Thyroid UK

Results advice please

Hi I am a newbie.

FERRITIN 22 (30 - 400)

TSH 4.6 (0.2 - 4.2)

FREE T4 14.6 (12 - 22)

FREE T3 3.3 (3.1 - 6.8)

TPO ANTIBODY 706.3 (<34)

GP gave me antidepressant for ongoing symptoms, not sure if I need them? Taking 100mcg thyroxine and diagnosed hypothyroid in 2011 thank you

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Hello Abbi and welcome to the forum. This is a great place to get help from other people.

Most people don't feel well until their TSH is 1.0 or even a little lower. Doctors don't know this but you'll hear this time and again on this forum. Before you take the antidepressants you need to get a dose increase and then retest in 6 weeks and so on until your TSH is near to 1.0.

Has your doctor told you that you have Hashimotos? This is indicated by your high thyroid antibodies level.

Your ferritin is woefully low and under the range. What has your doctor prescribed for it? If you correct deficiencies and get onto a better dose of levothyroxine it's unlikely you'll need antidepressants.

You also need to be tested for vitamin D deficiency which is common in people with Hashimotos and test for folate deficiency too.

Read SeasideSusie posts to find out what your doctor should be doing about ferritin deficiency and make an appointment to get the right treatment. In fact if you doctor gave you antidepressants without sorting out your ferritin deficiency, I would see a different doctor in the practice and point out you need the right treatment as antidepressants won't correct vitamin deficiencies.

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Thanks doctor has not prescribed me anything for the ferritin because he said ferritin is not a reliable marker for iron deficiency. Complete blood count showed MCV 76.1 (80 - 98) and MCHC 374 (310 - 350) Also VITAMIN D TOTAL 23.6 (<25 SEVERE DEFICIENCY) and B12 236 (190 - 900) FOLATE 1.8 (2.5 - 19.5)

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IRON 7.8 (6.0 - 26.) and TRANSFERRIN SATURATION 13 (10 - 30)

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Well your MCV is below range which indicates iron deficiency. Your iron level is only just above the bottom of the NHS range so nowhere near sufficient especially as your ferritin (iron stores) are rock bottom. What is your doc planning to do about your low levels?

You have severe vitamin D deficiency so what have you been prescribed? Your folate is below range and although vitamin B12 is within range it's better to be high in range.

You will feel much better when you get all of this sorted out. Have you discussed it with your GP?

Just noticed SeasideSusie has responded, please take her excellent advice.

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Thanks for reply I have not been prescribed anything for vitamin D I think GP should be addressing this and the folate

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So do I. How long ago did you get these results? I think given the low ferritin and under range MCV the doc should be addressing that too but you might have to check national or local CCG guidelines on iron deficiency.

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The results were done 3 months ago

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Abbi

MCV 76.1 (80 - 98) and MCHC 374 (310 - 350)

This suggests iron deficiency anaemia. Point this out to your GP and ask for the appropriate treatment.

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VITAMIN D TOTAL 23.6 (<25 SEVERE DEFICIENCY)

Have you been prescribed anything? If not point out the extremely big clue where it says <25 SEVERE DEFICIENCY and ask your GP to follow the local guidelines and prescribe loading doses of D3. If he prescribes 800iu daily then refuse and tell him the guidelines state loading doses. Your local area guidelines can be found on Google and will be similar to the NICE Clinical Knowledge Summary cks.nice.org.uk/vitamin-d-d...

"Treat for vitamin D deficiency if serum 25-hydroxyvitamin D (25[OH]D) levels are less than 30 nmol/L.

For the treatment of vitamin D deficiency, the recommended treatment is based on fixed loading doses of vitamin D (up to a total of about 300,000 international units [IU]) given either as weekly or daily split doses, followed by lifelong maintenance treatment of about 800 IU a day. Higher doses of up to 2000 IU a day, occasionally up to 4000 IU a day, may be used for certain groups of people, for example those with malabsorption disorders.

Several treatment regimens are available, including 50,000 IU once a week for 6 weeks (300,000 IU in total), 20,000 IU twice a week for 7 weeks (280,000 IU in total), or 4000 IU daily for 10 weeks (280,000 IU in total)."

When loading doses are finished you will need a sensible maintenance dose which might be 2000iu daily, it's trial and error and it's recommended to retest once or twice a year to maintain the level recommended by the Vit D Council which is 100-150nmol/L.

When taking D3 there are important cofactors needed vitamindcouncil.org/about-v...

D3 aids absorption of calcium from food and K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can cause problems.

D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds.

Magnesium comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds naturalnews.com/046401_magn...

Check out the other cofactors too.

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B12 236 (190 - 900) FOLATE 1.8 (2.5 - 19.5)

You are folate deficient with low B12. Do you have any signs of B12 Deficiency b12deficiency.info/signs-an... If so please post on the Pernicious Anaemia Society forum here on Health Unlocked for further advice healthunlocked.com/pasoc

Folate needs supplementing to at least half way through it's range and B12 is best at the top of the range.

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If your GP has ignored these results you should seriously consider making a formal complaint.

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Thyroid hormone can't work unless all vitamins and minerals are at optimal levels.

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"Severe deficiency" & he's not prescribed anything? I'd be depressed too, with a doctor like that!

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Abbi87 I hope you haven't started the antidepressants yet, I doubt very much if you need them, so if you haven't started I would seriously think about whether you really do need them.

You are undermedicated, plain and simple, your TSH is over range and your free Ts very low. The aim of a treated hypo patient generally is for TSH to be 1 or below with FT4 and FT3 in the upper part of their respective reference ranges.

From thyroiduk.org.uk/tuk/about_... > Treatment Options

"According to the BMA's booklet, "Understanding Thyroid Disorders", many people do not feel well unless their levels are at the bottom of the TSH range or below and at the top of the FT4 range or a little above."

The booklet is written by Dr Anthony Toft, past president of the British Thyroid Association and leading endocrinologist and is available from pharmacies and Amazon for about £4.95.

Also, Dr Toft states in Pulse Magazine,

"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)."

You can obtain a copy of the article by emailing louise.roberts@thyroiduk.org , print it and highlight question 6 to show to your GP.

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Your high antibodies confirm autoimmune thyroid disease aka Hashimoto's, which is where antibodies attack the thyroid and gradually destroy it. As the antibodies fluctuate, they can cause fluctuations in symptoms and test results.

You can help reduce the antibodies by adopting a strict gluten free diet which has helped many members here. Gluten contains gliadin which is a protein thought to trigger antibody attacks. You don't have to be Coeliac or gluten intolerant for a gluten free diet to help.

chriskresser.com/the-gluten...

stopthethyroidmadness.com/h...

stopthethyroidmadness.com/h...

hypothyroidmom.com/hashimot...

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FERRITIN 22 (30 - 400)

This is dire and thyroid hormone won't be able to work with ferritin at this level. It needs to be half way through it's range.

Have you had an iron panel, full blood count and Haemoglobin test done to see if you have iron deficiency anaemia? If you do have iron deficiency anaemia the treatment is 1 x Ferrous Fumarate two or three times a day, and with your level of ferritin you probably need the maximum.

Ideally you need an iron infusion to bring your level up within 24-48 hours whereas iron tablets will take months.

If taking iron tablets then take each one with 1000mg Vit C to aid absorption and help prevent constipation. Take iron four hours away from thyroid meds and two hours away from any other medication and supplements as it affects their absorption.

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Complete blood count showed MCV 76.1 (80 - 98) and MCHC 374 (310 - 350) HAEMOGLOBIN 120 (115 - 150) IRON 7.8 (6.0 - 26.) and TRANSFERRIN SATURATION 13 (10 - 30)

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Replied above.

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Could you just check the haemoglobin range, should there be a decimal point in the 225?

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Sorry haemoglobin range is 115 - 150

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