Results of blood tests - interpretation, am I hypothyroid?

[Barton103]

Following advice in this forum to request a T3 test, I now have my blood test results and would be grateful for interpretation. Quick summary again, I have a total thyroidectomy over 10 years ago and was on 200mg levothyroxine until 16months ago when my consultant reduced dose to 150mg due to my age, not in response to blood tests. I now have every multiple symptoms that I think are due to this and that I may be hypothyroid.

Results

Serum TSH 4.7 mu/L [0.4 -5.5]

Serum Free T4 18.1 pmol/L [11.5 - 22.7]

Serum Free Triiodothyronine 2.9 pmol/L [3.5 - 6.5]

Vit D 105.8 nmol/L ( I have been taking weekly supplement due to prior low level)

Folate 14.0 ug/L [5.4 - 24.0]

Ferritin 76 ug/L [10.0 - 307.0]

B12 1175 ng/L [210.0 - 910.0] I have been taking a supplement

I have a note on my results print out to speak to the Doctor regarding my thyroid set of results, and there is also a note on there saying that the T3 is below range. Is the level in my results low enough to make me have all these symptoms? Also is the TSH hormone suppressed enough as I had a thyroidectomy due to cancer.

Many thanks

Re

[greygoose]

You are very hypo! Your TSH isn't suppressed at all, it should be something like 0.001 if you've had cancer. My goodness, your doctor is an idiot! Yes, the level of your FT3 is low enough to cause you an awful lot of symptoms. It should be up near the top of the range.

Your TSH is so high because your FT3 is below range. And you really aren't converting very well. So, ideally, rather than increase your T4 back to 200 mcg (you needed it that high because you weren't converting very well) your doctor should leave the T4 where it is, and introduce some T3. But, by the sound of your doctor, I doubt there's much chance of him doing that.

[Barton103 in reply to greygoose]

I was very shocked by the TSH result to be honest, I did not know the level it should be, but anyone looking at that range can see it is nowhere near suppressed.

It was my ENT consultant that did the original operation that put my dose down, he is not an endo, so I guess that explains the nonsensical dose reduction.

Thank you for your help interpreting the results. I have a follow up with GP next Wednesday to go through results so I will be ensuring I pick up all of these issues with him.

[greygoose in reply to Barton103]

You're welcome.

[Clutter]

Barton,

I've never heard of an endo reducing dose because of the patient's age before!

The goal of Levothyroxine is to restore the patient to euthyroid status which usually means TSH of 1.0 or lower, with FT4 in the upper quadrant and FT3 in the upper third of range. It is low FT3 which cause hypothyroid symptoms. Read Treatment Options in thyroiduk.org.uk/tuk/about_... Email [e-mail] for a copy of the Pulse article if you would like to show it to your GP or endo when you ask for 200mcg to be reinstated.

Your vitamin and mineral levels are all good.

_______________________________________________________________________________

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.

[Barton103 in reply to Clutter]

Thank you so much for your feedback, I really appreciate your help. I have follow up with GP next week and will be going fully armed with information

[jimh111]

The need to suppress TSH following cancer varies from patient to patient. In recent years they have been able to grade the cancer and set an individual degree of TSH suppression thus avoiding risks associated with TSH suppression and unpleasant hyper symptoms. Often TSH only needs to be suppressed for five years or so. You should seek specialist advicen on whether you still need TSH suppression.

On the other hand you seem to be hypothryroid now, assuming your symptoms are consistent with hypothyroidism. Your highish TSH and fT4 with a low fT3 could be caused by selenium deficiency as selenium is needed for T4 to T3 conversion. I try a supplement for a fw weeks and if you don't feel any better ditch it. You doctors should look into why your fT3 is low. They should try increasing your levothyroxine a bit but I'm not sure it will help much.

Older people with higher TSHs live longer. TSH is higher as we get older. Nobody knows whether this is protective or pathogenic, i.e. whether you are better off with a lower or higher TSH when older. This might be why they dropped your dose. We are also at much higher risk of atrial fibrillation and consequental stroke as we get older. I'm not justifying the reduction in your dose, just explaining what may be the thinking behind it.

[Barton103 in reply to jimh111]

Thank you, this is really helpful, I was concerned about the high TSH but maybe it is no longer really an issue, I am 10+ years post cancer now. I will follow up on the selenium , worth trying

[jimh111 in reply to Barton103]

Your highish TSH is an issue, especially as you are having symptoms. I was just pointing out there may not be a need to suppress it. I would try selenium for a few weeks and if that doesn't work ask for an increase in your hormone dose.

[humanbean]

Your ferritin is not optimal. Improving the level may help with your T4 to T3 conversion. Most of us feel best with a level which is approximately mid-range, which would be about 150 - 160 with your reference range.

You won't find a doctor who would agree with what I just wrote. Many of them think a level anywhere in the reference range is fine even if that is very low in range.

You can buy prescription-strength iron tablets without a prescription from some pharmacies. I've got them from Tesco pharmacy and Lloyds pharmacy.

What to ask for : ferrous fumarate 210mg, in a box of 84. This is enough for one tablet, 2 or 3 times a day. Since many people find it hard to tolerate prescription-strength iron tablets you should start with just one box. If you can't tolerate them then there are other iron supplements you can try, but they generally cost more and have a lower iron content. Ask for advice on this in a new question on the forum if the problem arises.

With each iron tablet take a 500mg - 1000mg vitamin C tablet. This has two functions. Iron tablets often cause constipation. High dose vitamin C has the opposite effect. Take enough vitamin C to counteract the constipation. Also, vitamin C improves absorption of iron supplements.

It is essential not to overdo the supplementation of iron. Don't go any higher than mid-range. You will need to test regularly to check that you aren't taking too much. Start by testing after 6 - 8 weeks. Keep testing regularly.

Since your doctor might not be willing to test ferritin for you regularly you may have to pay.

Depending on your requirements at the time, you might be interested in one of these tests :

medichecks.com/find-a-test/...

medichecks.com/find-a-test/...

bluehorizonmedicals.co.uk/P...

bluehorizonmedicals.co.uk/T...

bluehorizonmedicals.co.uk/T...

[humanbean in reply to humanbean]

I forgot to mention that iron supplements and thyroid meds don't mix. Iron will reduce absorption of thyroxine. To overcome this they must be taken 4 hours apart.

[Barton103 in reply to humanbean]

Thank you , the iron bit sounds more complicated 😳 I have started just this week to try and increase my iron through eating lots of varied greens, particularly kale, spinach and broccoli. In time will this be sufficient?

[humanbean in reply to Barton103]

What to ask for : ferrous fumarate 210mg, in a box of 84. This is enough for one tablet, 2 or 3 times a day.

I missed a bit and should have written :

This is enough for one tablet, 2 or 3 times a day, for 42 or 28 days.

[humanbean in reply to Barton103]

I have never heard of anyone improving their iron levels through eating vegetables. It might maintain your level, but I find it hard to believe it would actually raise your level. Some people do manage to raise their ferritin levels eating liver once or twice a week, but obviously that is no good for a non-meat-eater.

Its up to you how your approach the issue.

You might find this document, written by one of our admins, of interest :

dl.dropboxusercontent.com/u...

[Barton103 in reply to Barton103]

Oh, just read the link another member sent me, and should be avoiding · brussel sprouts, swede, turnips, cauliflower, cabbage and kale !!! Right, will change my diet again 😀

[humanbean in reply to Barton103]

I must admit, I eat the vegetables I want to. There are limits on how much I will change, diet-wise, for the sake of my thyroid. I've gone gluten-free, kicking and screaming all the way about making that change. I'm not reducing my food choices any more than that.