Help understanding thyroid lab results

[Rae1667]

Hello Everybody,

I was found to be hypothyroid in April this year after visiting GP because of fatigue, muscle/joint aches and pains, very heavy periods, pins and needles in both arms and hands, tinnitus, dizziness, problems focusing eyes, sensation of pressure in my throat, IBS type symptoms and lack of interest in anything! (plus many of the other symptoms I've since found out are common to thyroid problems)

I've had three sets of tests done now, see below (2 routine by GP and one private by Medichecks). I'm 48 yrs old female, family history of autoimmune diseases - (I'm not Coeliac). Since the first set of results I've been taking 50mcg daily of Levothyroxine, early in morning with water. I also take 1 x 30mg daily Lansoprazole in evening for acid reflux/hiatus hernia (diagnosed in 2000, so have been taking PPI's for 16yrs now).

8/4/16:

Serum free T3 - 4.4 pmol/L (3.1 - 6.8)

Serum free T4 - 9.9 pmol/L (12.0 - 22.0)

Serum TSH - 7.4 mu/L (0.27 - 4.20)

26/5/16:

Serum TSH - 3.9 mu/L (0.27 - 4.20)

9/7/16: (Medichecks)

TSH - 2.52 mIU/L (0.27 - 4.2)

Free thyroxine - 13.97 pmol/L (12.0 - 22.0)

Total thyroxine (T4) - 98.4 nmol/L (59.0 - 154.0)

Free T3 - 4.36 pmol/L (3.1 - 6.8)

Reverse T3 - 21 ng/dL (10.0 - 24.0)

Thyroglobulin Antibody - 52.84 IU/mL (0.0 - 115.0)

Thyroid Peroxidase Antibodies - 159 IU/mL (0.0 - 34.0)

Vitamin B12 - 179.7 pg/ml (191.0 - 663.0)

Folate (serum) - 9.61 ug/L (4.6 - 18.7)

25 OH Vitamin D - 18.1 nmol/L (50.0 - 200.0)

Ferritin - 19.28 ug/L (13.0 - 150.0)

CRP - High Sensitivity - 8.1 mg/L (0.0 - 5.0)

I'd really appreciate any comments to help me decipher these as I'm still struggling to understand all this new information! I still have the symptoms even though GP says I'm normal now. After the last results I'm wondering how many of my symptoms are due to the vitamin deficiencies....I've been told to supplement B12 & D3 (but in what method or strengths?) and re-test in 6 weeks. My GP has not indicated if or when I should return for re-test.

I'm working my way through a couple of the recommended books but I still not sure what to do first to improve things or whether I'm being too impatient - thinking back, many of my symptoms have been building up for 3+ years and worsened after an early-stage miscarriage in July 2013.

With thanks in advance, so glad to have found this group and hope to know enough one day to pay it forward......

[Clutter]

Welcome to the forum, Rae1667.

B12 is deficient and is the likely cause of the pins and needles, tinnitus and dizziness you were experiencing. Your GP should test intrinsic factor and gastric parietal cell antibodies to rule out pernicious anaemia. If positive for PA you will need lifelong B12 injections every 2-3 months. If B12 deficiency is not due to PA but is because you are vegan or vegetarian you need loading injections to replace B12 ASAP and should supplement methylcobalamin thereafter. PA Society recommend B12 is optimal around 1,000.

VitD 18 is also deficient. My GP prescribed 40,000iu ProD3 capsules x 14 days followed by 2,000iu daily x 8 weeks which restored my vitD from <10 to 107. The vitD deficiency causes musculoskeletal pain, fatigue and low mood. Take vitD 4 hours away from Levothyroxine.

My understanding is that NHS will prescribe B12 injections and vitamin D3 supplements when levels are deficient and I think you should discuss this with your GP.

Ferritin is very low, halfway through range is optimal. Because it is within range your GP is unlikely to prescribe iron but you can buy your own over the counter or online without prescription. Ferrous Fumarate is recommended as it has good elemental iron content. Take it with 1,000mcg vitamin C to aid absorption and minimise constipation. Take iron 4 hours away from Levothyroxine.

Thyroid peroxidase antibodies are positive for autoimmune thyroid disease (Hashimoto's) which causes 90% of hypothyroidism. 100% gluten-free diet may improve symptoms and reduce antibodies.

chriskresser.com/the-gluten...

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

TSH 2.52 is rather high for someone taking Levothyroxine. Ask your GP for a dose increase. Most people are comfortable with TSH 1.0 or lower, FT4 in the upper quadrant, and FT3 in the upper third of range. Read Treatment Options in thyroiduk.org.uk/tuk/about_... Email [e-mail] if you would like a copy of the Pulse article to show your GP.

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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.

[Rae1667 in reply to Clutter]

Thank you, Clutter. Lots to get on with there, such a relief to be pointed in the right direction. Thank you.

[dbreweur]

Your TSH looks better now than it did in your first blood work (I think I'm at about the same level right now on 25 mcg of Levothyroxine) - but from what I've read, even 2.52 can be too high for some people, leaving them symptomatic.

Hopefully, another more experienced member will be able to give both of us tips on how to get it to a more comfortable level. Good luck!

Edit: Clutter must have replied at the same time I did - some great information up there. Thanks, clutter!

[Rae1667 in reply to dbreweur]

Yes, wow! and so quick. Thank you.

[Angel_of_the_North]

Were both tests done fasting at the same time of day? I ask because TSH drops after eating and during the day.

[Rae1667 in reply to Angel_of_the_North]

Hi there,

The first test (April) was not. Taken about midday, no fasting.

The other two (May & July) were approx 11am but I was fasting and hadn't taken the levo beforehand....

How much would the mid morning test affect the results do you think?...

[Angel_of_the_North in reply to Rae1667]

TSH would be lower than at 9am. But it also means that you were probably much worse in April!

[Rae1667]

Oh! Thank you, I'll remember that for future tests...