Advice on new test results please - hypo

[chellegsd]

After receiving such good advice on this forum from so many of you lovely people I hope you can help me again with my latest blood test results.

As requested I asked for more tests at my 6 week b/t - as advised I asked for B12, ferritin, folate and Vit D and the antibody test for Hashimoto (was advised that the antibody test would take a lil longer so don't think it is included in these results unless that's what Erythrocyte sedimentation rate means??).

Had the test done last Thursday at 7.40am (didn't take my levo as advised)- fasted as cholesterol was to be included. Friday I received a call from the receptionist to say the doctor wanted me to repeat the kidney function test in a week as my levels were too low for my age. Told me I didn't drink enough water and to make sure i was hydrated, tried to stress that I drink way over the recommended amount but pretty sure she didn't believe me as stressed again to drink lots of water.

As you can see from the attached photo it states my thyroid function is normal at 4.1. For some reason I was only allowed to attach one photo so here is what the 2nd page says:

Serum creatinine 86 umol/L 49.00 - 90.00 umol/L

GFR calculated abbreviatd MDRD 64 mL/min/1.73m 'up' 2

Serum vitamin B12 - (tomirvine) - A Normal. no action required

Serum vitamin B12 385 pg/mL 191.00 - 663.00 pg/mL

Serum folate 7.3 ng/mL 4.60 - 18.70 ng/mL

Serum ferritin (tomirvine) A Normal no action required 92 ng/mL

(men and post menopausal women 30 -400 ng/mL

I hope this all makes sense to someone as tbh I haven't a clue. And I have no idea why my Serum free T4 level wasn't tested this time.

I am still taking levo 25mg and to start off with my hoarse voice did noticeably improve but in the last 2 weeks the hoarseness is returning. There has been no improvement in the numbness/tingling in my hands and feet and I am now finding I lose strength in my fingers and drop things and a few days ago my leg gave way and I fell hurting my knee and thigh (but this could just be me being clumsy). My muscles still ache especially my legs, still gaining weight and feeling more and more tired. My hubbie thinks my mood swings haven't improved and I'm getting more stressed in situations that usually I wouldn't. The itchy skin is still driving me mad especially my scalp and my hair is definitely thinning but I believe this is a side effect of the levo.

I've been booked in for the repeat blood test Monday 15th August and I finally get to see a doctor on Thurs 25th August (this will be the first doctor that has seen me since my cholesterol specialist first suspected a thyroid issue back in May).

Again sorry for such a long post but am hoping someone can clarify what all this means ... thank you for your time and kindest regards

[PinkNinja]

Hi.

I am sorry to hear you are still suffering. I believe that at least part of the reason for this is that your TSH is still higher than it should be for you as it is right at the top of the range. Recommendations are that thyroxine should be increased until symptoms disappear, usually with the caveat that TSH remains in the normal range. It does appear, however, that some people require their TSH to be below range in order to achieve good levels of T4 and T3. 25mcg is a starter dose so perhaps it is time to ask your GP for an increase to 50mcg. Unfortunately in some areas the lab will not test T4 unless the TSH is out of range.

Although your folate is within range you may benefit from a supplement as it is in the lower half of the range. If you supplement with folate or folic acid it is a good idea to supplement with vitamin B12 and the other B vitamins too as they work together.

I couldn't see a vitamin D result on your photo. Did they do that one? A vitamin D deficiency could be contributing to some of your symptoms.

Although your cholesterol level is high, you may well find that it comes down to normal when you are on a high enough dose of thyroxine. It is important that you don't take statins until your hypothyroidism is adequately treated and you most likely won't need them at all!

I hope that answers your questions and that you start to feel better soon.

Pink

[chellegsd in reply to PinkNinja]

Hi Pink,

Thank you for your reply. The nurse who took my blood said for some reason the doctor refused to test Vitamin D levels - unfortunately I will be seeing a different doctor at the end of the month but will ask again for the Vit D test and the reason if refused again.

I won't be seeing my cholesterol specialist again til November so hopefully the levels will be lower by then but I definitely wont be going back on the statins.

Thanks again

[PinkNinja in reply to chellegsd]

I've heard that some areas won't test vitamin D unless the calcium level is abnormal. Perhaps this was his reason. Unfortunately this means that some people's vitamin D deficiency doesn't get diagnosed. Given the large percentage of people with vitamin D deficiency and all the media coverage recently I am surprised this is still happening.

[SeasideSusie Remembering]

chellegsd A TSH of 4.1 is barely in range, it is too high for a treated hypo patient and you need a dose increase. Most hypo patients need a TSH of around 1 or below and FT4 and FT3 in the upper part of their ranges. You should have an increase in your Levo.

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, wrote this in a Pulse Online magazine article:

"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance.

But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."

If you email [e-mail] she will let you have a copy of the article which you can print out and show your GP at some point.

The antibody tests for Hashimoto's would be under the Thyroid Function Test section. Erythrocyte sedimentation test is to help detect inflammation associated with conditions such as infections and autoimmune diseases. It could be high if you had a virus at the time (cold??) or you may have autoimmune thyroid disease so the antibody test is useful there.

Your B12 is far too low at 385. The Pernicious Anaemia Society recommends 1000. You should supplement with Jarrows or Solgar sublingual methylcobalamin lozenges 5000mcg daily. This low B12 explains the tingling you are experiencing.

Whilst taking B12 we should take a B Complex to balance the B Vits. Thorne Basic B or Jarrows B Right both contain 400mcg methylfolate which will help raise your folate level which is too low at 7.3. It needs to be at least half way so that would be 12. Both of those brands you can find on Amazon.

Ferritin level is OK, minimum required for thyroid hormone to work is 70, 100 is better and optimal is half way through range.

The muscle aches are probably due to low Vit D. Did they not test that? I think it takes longer to come back. If they didn't test it you could ask again or just get a private at home blood spot test from City Assays, costs £28, just Google and ring them up, they post the test out to you and the result is usually back within a week.

It's still early days and you're still on a low dose. When you're optimally treated and the test results are in the right place for you to feel well, things should improve including your weight.

[chellegsd in reply to SeasideSusie]

Hi Seaside Susie,

Thanks for replying again, hopeless with names but never forget a dog

The receptionist didn't think the Hashimoto's test was included but I was unsure what ESR meant, I didn't have a bug but hopefully the repeat test next week will explain more. Do you know if kidney function and thyroid are connected at all?

I will ask again for Vit D test (dr refused that one) and if no joy will get a private one done.

I think someone mentioned B12 before but thought I'd wait til the tests came back but thanks for clarifying levels as I would probably thought everything was ok as levels were within range.

I will also email and pass on the article to my doctors surgery. I'm sure they will appreciate it

Thanks again for all your advice. Kindest regards, deosil

[SeasideSusie Remembering in reply to chellegsd]

chellegsd I can't say with any certainty about thyroid and kidney, I just know I don't have a problem.

I will also email and pass on the article to my doctors surgery. I'm sure they will appreciate it

Ha ha! Actually, if you do that, when you see your GP it might be an idea to say something along the lines of

'Did you get to see the article written by Dr Toft that I sent in? I was hoping you've had time to read through it so we could discuss it'. Bring the subject up and get his views. I can't see how he can go against the thinking of one of his peers. It could be useful and give you some leverage with regard to him agreeing to getting your TSH down.

As Pink Ninja says, some surgeries will no longer do Vit D tests. I've actually ordered one for myself today from City Assays. I do supplement anyway, got mine up from Severely Deficient to a very good level, I just want to see where it is now as I lowered my maintenance dose for the 'summer' (bit sporadic that, wasn't it ).