My wife was diagnosed approx 3 years ago with hypothyroidism. She has been taking 75mg Levothyroxine for probably 24 months now but has been getting worse in her symptoms of tiredness, appetite, anxiety, labido and generally happiness. We have been together for 14 years but the last three have significantly changed.
We decided to revisit the gp together after looking through the infomation on this forum and the wider net. Our appointment was with a new doctor last month and our aim was to find out about the viability of changing medication or dosage. Specifically questioning him about t3. He instantly noticed that my wife looked tired and that 10-12 hrs sleep a day and still feeling lathargic doesnt seem right and so said that more blood tests would be required. The results came back mostly within range. He said this would probably be the case but needed to do the tests for him to have a valid reason to refer her to an endocrinologist.
she is currently waiting for her first appointment date with an endo. So far been waiting 1 month without an appointment date set. In the meantime we have ordered and received some t3 from a forum member just to at least try something but my wife has refrained from using any until the endo has looked into the results. We have also got the blood test results this week but I couldn't see any ft3 or ft4 results. We phoned the surgery and they said they haven't done a test which separates t3 and t4. Does this even make sense? Maybe they did originally 3 years ago but the results below are the most current as of 4Aug17.
Ideally we need someone to decipher these results as the only thing we see relevant to her condition is the TSH level. We even started doubting if there was a thyroid issue as the meds have done nothing and after doing an online nhs multiple choice test for depression my wife was on the higher end of the scale.
We are both concerned that if we don't go Into the meeting with the endo armed with a plan of some sort the they will just move us from pillar to post.
Please help, results below:
Serum TSH level 1.26 range 0.35-4.50
Senim Vitamin B12 241.6 ng/L range 180-2000
Serum folate 8.48 ug/L range 3.10-18.30ug/L
Serum ferritin 41 ug/L range 13.00-150.00ug/L
Serum cholesterol 4.1 mmollL range <5 00mmol/L
Serum HDL cholesterol level 2.36 mmoVL range 1.00-3.00mrnol/L
Serum cholesterol/HDL ratio 1.7 range <4.00 Se non HDL cholesterol level 1.7 mmol/L
Senim C reactive protein level <06 mg/L range 0.00- 5 00mglL
Serum ALT level: 12 lU/L range 10-36
Serum alkaline phosphatase 42 IU/L range 30-130
Serum total bilirubin level: 21 umol/L range 0- 21
!!Serum albumin 51 g/L range 35-50
AST serum level: 19 IU/L range 0-31
Serum total protein 75 g/L range 60-80
Serum sodium 143 mmol/L range 133-146
Serum potassium 4.5 mmol/L range 3.5-5.30
Serum creatinine 74 umol/L range 45-84
Serum urea level 4.1 mmol/L range 2.5-7.8
GFR calculated abbreviated MDRD 80 mL/mln range 60-150
Plasma glucose level 3.0 mmolIL range 3-7.8
Neutrophil count 2.2 10*9/L range 1.8- 7.5 Lymphocyte count 1 10*9/L range 1-4
Monocyte count 0.2 10*9/L range 0.2-1
Eosinophil count 0.1 10*9/L range 0-0.4
Basophil count 0 10*9/L range 0-0.1
04 Aug 2017 .l Full blood count FBC (GE8409) Under observation no action
!!Total White cel count 3.6 10*9/L range 4-10
Red blood cell (RBC) count 459 10*12/l range 3.8-5.5
!!Haemoglobin estimation 152 g/L range 120-150
Haematocrit 0.462 range 0.37-0.47
!!Mean corpuscular volume (MCV) 101 fL 80-100
Red blood cell distribut Width 13.1 % range 0-16%
!! Mean corpusc. Haemoglobin 33pg range 27-32pg
Mean corpusc. Hb. Conc. (MCHC) 328 g/l range 280-350
Platelet count 276 10*9/L range 150-400
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Richardcash
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Richardcash Personally, I wouldn't advise using any T3 until FT4 and FT3 have been tested at the same time. You need to know where in range they lie, if FT4 is high and FT3 low then that can indicate poor conversion and the additon of T3 may help. If FT3 is in balance with FT4 near the top of the range then conversion is good and adding T3 isn't a good idea.
You can actually get home thyroid tests, either fingerprick or by blood draw, that will test TSH, FT4 and FT3 together at a very reasonable price. Blue Horizon Thyroid Plus Three or Medichecks Thyroid Monitoring. Many of us do our own tests using these two companies. It's also advised to test antibodies if not already done, and those come with a Blue Horizon Thyroid Plus Six or Medichecks Thyroid Check Plus.
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Serum TSH level 1.26 range 0.35-4.50
This is pretty good. The aim of a hypo patient generally is for TSH to be 1 or below or wherever it is needed for FT4 and FT3 to be in the upper part of their reference ranges. So you need FT4 and FT3 tested.
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Senim Vitamin B12 241.6 ng/L range 180-2000
Serum folate 8.48 ug/L range 3.10-18.30ug/L
Folate is a little low. Recommended is at least half way through it's range so 10.7 with that range.
I have read (but not researched so don't have links) that BCSH, UKNEQAS and NICE guidelines recommend:
"In the presence of discordance between test results and strong clinical features of deficiency, treatment should not be delayed to avoid neurological impairment."
And an extract from the book, "Could it be B12?" by Sally M. Pacholok:
"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".
"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."
Sublingual methylcobalamin lozenges are what's needed to supplement B12 yourself along with a good B Complex to balance all the B vitamins
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Serum ALT level: 12 lU/L range 10-36
Serum alkaline phosphatase 42 IU/L range 30-130
Serum total bilirubin level: 21 umol/L range 0- 21
!!Serum albumin 51 g/L range 35-50
AST serum level: 19 IU/L range 0-31
These are liver function tests. l can't interpret them. You could check with labtestsonline.org.uk/under... or ask your GP, especially as Albumin is just over range, bilirubin is top of range, ALT and Alk Phos are low in range.
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The full blood count 'under observation' - have they explained what they're keeping an eye on? If not then ask.
The others are all in range.
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Ideally, she also needs Vit D and Ferritin tested. Also thyroid antibodies as mentioned above.
Thanks SlowDragon - I should have gone to Specsavers
Sorry Richardcash I missed the ferritin result.
Serum ferritin 41 ug/L range 13.00-150.00ug/L
Ferritin needs to be at least 70 for thyroid hormone to work. Recommended is half way through it's range, and for females I've read it should be 100-130.
Iron supplements can be purchased as I doubt her GP will prescribe anything for that level. Ferrous fumarate from Amazon but retest after finishing the pack (84 I think). Each iron tablet should be taken with 1000mg Vit C to aid absorption and help prevent constipation, and iron should be taken 4 hours away from thyroid meds and 2 hours away from any other medication and supplements.
However, eating liver regularly, maximum 200g per week due to it's high Vit A content, will also raise the level and is much easier than trying to fit iron tablets around everything else.
If you can afford a private test, it would be worthwhile. We have recommended labs and Medichecks and Blue Horizon do home postal pin-prick tests. You have to make sure she's well-hydrated for two days previously. On the morning of the test her hands have to be warm so that blood will be drawn easily. I shall give you the link:
TSH, T4, T3, Free T4, Free T3 and thyroid antibodies. Your GP should test B12, Vit D, iron, ferritin and folate. I see her B12 is too low. The recommendation is that under 500 causes changes in the spinal fluid so we supplement to around 1,000 as recommended by the P.A. society in order to try to help avoid dementia/alzeimers.
Both Vit B12 and Vit D are prohormones so are essential to be optimum.
Others will respond to the other results.
When I was diagnosed and given levothyroxine I was far worse than before I was diagnosed and that took a long enough time so I was pretty unwell. Her TSH could be lower, Dr Toft, ex of the BTA recommends:-
6 What is the correct dose of thyroxine and is there any rationale for adding in tri-iodothyronine?
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).
Even while taking the slightly higher dose of levothyroxine a handful of patients continue to complain that a sense of wellbeing has not been restored. A trial of levothyroxine and tri-iodothyronine is not unreasonable. The dose of levothyroxine should be reduced by 50µg daily and tri iodothyronine in a dose of 10µg (half a tablet) daily added.
While taking both hormones it is important serum TSH is normal and not suppressed
The two most important tests, rarely taken are Free t4 and Free T3 and the reason is on the following link:
levothyroxine is T4 only. It should convert to T3 and T3 is the only Active thyroid hormone required in all our receptor cells. Without it we have little energy.
Essential to establish is she has high antibodies, which means autoimmune thyroid disease also called Hashimoto's. In UK about 90% of hypothyroidism is due to Hashimoto's
Medics here only ever call it autoimmune
With Hashimoto's we very often have very low vitamin levels as Hashimoto's affects the gut
Have you received a date to see the Endo yet? I would ask in the surgery if not heard anything when the doctor wrote to them. If they can't find that he has then I would tell him your have t received an appointment yet and ask when he asked for an appointment. He seemed keen to get it sorted for you so may be needsa memory jog.
Don't take anything before you see the Endo. If he knows you have taken T3 and bloods he runs will show that then he may refuse to see you again. At the moment you need his help. I appreciate dwhen you feel so rough you want to seen quickly but he probably has many others to see as well. Once you get an appointment and if it's a long way away then you could always ask if you could have an earlier appointment if he gets a cancellation.
In the mean time jot down all your symptoms and any questions you have. Often when face to face your mind goes blank! Helpful if you can take someone with you, your husband if he is able as he sees you on a daily basis and knows how difficult this is for you.
Vitamin B12, folate and ferritin too low to allow good use of thyroid hormone. Do you have free T4 and free T3 results? Most people need TSH under 1 to feel well.
Thanks for all your help, I am 'the wife'! Currently looking into private treatment as the waiting list to see the NHS endo is at least 6 months. I know it's not very long in the grand scheme of things but I'd rather get it sorted sooner than that. In the mean time, I'm going to try and cut out the gluten in my diet, I don't think I have much anyway but I'll monitor it and be a bit more conscious. I will request a Vit D, Vit B12, Ferritin and foltate check again and discuss with my GP.
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