and by the sound of your symptoms, and your high TSH, you need it higher. But increasing your levo is not a good idea because your FT4 is already pretty high. You need to reduce your levo and add in some T3 if you want to be well.
Ferritin 331 (30_400)
This looks good, but...
CRP 35 (5)
your inflammation is very high. High levels of inflammation falsely raise ferritin levels, so your ferritin probably isn't as good as all that.
Vitamin D 42 (50_200)
Much too low. You need to see your doctor about that and get loading doses - which should be taken with magnesium and vit K2-MK7.
Serum folate 8.79 (8.83_60.8)
Vitamin b12 472 (145_569)
Both too low. Folate should be over mid-range, and B12 over 550 (never mind about the top of the silly range).
I would suggest a good B complex - Igennus, Thorne Basic B - with methylcobalamin (B12) and methylfolate 400 mcg.
Thanks for your reply. About a year ago my TSH was 0.02 so they reduced my levo, over the next two blood tests my TSH had gone to 3.85 and then 4.40 so I was told to take 175 one day then 150 the next as my T4 was too high to take more levo. The doctor will not give me T3. They wouldn't even give me b12 when it was as low as 114. I have been taking supplements for about 6 months and my b12 is now at 472. I have been struggling with these symptoms for 8 years now. They can't get my TSH to be stable.
OK, but it's not about the TSH. And they should not be dosing by it! TSH is never going to be stable if they use it to dose by. Dosing should be by the FT3 but they won't even test that.
As I said, your FT3 probably needs to be higher, but increasing levo even further is not the answer. It's still too high. And that is probably making your bad conversion even worse.
If I were you, the first thing I would do is get that vit D sorted. Talk to your doctor about it because that is a deficiency and they should treat it.
If you're in the UK, your GP cannot prescribe T3. The intial prescription has to come from an endo. So, ask to be referred. You could use your unstable TSH as a reason for the request. But, as you have Hashi's, TSH is always going to be unstable. It doesn't matter because TSH doesn't cause any symptoms. It is just a rough guide to thyroid status.
Thanks for your help. I'm at the doctor's tomorrow so I will see what they say to the vitamins. They don't seem interested unless your dieing. I have seen two endo's through the NHS and they just said my readings were fine.
They might be fine for some people, but they're obviously not fine for you. Hypo is a very personel thing and we all need what we need.
BUT a TSH over 4 is never fine for anyone. It's hypo. You're hypo when it goes over 3. A vit D reading below range is never fine for anyone. It should be up around 100.
When we are hypo we cannot just be passive and just accept when doctors tell us. We have to learn all we can about our disease and advocat for ourselves. Because often we know more about it than they do! We have to be strong and insistant. OR we have to stop consulting doctors altogether and self-treat. Which is what a lot of people do.
Thanks, yes I'm trying to get it sorted by myself rather than relying on the doctors. The advice on this forum is fantastic and I have made notes to go to the doctor with tomorrow.
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)
Do you always get same brand levothyroxine at each prescription
Hi, the test was done 24hours after my 150 dose of levo. I was told to alternate doses as my TSH had gone to 0.02 so they reduced me to 150 levo but over the next 2 bloods tests my levels had gone to 3.85 and then 4.40 so they told me to add 175 dose every other day but it obviously hasn't worked. I don't want to take any more levo as my T4 is already high. Same brand every time. I take Holland and Barrett 500ug b12. My b12 was 114 6 months ago and they wouldn't treat me so I started taking the supplements.
Get yourself a decent quality B12 and vitamin B complex as outlined in my other reply
Your conversion of Ft4 (levothyroxine) to Ft3 (active hormone) is poor because your vitamin levels are very poor
First step is to improve low vitamin levels
This should improve low Ft3 and reduce Ft4 a little
Many (most?) Hashimoto’s patients need to supplement vitamin D, magnesium and vitamin B complex continuously. Some also need separate B12 as well, especially if vegetarian or vegan
As you have Hashimoto’s have you had coeliac blood test
If not, request GP test BEFORE considering trial on strictly gluten free diet
1.1.1 Offer serological testing for coeliac disease to:
people with any of the following:
persistent unexplained abdominal or gastrointestinal symptoms
faltering growth
prolonged fatigue
unexpected weight loss
severe or persistent mouth ulcers
unexplained iron, vitamin B12 or folate deficiency
type 1 diabetes, at diagnosis
autoimmune thyroid disease, at diagnosis
irritable bowel syndrome (in adults)
first‑degree relatives of people with coeliac disease.
Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels
Low vitamin levels affect Thyroid hormone working
Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common.
A trial of strictly gluten free diet is always worth doing
Only 5% of Hashimoto’s patients test positive for coeliac but a further 81% of Hashimoto’s patients who try gluten free diet find noticeable or significant improvement or find it’s essential
A strictly gluten free diet helps or is essential due to gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)
Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and may slowly lower TPO antibodies
While still eating high gluten diet ask GP for coeliac blood test first or buy test online for under £20, just to rule it out first
Assuming test is negative you can immediately go on strictly gluten free diet
(If test is positive you will need to remain on high gluten diet until endoscopy, maximum 6 weeks wait officially)
Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse
The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported
In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned
Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.
Similarly few months later consider trying dairy free too. Approx 50-60% find dairy free beneficial
With loads of vegan dairy alternatives these days it’s not as difficult as in the past
my TSH had gone to 0.02 so they reduced me to 150 levo but over the next 2 bloods tests my levels had gone to 3.85 and then 4.40 so they told me to add 175 dose every other day but it obviously hasn't worked.
What were Ft4 and Ft3 results and vitamin levels on 175mcg daily
With serum B12 result below 500, (Or active B12 below 70) recommended to be taking a separate B12 supplement and 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
IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results
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 until over 500
Post discussing how biotin can affect test results
I haven't been tested for coeliac I'm at the doctor's tomorrow so I will ask. I was on 200 levo and I took that dose for about 3 years then I started to get shaky hands and terrible anxiety so I went back to the doctors and my TSH was 0.02 so they reduced me to 175 which didn't help so they reduced it to 150 which helped at 1st but then my TSH started dropping so they suggested the alternating dose. I have never managed to get rid of my floaty brain fog and leg weakness in the 8 years of taking levo. When my dose was 175 each day my T4 was 28.
This is a very common error but unless you're a vegan or vegetarian it is not all about out of range/in range like most vitamins. (EDIT: I just read you are not vegan/vegetarian)
The 114 reading is all that matters, unless you have reasons of diet for the deficiency the 114 reading shows you have an absorption issue of an unknown source. Could be tapeworm, celiac disease, use of PPIs, h pylori, pernicious anemia, bariatric surgery etc.
When one has an absorption issue you simply need ongoing supplementation. And some need shots. Not everyone can rely on passive absorption of pills. Retesting shows nothing and can cloud the issue especially if your doctor is not educated in this area & many are not - unfortunately. And even worse they often do not even know they carry erroneous thoughts on the issue. So please educate yourself so you're armed against these erroneous claims that can adversely affect one's health.
Here are some helpful, concise links, with medical footnotes -
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