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TSH 28.3 (0.2 - 4.2)

Free T4 10.7 (12 - 22)

Free T3 4.0 (3.1 - 6.8)

Thyroid peroxidase antibody 335 (<34)

Thyroglobulin antibody 276 (<115)

Ferritin 33 (30 - 400)

Folate 2.38 (2.50 - 19.50)

Vitamin B12 183 (180 - 900)

Vitamin D 27.2 (25 - 50 vitamin D deficiency. Supplementation is indicated)

Just wondering if I could get some advice on results? Thank you in advance.

8 Replies
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Elspeth1986 You're obviously hypothyroid, with autoimmune thyroiditis (aka Hashimoto's), along with dire nutrient levels.

Has your GP seen these results? What has he said?

Are you diagnosed and on any thyroid meds?

Have you been prescribed anything for your nutrient deficiencies, if so what and the dose?

Thanks for reply my endo has told me there is no way I can be hypothyroid if I have always been thin and nothing except 800iu D3 and ferrous fumarate prescribed. Diagnosed 2012 and taking 150mcg levothyroxine.

Elspeth - your endo is talking through his **se. Of course you're hypothyroid. In the UK you are hypo when your TSH hits 10 so I'm assuming that you had a diagnosis originally on high TSH to be prescribed Levo. It doesn't matter that you are thin, it's not obligatory to put weight on! Your endo should know better, so should yourGP.

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Thyroid peroxidase antibody 335 (<34)

Thyroglobulin antibody 276 (<115)

As mentioned, your high antibodies mean that you are positive for autoimmune thyroid disease aka Hashimoto's which is where antibodies attack the thyroid and gradually destroy it. The antibody attacks cause fluctuations in symptoms and test results. Your doctors obviously know nothing about hypothyroidism so we don't expect them to know about Hashi's (most doctors dismiss antibodies as not important). So you need to help yourself here.

You can help reduce the antibodies by adopting a strict gluten free diet which has helped many members here. Gluten contains gliadin (a protein) which is thought to trigger autoimmune attacks so eliminating gluten can help reduce these attacks. You don't need to be gluten sensitive or have Coeliac disease for a gluten free diet to help.

Supplementing with selenium l-selenomethionine 200mcg daily can also help reduce the antibodies, as can keeping TSH suppressed.

Gluten/thyroid connection: chriskresser.com/the-gluten...

stopthethyroidmadness.com/h...

stopthethyroidmadness.com/h...

hypothyroidmom.com/hashimot...

thyroiduk.org.uk/tuk/about_...

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Have you had dose changes due to test results? Have you ever experienced any hyper-type symptoms. These can happen when the antibodies attack and dump a load of hormone, but it's just a temporary 'Hashi's swing' and things go back to normal.

You are obviously in a very hypo phase at the moment and desperately need an increase in your Levo to bring your TSH down to around 1 or below and your free Ts in the upper part of their reference ranges, which is where most people feel best.

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Ferritin 33 (30 - 400)

For thyroid hormone to work ferritin needs to be at least 70, preferably half way through range. For ferritin that low you really need an iron infusion, that will bring your level up within 24-48 hours, iron tablets will take months.

How much ferrous fumarate has been prescribed?

Take each iron tablet with 1000mg Vitamin C to aid absorption and help prevent constipaton. Always take iron 4 hours away from thyroid meds and two hours away from other medication and supplements as it will affect absorption.

Also, you can help raise your level by eating liver regularly, maximum 200g per week due to it's high Vit A content, and including lots of iron rich foods in your diet apjcn.nhri.org.tw/server/in...

Have you had a full blood count and iron panel to see if there is iron deficiency anaemia? If not then ask, low ferritin can indicate iron deficiency anaemia so it needs further checking.

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Folate 2.38 (2.50 - 19.50) Vitamin B12 183 (180 - 900)

You are folate deficient with very low B12. Check for signs of B12 deficiency here b12deficiency.info/signs-an... then please post on the Pernicious Anaemia Society forum for further advice, quoting folate, B12 and ferritin results, any iron deficiency information you may have, and any signs of B12 deficiency you may be experiencing healthunlocked.com/pasoc

You probably need testing for Pernicious Anaemia and may well need b12 injections.

Please don't ignore this, it is very important.

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."

You also need to ask your GP why these results have been ignored.

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Vitamin D 27.2 (25 - 50 vitamin D deficiency. Supplementation is indicated)

Well, 800iu D3 isn't going to ever raise your level. It is hardly a maintenance dose for someone with a reasonable level. You are 2.2 away from severe deficiency and you need loading doses. See NICE treatment summary for Vit D deficiency:

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)."

Each Health Authority has their own guidelines but they will be very similar. Go and see your GP and ask that he treats you according to the guidelines and prescribes the loading doses. Once these have been completed you will need a reduced amount (not a paltlry 800iu) to bring your level up to what's recommended by the Vit D Council - which is 100-150nmol/L - and then you'll need a maintenance dose which may be 2000iu daily, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. You can do this with a private fingerprick blood spot test with City Assays vitamindtest.org.uk/

There are important cofactors needed when taking D3

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 be deposited and 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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Hashi's and gut/absorption problems go hand in hand and very often dire nutrient levels are the result. SlowDragon has some very useful information and links about this.

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Your endo is obviously a diabetes specialist who knows nothing about hypothyroidism (but pretends he does) and even less about Hashi's, he's a disgrace. So is your GP to go along with this. Sack them both. Find another GP (maybe a better one in your practice, if not find another practice) then if you really want to see an endo (and they're really not worth it) then email louise.roberts@thyroiduk.org for the list of thyroid friendly endos, see who is in your area and ask for feedback from members.

I had dose changes but always been thin. TSH when diagnosed was 44 (0.2 - 4.2)

I assume your dose changes were down to test results showing possibly suppressed TSH and your doctor said you were overmedicated.

If so, this would probably have been due to a Hashi's flare which happens when the antibodies attack the thyroid and dump a load of cells into the bloodstream and producing hyper-type results/symptoms. These Hashi's flares are temporary and things go back to normal. Dose adjustment can be made but readjustment should also be made when things settle down. Your current results show you are in a very hypo phase and you desperately need your dose increased.

Ferrous fumarate once a day

MCV 77.5 (80 - 100)

MCHC 375 (310 - 350)

Haemoglobin 120 (115 - 150)

MCH 28.2 (28 - 32)

Iron 9 (6 - 26)

Transferrin 15 (12 - 45)

Elspeth - these results suggest iron deficiency anaemia so you need to point this out to your GP and ensure he follows the treatment guidelines because 1 x ferrous fumarate is not enough.

NICE Clinical Knowledge Summary for iron deficiency anaemia treatment (which will be very similar to your local area guidelines):

cks.nice.org.uk/anaemia-iro...

How should I treat iron deficiency anaemia?

•Address underlying causes as necessary (for example treat menorrhagia or stop nonsteroidal anti-inflammatory drugs, if possible).

Treat with oral ferrous sulphate 200 mg tablets two or three times a day.

◦If ferrous sulphate is not tolerated, consider oral ferrous fumarate tablets or ferrous gluconate tablets.

◦Do not wait for investigations to be carried out before prescribing iron supplements.

•If dietary deficiency of iron is thought to be a contributory cause of iron deficiency anaemia, advise the person to maintain an adequate balanced intake of iron-rich foods (for example dark green vegetables, iron-fortified bread, meat, apricots, prunes, and raisins) and consider referral to a dietitian.

• Monitor the person to ensure that there is an adequate response to iron treatment.

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