Help interpreting my blood test results....

[Jim_B]

Hi there!

First time poster here but long time reader. I'm a 26 year old male who had a TT in June last year for the treatment of a Papillary Follicular variant Thyroid cancer, I also had RAI treatment in November. Considering the size of the tumour (8cm) I was very lucky and my prognosis has been good from the start. I'd say im in a position which I imagine many people can empathise with, in that im extremely happy to be essentially cancer free but im still far from feeling good (Brain fog, fatigue, achey, feel down etc) I know its been a relatively short time since my operation but ive done a lot of reading and come to understand if I ever really want to feel 'normal' again I need to take it somewhat into my own hands.

This is where I would really appreciate some input from people who are more in the know than I am. Ive just had my latest blood results back and everything was considered 'within range' and therefore no further action to be taken, but from what I understand in range does not necessarily mean its anywhere near optimal and that's what I would really like to work towards. Im currently taking 175mg of Levo before bed and ive been taking a basic multi vit with iron in the mornings. I think my free T4/T3 levels are looking ok but I was thinking my ferritin and B12 levels are a little low and this could maybe be contributing to some of my symptoms.

TSH - 0.46 miu/L (0.35-5.00)

Free T4 - 17.2 pmol/L (9.0-19.0)

Free T3 - 4.2 pmol/L (2.9-6.1)

Serum Ferritin - 65 ng/mL (22-275)

Serum Folate - 10.0 mg/L (3.0-20.0)

B12 - 337ng/L (140-682)

Any help or advice would be greatly appreciated!

James x

[shaws Administrator]

Welcome to our forum. I am glad your op went well and that you are now ensuring that you get your health back to normal. This is a link for your info and this is an excerpt:-

For initial TSH suppression, for high-risk and intermediate-risk patients, the guidelines recommend initial TSH below 0.1 mU/L, and, for low-risk patients TSH at or slightly below the lower limit of normal (0.1–0.5 mU/L).

thyca.org/pap-fol/more/tsh-...

Someone will respond re your blood test results above but I will say that your B12 is too low and should be towards the upper range. You can supplement with sublingual B12 but it has to be methylcobalamin and not cyanocobalamin.

Your GP should also test your Vitamin D as we can also be low.

Maybe your GP/Endo will consider adding some T3 to your T4 as that may benefit you.

[Clutter]

Hi James,

I'm also thyroidless since 2012 after Hurthle cell carcinoma.

Are you under the care of an endocrinologist? It's usual to keep TSH suppressed <0.1 for 5 years to avoid a recurrence of the cancer. After 5 years without recurrence I believe you are officially in remission. NB Just realised your age 26 means you are less at risk being under 40, so that may be why your TSH isn't suppressed.

Your FT4 looks good but your FT3 could be a bit higher. Ideally both will be in the top 75% of range.

I was very unwell on Levothyroxine (T4) monotherapy for 18 months but I am recovering now with the addition of T3 which resolved brain fog, clarity of thought and concentration in a few days and a host of other debilitating symptoms which had made me 90% bedridden. There is evidence that thyroidless patients may need the addition of T3 to feel well. eje-online.org/content/161/... If your GP/endo/oncologist won't prescribe T3 I strongly recommend self medicating and will send you a link if you PM me.

Your folate is ok but your B12 needs to be nearer the top of the range. 1-2,000mcg Jarrows B12 methylcobalamin daily would probably correct your low B12. b12deficiency.info/what-to-...

Ferritin is low and needs to be about half way up the range. I've seen ferrous fumarate recommended taken with 1000mg vitC to aid absorption. Make sure iron is taken 4 hours away from Levothyroxine as it prevents absorption of T4.

I'd advise getting your vitamin D tested as this needs to be high in range and is often low or deficient in hypothyroid patients. vitamindcouncil.org/vitamin...

Improving your vits and minerals will undoubtedly help with some of your symptoms but I suspect that you need T3 before you feel well again.

[Jim_B]

Hi there, thank you both for your responses.

Unfortunately im not under the care of an endo, just my gp and oncologist. My TSH when tested previously was at 0.03 but ive lowered my T4 since by 25mcg which has definitely made me feel better but im not as suppressed. I think I might need to see my oncologist and make some enquiries to see how suppressed she would like me to be.

I bought some 1000mg B12 supplement pills today but it appears that they are Cyanocobalamin, is it much better to take Methylcobalamin?

I think I need to do some more reading into ferritin levels, I take basic iron tablets with my RDA of 14mg but I imagine I might need more to boost up my levels. Do you know where a good place to start with when supplementing iron? Im vegetarian as well so apart from spinach and nuts I don't get any iron from red meats.

I think when I go to see my GP next I will just lay it on thick and take all my findings with me to support the benefits of taking T3 with T4. If not, im more than happy to go down the self medicating route, I think I have a pretty good understanding of where I need to be at in terms of my levels but im not really sure of where I would start with the dosing. I imagine its just a slow process of trial and error. Would be great to be able to continue taking the same dose of T4 and take a small dose of T3. Do you think it would take much to boost the T3 up more in the optimal zone?

Thanks again for all your help

[Clutter]

If you use HU Search there's a wealth of info on iron and ferritin and there may be something on this link healthunlocked.com/thyroidu...

If you can afford to buy more B12 I'd recommend Jarrows methylcobalamin sublinguals and take the cyano too. B complex with less than 100mg B6 would be good and magnesium and zinc.

20mcg T3 is equivalent to 50mcg T4 so reduce your T4 to 125mcg. ncbi.nlm.nih.gov/pubmed/204...

My last FT4 and FT3 were high in range on 100mcg T4 and 20mcg T3. Previously my FT3 was below range. I hit a bit of a wall when I increased activity and I now take 100mcg T4 plus 40mcg T3 split into 2 doses.