Hello All
My 44 year old friend Michael has suffered crushing fatigue for a couple of years now. He also gains weight very easily and generally feels out of sorts. This blood test was taken early in the morning after an overnight fast. He is not taking any thyroid hormones or supplements.
Thank you so much for helping him make sense of it all, especially the rT3 ratio, which I know nothing about. And why his ferritin is so high - iron metabolism mis-firing?
Hi and it is good of you to enquire for your friend Michael. Symptoms used to be the priority before blood tests came into force and doctors told to only diagnose upon them alone which has caused many people more problems.
The TSH is rising and in some countries when it is 3 the person will be diagnosed and given levothyroxine. In the UK, for some unknown reason, the rule is that the TSH has to reach 10 and by that time many have suffered unnecessarily for years.
Others will respond to the other blood test results.
Before the blood tests were introduced, patients were given a trial of thyroid hormones and if they benefited they continued. Some people have symptoms but blood tests don't coincide. This is an excerpt from the World Thyroid Register and Dr Skinner has since died but he was a one-man mission as he was treating patients who wouldn't be otherwise by the NHS.
Excerpt:
Dr Skinner’s work involved a specific group of patients who have thyroid chemistry within the reference range but clinical signs and symptoms of disease; he argued that blood tests should not be pivotal in the diagnosis and treatment of hypothyroidism as they had never been validated as a marker of optimal health. Secondly, in this particular group of patients it was not known what their blood test results were when they were healthy therefore using blood tests as the only criteria for diagnosis was not sufficient.
It must be emphasised that Dr Skinner was not doing anything new nor prescribing new medication for the treatment of hypothyroidism; patients were diagnosed and treated for this disease based on clinical signs and symptoms and medical examination before blood tests were established and thyroid replacement using natural preparations was the norm prior to synthetic preparations.
worldthyroidregister.com/Le...
Another excerpt of another of Dr Skinner's letter on the same link:
I write as a medical practitioner who has focused on the problems of hypothyroidism for some fifteen years. I was interested to read your small paragraph on a patient who had been essentially undiagnosed for five to six years. I write to indicate that this is the least of it and in my experience this is one of the most serious shortfalls in modern medical practice.
I have come across literally thousands of patients who remain undiagnosed or do not receive an adequate level of thyroid replacement based on thyroid chemistry which has never been validated and is predicated on a ‘range’ of values (known as a 95% reference interval) notwithstanding the patient’s earnest solicitations that they do not feel well as would appear to be the case in the patient in your little piece
The matter has compounded by a recent extraordinary pronouncement by the Royal College of Physician and Family Practitioners who not only endorsed this erroneous view but further suggested that a certain thyroid reading - namely a TSH reading above 10 - is required to be at a given level which is statistically wayward to say the least and not even commensurate with clinical practice.
Responsible and sensible deputations to Government, Royal Colleges and the General Medical Council have to date fallen on stony water. We have one last resort namely to establish a World Thyroid Register and if this Register contains a reasonable number of people we may be able to change medical opinion or even - dare I suggest - engage in debate with Endocrinologists and Royal Colleges which to date not has been possible and indeed my futile attempt to join the Royal Society of Endocrinology resulted in my being thrown out prior to attending a single meeting; so much for academic interaction.
He needs a full iron panel to see why his ferritin is so high. He could have an iron storage problem such as hemochromatosis.
B12 should be over 500 and preferably close to 1000.
Michael's B12 result is low, he may have B12 deficiency and also Pernicious Anaemia. Look at the Pernicious Anaemia Society website for information about test results and symptoms. Pernicious Anaemia and Hashimoto's thyroid disease are both autoimmune illnesses, and can come together. His folate result is also low, but ferritin is high, needs investigating as well. Michael must go back to his doctor. Best wishes sorting this out.
B12 is actually in range it his folate that is below range.
Sorry, you're right, looked again on a larger screen, thought it was 104 before. It is in the range, but still low. 😊
You can edit your original post so it doesn't confuse MaxiFrustrated
There is no need to go down the PA route yet until he has had full bloods, iron panel etc done and looked at.
Thanks blue bug. How edit? He has provided me with a picture of his test results letter, which I cannot edit. Test was done privately. B12 result is notes low in the range provided.
Sorry I think I confused you. Forest1000 should edit their post NOT you.
The vitamin B12 level while low is not currently at a level to start immediately worrying about PA.
Your friend needs to find out why their ferritin level is so high as they may have other issues. The reason to do all the tests before starting to supplement is that B vitamins can change the dimensions of red blood cells, alter white cell counts etc and if there is anything wrong on these tests they will need to be repeated 6-8 weeks later.
In short the aim is to get his doctor to step up and do his job.
His folate level is also too low. It should be halfway in the range instead of below it.
The vitamin B12 is low but in range.
He basically has an issue with his B vitamin levels so needs to supplement them.
He also needs to have a full blood count, iron panel and liver enzyme tests to confirm there isn't a sinister reason why his ferritin level is so high. If his doctor refuses to do these tests then he's going to have to get them done privately by the likes of Blue Horizon. He should have these done asap and first BEFORE supplementing the B vitamins.
Many thanks all. I will forward your replies to him. Can anyone give some feedback on his rt3 reading?
I'd say his thyroid is sluggish, but unfortunately he is miles away from getting a diagnosis. Some of the vitamin issues are lower hanging fruit, and the thyroid may improve after his vitamins are in order.
RT3 comes up occasionally on this forum, but there is not a ton of information around about it 
rT3 itself (reverse T3) is made by the body at the same time it makes T3, except that rT3 is an inactive but almost identical molecule. It blocks the T3 receptors, and in healthy people is used by the body to regulate T3 supply.
In ill people in general rT3 is often higher. The body goes a bit crazy about making too much. So it may clear up when the other things improve.
I don't know enough about this to say much more, although I've been scouting about for a while as I also had high rT3 at one point in my illness. As far as I know there isn't really a treatment besides tweaking thyroid medication, as they can contribute to the problem It may indicate that if he does try self medication with thyroid hormone he should steer away from T4 (Levothyroxine or synthroid), as that might make it worse. But he equally well might be fine with it.
My rT3 is high with a ratio of 10.4, (range >20), so I recently did some reading...
My understanding is that the body makes rT3 instead of T3 when stressed, to protect you; to stop you over-doing things and causing more damage to your body. The fatigue makes you rest, just like pain in a joint makes you stop using that joint. The body does everything for a reason; it always does it's best for you - with what it's got! If the body made less rT3 and so more T3 you would be more active - causing more damage, because nutrients, or hormones or whatever aren't optimal.
You have to learn as much as you can to help yourself.
Good luck with optimising.
B12 and folate are much too low and could cause some of the symptoms. Ferritin is too high, which can be dangerous and needs investigation by GP. Can cause fatigue etc - the quick temporary answer for that is to donate blood. Thyroid isn't great, but that could be because of low B12 and folate.
Thank you all for all your input. Michael is very appreciative. He plans to consult his GP to get to the root of that high ferritin reading and will then boost his B's and whatever else shows is needed after a second blood test.
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