Please help with lab results! I need answers!

So I have been suffering with low thyroid symptoms for quite some time now. I am 26 years old, and notice the more severe symptoms at 20 years old. I have symptoms such as slow digestion, brain fog, depression, anxiety, tremors when nervous, dry skin, dark circle around eyes, not refreshed after sleep, NEED NAPS through the day, lack of appetite, not able to run the way that I used to be able to shortness of breath. Muscles get sore just walking up a flight of stairs now. I'm not that old am I?! I've gotten labs done and just got the results from my MD. I have been prescribed folic acid and vitamin D. He says that if things don't get better in a month he may consider prescribing Nature-Throid. I just want to feel normal again. 😢. I've been snooping around this website for quite some time in my quest to understand my symptoms, and have seen some very knowledgeable people give seemingly great advice. Any advice would help a ton! Thanks!

Iron 309 (250-425 mcg/dL)

Vitamin B12- 719 (200-1100 pg/mL)

Vitamin D- 19 (low) (30-100 ng/mL)

TSH- 1.33 (0.40-4.50 mIU/L)

Free T4- 1.3 (0.8-1.8 ng/dL)

Free T3- 2.9 (2.3-4.2 pg/mL)

Reverse T3- 14 (8-25 ng/dL)

Thyroglobulin antibodies <1

Thyroid peroxidase antibodies <1

Folate 260 (low) (>280 ng/mL)

Ferritin 109 (20-345 ng/mL)

The doc says that all of my symptoms may be a result of the low folic acid and vitamin D so I was given prescriptions for both. Says my thyroid seems fine right now, but I do understand that what is considered within range may not be what's best or optimal for someone. Low thyroid runs in my family. What do you guys think? Thanks so much!

27 Replies


Yes, Vit D is very low so you should hopefully feel better once you have treated these - what meds and what dose did your doc give you? Can't quite tell with the folate as no range but will assume the same.

Did you get ferritin and blood count done to see if you're low in iron as this can cause things such as shortness in breath - post these results also if you have. Might be worth getting iron retested after folate deficiency resolved also if they seem okay.

In regards to thyroid, can't really comment until you post the ranges as different labs use different methods (the numbers in brackets after the results) but your tsh looks okay. You are not showing any indication of autoimmune thyroid issues at the mo.

I do sympathise, that is basically how I spent my teens and twenties and understand how frustrating it is - so so sleepy and never had an appetite, even when my thyroid got diagnosed, this did not improve things. Unfortunately so many of your symptoms can be caused by a huge number of issues so really hard to advise.

I would start with your stomach and figure out what is going on there first as you mention a few issues in that department and is the most important to resolve. If you don't feel like eating, then there is normally a reason why. Without eating enough, you will also be likely deficient in things you need and will lack in energy. The most likely culprit for digestive problems, all over aches and severe fatigue is gluten. This would be worth trying especially if you have thyroid issues in your family. You can get tested for coeliacs but the blood test is unreliable and can only be ruled out with endoscopy but even this doesn't rule it out so you could just try a gluten free diet for three months to see if anything improves. It must be 100% gluten free including cross contamination.

If this doesn't work, you can try a six week elimination diet to look at other food types/groups that you might be intolerant too.

Then just keep looking at each of your problems and ruling things out and hopefully having some improvements in the mean time :-)

Your T4 and T3 levels and other thyroid results might not be 100% optimal but nothing screaming that your thyroid is the problem to be honest, nothing that other issues could not be causing. Your T3 is a little on the low side. Maybe others here would have a different opinion?

What's the range on your B12 out of curiosity?

Also, with folate low, either you have a stomach issue and have absorption issues or you don't eat enough in your diet. I do think it's worth checking your iron levels properly too though and if these aren't okay, then more likely stomach issues :-)

I have edited and updated my labs in an effort to make it easier to read. I've added the ranges as well as the B12 and ferritin labs. I have been prescribed folate but not vitamin d. Was told to buy some otc 5000 mg vit D supplements from a vitamin store!

Do you mean you've been prescribed folate rather than ferritin? Ferritin can be deceptive without blood counts so wouldn't like to say although looks okayish, could maybe do with being a little higher. Are you in the UK? The Vit D supplements you can get over the counter here are not going to be anywhere near strong enough - you'll need really high dose as you are severely deficient. Post on a separate post for advice on Vit D supplements as others here are better than me with that one

Yes my mistake, I meant that I had been prescribed folate at 15 mg. I will absolutely look into the Vit D sups as well. I am actually in the U.S. I've had blood glucose and cortisol checked as well, which came out within range. The test was pretty comprehensive. Expensive too!

When did you start to feel better? What helped with you? If you don't mind me asking.

To be honest going gluten free and sorting stomach issues - turned out to be my initial problem from the start - but then this left other issues to resolve. That's not to say that this is definitely your problem though but it's a good place to start dealing with things. You've obviously got some stomach issues and deficiencies and it's best to start with the basics when you are clueless. Check diet, check getting enough of everything, get your deficiencies resolved which will remove symptoms caused by these leaving you with a smaller number of things to figure out. Also decide, did you have a stomach issue before diet not so good/no appetite and therefore what is the stomach issue, or could your diet/lifestyle not being great possibly cause these deficiencies which could be stopping everything working optimally. People often don't realise how essential some vits are for your body and how bad deficiencies can feel. If you've got one deficiency, you're likely to have more of other things not often tested for

Rules out basics, see what you're left with and keep trying to figure these things out. If you've dealt with all these and your T4/T3 levels are still on the low side, maybe more indicative of something else going on with thyroid. Also any more specific symptoms are good to focus on :-)

Also maybe check blood glucose levels and definitely cortisol :-)

looks like you might have Central Hypothyroid given TSH and free t4 and t3 are all low in their ranges

ask your endo this in a direct question as they far too often think its rare when its not

Hmm.. that's interesting I have to look into the possibility. From what you're saying it would make sense. What are some of the causes of central hypothyroidism? What would you say is the most effective treatment for central hypothyroidism? Levo? NDT? T3 only? Thanks!

bang on the head,heavy blood loss or simply genetic but it could also simply be you need a raise in dosage

as for treatment that too depends what works for one may not work for another

There is nothing called central hypothyroidism in text books, it is either primary or secondary hypothyroidism.

Really well thats wrong because correct names are central or tertiary hypothyroid ...yes they are both secondary forms but that shows real ignorance in whose writing text books

I would think an increase in thyroid meds would be a good start. TSH isn't that low plus it's unreliable anyway once on medication. Then increasing the other levels willl certainly help general health and thyroid.

Vitamin D must be addressed as a priority and check the dosage you've been prescribed. Vitamin D is fat soluble, so take with fat containing food - the best form is an oily gel capsule and 5,000 i.u. minimum to get you going. Taken with vitamin k2, it'll direct calcium to your bones. Vitamin d is a hormone and a severe deficiency is often found in anyone with very high cortisol levels. My guess is that you have adrenal issues...

Welcome to the forum, Ttmw.

Thyroid results are euthyroid (normal). TSH is low-normal, FT4 is mid-range but FT3 is low in range. Thyroid antibodies are negative for Hashimoto's. I don't think central hypothyroidism is likely as another member suggested because FT4 is not low, it is mid-range.

Correcting vitamin D deficiency should improve conversion of T4 to T3 which will raise FT3 level as well as resolve the symptoms of vitD deficiency.

Ferritin and iron levels are good.

I agree with Clutter. I'd leave thyroid meds alone for now, especially since you'd have an extra issue with converting additional t4 to t3 with such low vit d levels.

If things don't improve after a month or two with the vitamins you're taking, then consider a more bioavailable (expensive) form of folate - methylfolate ideally as part of a methylated b-complex that includes p-5-p, pantothenic acid (for your adrenals) and methylcobalamin. The reason being - some people struggle to methylate B vitamins themselves.

Hi Ttmw, at 26 years old you should feel great. You should have growth hormone and enzymes galore and plenty of things you may not have when you are older. Even your antibodies seem nonexistent so it's a puzzle. Did your doctor express anything more about the low folate? Folic acid supplements may not work well for you if you have the MTHFR defect. Dr. John Bergman says the your body ALWAYS has a good reason for what it does. Unfortunately doctors don't look for it many times. I would try to find clues.

I was given a prescription for deplin which is the bioactive form of folate. L-methylfolate. I have 5000 mg vit D and 15 mg of deplin that I started taking today. We'll see what happens. Fingers are crossed. Thanks everyone for the amazing advice. What an amazing community. You guys help more than you realize. Keep it up! I'll keep everyone posted!

Ttmw, I read in that article that a possible zinc deficiency may cause the folate deficiency. A year or so ago I posted an article about minerals deficiencies. It all starts in the gut and and not enough acid to metabolize minerals and amino acids but it's typical for low thyroids to have this problem.

Thanks for the information! My zinc is within range. At this point I'm going to try to bring my vitamin D up from 19 to the upper range. I've started my L-Methylfolate, so hopefully things change as I address these deficiencies! Fingers crossed!

One more thing, Ttmw. You can put this on the back burner for now but there is some controversy about vitamin D supplementing. Mine is also very low although I have no symptoms, never sick, no infections, etc. It seems some of us only raise the INACTIVE D which is really a prohormone and not a vitamin, when we supplement. I took large amounts for a time. Not sure why this happens to receptors, possibly an internal infection.

I totally agre at 26 the OP should feel great however sadly that is not always the case and sometimes the symptoms appear light years before the blood work really shifts and its perplexing for the suffering patient

Thyroid seems absolutely fine looking at the bloods. Folate deficiency is very rare because most of the veg we eat are full of folic acid. To diagnose proper folic acid deficiency there is a test called "red cell folate".

There are markers in full blood count specially MCV (red cell size) when there is true folic acid deficiency MCV goes up making big red cells. Low Vit D could well be the reason for all your symptoms.

I can see Vit D levels are very low!!!

Thanks so much for your input! Really been keeping an eye on my Vitamin D levels, my Doc said the same thing. Getting as much Sun light as possible (which is becoming increasingly difficult because of the seasons changing) and taking my supplements as well.

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