General lab work

Hi, I have been hypothyroid for around three years and currently take 50 mcg of L-thyroxine daily. I recently received the following lab results:

TSH 4.21

Hgb 11.4

Hct 35.5

Mcv 91.3

Mch 29.3

Rbc 3.89

Vitamin D 25 OH (total) 26.3

I know these are not that abnormal but I feel dizzy and tired all the time and think maybe my medication should be adjusted. It's been 2 weeks since I received the lab work via email but my doctor's office hasn't called to say that they think anything should be changed or that any of my lab #'s are off. I also have high blood pressure and chronic kidney disease and have been to like 10 different doctors appointments over the last 3 months. I could call and ask but I'm just so sick of asking them questions. Any thoughts are appreciated. My general question is does anyone think these labs are indicative of further action?

19 Replies

  • Well, Clutter will comment more wisely than me on the TSH, which looks to me way too high and needing an adjustment on the Levo to get it back to around I, or at least between .5 and 1.4 which is what the European Thyroid Assoc guidelines say is what to aim for.

    But I would just say on your haem level that though this is probably within the lab reference range, I would not be happy with it at all.

    The haem ranges are often as follows, though they can vary from lab to lab.


    male 13.5-18.0 g/dl

    female 11.5-16.0 g/dl

    So on those ranges you are right at the bottom. But there is no solid evidence for setting the female haem level so low. I would want to see my haem level up into the male range, say 14, or at least 13.5.

    I think you are very low in iron, and that is partly why you are dizzy and tired.

    Are you taking iron supplements? Are iron supplements contradicted by any of your other conditions? If you can take iron safely, you should take some.

    Hypothyroidism affects the kidneys, so it is very important that you get it under control.

    I think you should make an appointment with your GP (who won't listen to the haem argument, but you can take the iron into your own hands.)

    You could do with a serum ferritin test, and that s/he will probably grant.

    Just looking up some refs for you.

  • If you go into Pubmed you will find an article called "Why should women have lower haemoglobin and ferritin reference ranges than men?"

    Men would be thought anaemic at your level, you see.

    This is a quote from it: "We propose that the current “normal” values for red blood cell count and haemoglobin and serum ferritin concentration cited by laboratories were obtained from sampling populations that contained a large proportion of women with iron deficiency. We suggest using reference ranges for men for these parameters when assessing the haematological and iron status of women. By current criteria, iron deficiency is the commonest cause of anaemia in the world, with more than half a billion people experiencing adverse effects. If this hypothesis is accepted then noticeably more women will be classified as being iron deficient or anaemic. Reclassification of red blood cell count and haemoglobin and serum ferritin concentrations to normal values for men would be expected to have fundamental and positive implications for women's health and welfare."

  • This is the kidney ref I hope

  • And I haven't even started on D.

  • Thank you Aspmama. The link you provided has a lot of information, I will have to read it a couple more times to understand exactly what it all means. The main point I'm getting is that ckd and hypothyroid are related and should be treated together. I will have to ask my doctor more questions about the specific prescriptions I currently take so they can explain whether the whole picture is causing the issues. Thanks again

  • email and ask for a copy of Dr Toft's article in Pulse Online (doctors magazine). Read and highlight question 6 where it states the aim of TSH and discuss with your GP.

    Your TSH is too high for someone on thyroid hormone replacements - no wonder you don't feel well not even including your other results.

    50mcg Levo is usually a starting dose with the aim usually of 25mcg increments until the TSH is low - not to be somewhere within the range.

    Next time you are due a blood test make the earliest possible appointment and leave about 24 hours between the last dose of levo and the test - also fast.

  • Thank you, I will try your suggestions. I am so happy I asked for advice because everyone here has been very informative. :)

  • If you are on antid's too. Get your doctor to test your Free T3 which I think will be low as psychiatrists can prescribe T3 for their patients. Some of us cannot convert levothyroxine into sufficient T3 and because you are so little levo it may cause you to have all these other symptoms.

  • Thank you! I am not currently taking an iron supplement or any other supplements because I don't really know how those affect the absorption of all my other meds. I have 4 blood pressure scripts, 2 antidepressants, high chloresteral, nexium etc. I would assume my GP and my nephrologist haven't really looked at how it all relates either

  • Ask your doc for a serum ferritin (bet it is way low, even if just within their range). Point out that if you were male you would be thought anaemic, and anyway you are right at the bottom of the normal range and having symptoms which would be consistent with low iron levels, and ask if you can begin to take iron supplements or if they would cause difficulties given the other conditions and medicines.

    D you can certainly take straight away.

    If you are low in these two it is another safe bet that you are low in a range of other nutrients.

    The good news is that at least that is something which can be put right.

    The high cholesterol goes along with the hypothyroidism.

  • If you are hypothyroid and taking thyroid meds your TSH should be around 1.0 or below

    The vital tests we need to help you are

    Free t4

    Free t3




    Vit d3

    None of which have been done

    On the face of things you are seriously UNDERMEDICATED with thyroid meds and need an increase

  • Thank you reallyfedup. You are right, I have not had any of those tests. I was kind of hoping my doctor would call and discuss my labs but since they haven't I will have to call them. I'm just tired of having to prompt my doctors to notice the things I do. Lol. Thanks

  • Volleyballmom, do you have a restricted diet? (no meat, no red meat, very little green veg, no this or that?)

    The 50 mcg of levo thyroxine is not enough for you, that's a first. Hemoglobin is too low (should be at least 13.5) and vitamin D is too low. Who knows what else is suboptimal, borderline, etc. With hypothyroid, the diet has to be excellent because absorption of nutrients is compromised. Nothing works. If you are dizzy, let's interview your digestive tract. ;)

    You need to build up the body in order to feel better. Not just taking vitamins and minerals but that's a start. Find out what blood tests the other specialists did for you. Maybe they did B12, folate, ferritin and rest of it all.

  • I don't have a specific diet. I try to follow DASH (high blood pressure) guidelines but I have never really recorded precisely what I eat. I have recently read some articles that indicate maybe avoiding gluten might help but no one has ever told me to do so. I maybe have one serving per day of grains, it's not always everyday. Lately I have been eating less of everything in general because I'm not that hungry.

  • Welcome to the forum, Volleyballmom.

    You need a thyroxine dose increase. The goal of Levothyroxine is to restore the patient to euthyroid status and for most people this will be when TSH is around 1.0 with FT4, which doesn't appear to have been tested, in the upper range.

    I'm assuming you are in the USA where vitD 26.3 ng/ml is suboptimal and you need to supplement D3 4,300iu to bring it up to around 50ng/ml.

    It's not possible to interpret results without ref ranges but you can check what over and under range results mean by looking at red blood cell evaluations in


    I am not a medical professional and this information is not intended to be a substitute for medical guidance from your own doctor. Please check with your personal physician before applying any of these suggestions.

  • Thank you. Yes I am in the US. I will ask my doctor about whether it matters what time of day would be best for adding a vitamin d supplement based on when I take my other meds.

  • Volleyballmom, vitD should be taken 4 hours away from Levothyroxine as it can impair absorption of Levothyroxine. I've no idea whether it might interfere with other meds.


    I am not a medical professional and this information is not intended to be a substitute for medical guidance from your own doctor. Please check with your personal physician before applying any of these suggestions.

  • Based on your others meds, I don't know, but the best time to take vit D supps from the point of view of the body's rhythms is midday - when we would get maximum sunlight in the wild.

    If you're in the US you will get better treatment than you would over here in the UK I think.

    Do you get out in the sun much?

  • Your TSH at 4.21 is way too high it should be around 1.0 or below

    Whats vital is

    Free t4





    Vit d3

    Without those results we have no clue whats going on

    The other tests tell us nothing about your thyroid status

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