Can I get some thoughts on these blood test results?

I have been feeling extremely tired, rundown, emotional etc for the last few months. I went to my GP whose immediate thoughts were thyroid problems so ordered a blood test these are those results....

TSH - 2.06 mu/L (0.35-4.5)

I was told that all was normal but as I had only been tested for TSH I pushed for further tests which my GP reluctantly agreed to and these are the results....

Serum free T3 level - 4.3 pmol/L (3.5-6.5)

Thyroid peroxidase antibod lev - <28 u/mL (0.00-60.00)

Serum TSH level - 2.52 mu/L (0.35-4.5)

Serum free T4 level - 13.8 pmol/L (11.00-23.00)

Serum ferritin - 46 ug/L (22.00-332.00)

Serum vitamin B12 - 258 ng/L (161.00-531.00)

Serum folate - 8.7 ug/L (2.9-16.9)

Again I was told all results were normal. I also suffer from Psoriatic Spondylo Arthritis so my GP is going to write to my Rheumatologist for his opinion. I still suspect my thyroid as I have many of the symptoms plus a family history of thyroid problems, should I be pushing for a referral to a specialist?

[shaws]

Some links with info.

thyroiduk.org.uk/tuk/testin...

You will find the above interesting.

thyroiduk.org.uk/tuk/diagno...

thyroiduk.org.uk/tuk/testin...

thyroiduk.org.uk/tuk/about_...

I am not very good with blood tests and someone will comment on them better than I can.

B12 - far too low should be aiming towards the higher level. Supplement with methylcobalamin Vitamin b12 sublingual and goes straight into bloodstream. Excess is excreted.

T4 - too low

Ferritin and folate - too low.

[Hidden in reply to shaws]

Thanks for the reply shaws - I'll look into b12 supplements. Thanks also for the links!

[Heloise]

Hi Bram, Sorry that this isn't as positive as you would like but I'm sure you can get to feeling better. As Shaws mentions, your levels are not optimal. You are not producing enough T4 since it should read in the upper third of the range and without that, naturally your FT3 is also too low. No wonder you have hypo symptoms. The co factors being low also affect the thyroid or vice versa. I'll assume your vitamin D level would be low also if they had tested for it. You have raised TPO antibodies although not hugely high, something is definitely going on. I do not understand why GP's do not see this. This website is very helpful and this is what they recommend for lab tests:

stopthethyroidmadness.com/l...

This is one of a series of videos explaining that Hashimoto's is primarily an autoimmune condition as is your other condition but they can be improved. This will explain one aspect:

youtube.com/watch?v=3_uaUXi...(Not working as expected?)

[Hidden in reply to Heloise]

Thanks for the link and video very helpful!!!

[eeng]

On the plus side, your doctor immediately thought to test your thyroid, not fill you up with anti-depressants.

[Hidden in reply to eeng]

Yes I'm grateful for that though I know I'm not suffering from depression in the true sense so I would have fought that diagnosis!!!

[Hidden]

Your PsA (psoriatic arthritis) could be making you feel lousy all on its own - it is an insidious disease. I don't think you will get very far on these blood results although Shaws may well have a point but unlikely any GP (and yours sounds good) will see it this way.

As has been said can take vitamin B12 supplements yourself without doing any harm. Are you on any medicine (DMARD) for the PsA at all? I think I would want to start by addressing this if not. Twitchy

[Hidden in reply to Hidden]

Hi Twitchy,

I'm on Etoricoxib (Arcoxia) for my PsA. Pain wise I've never felt better which is why I don't believe this to be linked to the PsA, I don't feel ill in the same way as I did before the PsA was diagnosed if that makes sense....

I will definitely be getting some B12 into me especially as I'm also on Omeprazole which I believe can block the absorption of it.

[Hidden]

Yes the b12 sounds like a good idea - I think there are several types and one is much better than others so perhaps people in the know will respond to advise you on this. I have some in my drawer but haven't used it

yet as my serum b12 is a fair bit higher than yours absolutely I take so many pills.

Have you had your inflammatory markers checked recently to see if there is systemic inflammation even if it isn't showing up in your joints?

If I were you I would get my vitamin D and calcium levels checked too.

I have RA but no significant pain or swelling in my joints anymore - just a low ache and a high ESR. I'm also hypothyroid and my GP diagnosed me about ten years ago as borderline but after I started Levothyroxine I soon needed to go up until I got to 150mcg.

Now down to 100mcg and I've not been at all well since stopping all my RA meds 8 months ago. I kept on pushing GPs to accept that this might be thyroid related but with my FT4 at 15 and my TSH at 0.2 there was no budging them that it wasn't a hypo matter. But things did at least improve when I got myself tested for Vit D privately and found I was low. My GP reluctantly prescribed AdCal D3 and a lot of my symptoms were alleviated although recently I have been very unwell again so am back on Methotrexate injections.

I think Arcoxia is just an anti inflammatory not a disease modifier so it won't actually be suppressing your immune system? So the fatigue and feeling of unwellness could still be part of your PsA without joint pain perhaps?

Twitchy

[Hidden in reply to Hidden]

That's interesting Twitchy. My ESR is high at 42 (1-12) and Serum C reactive protein is also high at 27 (0-5). You are right that Arcoxia is an anti inflammatory not a disease modifier I don't meet the criteria for the disease modifiers as I'm not in enough pain!!!!

[Hidden]

How strange? - have you been told this by a consultant rheumatologist or just your GP? I am pretty sure that having a diagnosis of PsA entitles you to be on at least one DMARD if you want one.

Maybe you are confusing these criteria for those for the biologic drugs which are extremely expensive - but even the PsA actually meets the criteria for these drugs faster than RA does.

As far as I know (and I have three friends with PsA) even just uncontrolled psoriasis without the arthritis makes you eligible for the disease modifying drugs. PsA, like RA, can make you feel very ill and tired without huge amounts of pain and if your imflammatory markers are high - which mine are too - then they usually use DMARDs to get them down rather than anti inflammatories alone.

I do find myself a bit of an odity as, although I started out with a lot of joint pain, I have very little these days but have been so tired, suffered peripheral neuropathy (nerve pain) and autoimmune hives. My rheumatologist has put me back on a low dose of the DMARD Methotrexate because, of the three I have tried so far it is only the one that doesn't give me awful rashes. I feel very ambivalent about being on this powerful drug again when my joint pain is only minimal still but I am being referred to a dermatologist and getting a second opinion about all the rest from a rheumatologist who specialises in immunology and connective tissue diseases and related fatigue. My consultant is only interested in swollen joints and I want to get the opinion of a doctor who is more holistic in his approach.

I do have to say that I would so much rather all this came under one big heading of immunology and there weren't rheumatologists and endocrinologists in their own little worlds refusing to look at the bigger picture a patient presents with!

Also I'm feeling terribly sick after my return to methotrexate last night so if you find you still don't need these DMARDs then that would be good - but NSAIDs and cox inhibitors or Proton Pump Inhibitors (Omaprazole) aren't risk free either. Twitchy

[Hidden in reply to Hidden]

You are right I am getting confused with the biologic drugs however I don't recall DMARDS being mentioned at any point. Hmmm maybe I should visit my rheumatologist again....

[Hidden in reply to Hidden]

I would say so! I know a lot of people here believe strongly that doctors have very narrow ideas of normal ranges regarding thyroid etc and I am sure they are right.

But getting a GP to accept this is nigh on impossible so I have given up trying.

However with PsA you can't afford to let the disease get out of control and fatigue,and raised inflammatory markers could well be significant.

You may find one of the mildest of the DMARDs, Hydroxichloraquine, very helpful in boosting your energy levels.

Also, don't forget we all have very different pain thresholds and yours might be very high? Good luck. Twitchy

[Hidden in reply to Hidden]

Thanks just booked a GP appt to get myself referred back to the Rheumatologist as I've just found out that Bupa won't cover any further appointments unless it's a flare up. By the time I see the GP on the 30th (yes that was the next available appointment!!) they should have written to my rheumatologist and heard back from them so will hopefully be a straight forward request. In the meantime I'm heading out shortly to get some B12 supplements....

Thanks for all the advice Twitchy - I really appreciate it

[Hidden]

You are most welcome Bramalfie - I really hope you feel better soon. Twitchy