Thyroid results

Hi should GP be doing something about these thanks

TSH 44.6 (0.2 - 4.2)

Free T4 9.2 (12 - 22)

Free T3 3.0 (3.1 - 6.8)

Ferritin 27 (30 - 400)

Iron 8.1 (6.0 - 26.0)

Transferrin saturation 16 (12 - 45)

Folate 2.3 (2.5 - 19.5)

Vitamin B12 154 (180 - 900)

Vitamin D 22.7 (<25 severe vitamin D deficiency)

Red blood count 4.43 (3.8 - 5.8)

White cell count 7.11 (4 - 11)

MCV 76.2 (80 - 98)

MCHC 377 (310 - 350)

MCH 28.2 (28 - 32)

Haemoglobin 116 (115 - 150)

Haematocrit 0.43 (0.37 - 0.47)

Platelet count 256 (140 - 700)

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41 Replies

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  • Yes, they indicate primary hypothyroidism. Has your GP seen these results?

  • Hi no GP hasn't seen results I am under an endo

  • Are you taking levothyroxine? What dose? Have you been diagnosed?

    Phone the Endos secretary and tell her that your TSH is 44.6. and all of your other results are dire. You can always fax or send her a copy of your results for the Endo to look at.

  • Hi I am diagnosed and I take 25mcg levothyroxine diagosed 2012

  • Have you ever been on a higher dose?

    Do you have positive antibodies?

  • Hi yes I have been on a higher dose which was 175mcg levothyroxine results below

    TSH 1.80 (0.2 - 4.2)

    Free T4 18.7 (12 - 22)

    Free T3 3.9 (3.1 - 6.8)

    TPO antibodies 904.5 (<34)

    TG antibodies >1000 (<115)

  • Blue_89

    TPO antibodies 904.5 (<34)

    TG antibodies >1000 (<115)

    Has anyone bothered to tell you that you have autoimmune thyroid disease aka Hashimoto's as confirmed by your high antibodies? This is where antibodies attack the thyroid and gradually destroy it. It would appear that you have yet another useless endo who either is totally ignorant about Hashi's or thinks it's not important.

    I am struggling to understand why your dose was reduced to 25mcg. Usually it's because TSH becomes suppressed, the doctor panics because he doesn't know the nature of Hashi's, the dose is reduced by far too much and the patient ends up in a severely hypo state.

    With Hashi's, when the antibodies attack the dying cells dump a load of thyroid hormone into the blood and this can cause TSH to become suppressed and Free T4 and Free T3 to be very high or over range. You may get symptoms of being overmedicated (hyper type symptoms) to go along with these results that look as though you are overmedicated. Unless a GP knows about Hashi's and these hyper type swings, then they panic and reduce or stop your thyroid meds.

    The hyper swings are temporary, and eventually things go back to normal. Test results settle back down and hypo symptoms may return. Thyroid meds should then be adjusted again, increased until you are stable again.

    So what you need right now is an increase in your Levo, 25mcg for now, retest in 6-8 weeks and another increase of 25mcg, repeat every 6-8 weeks until your symptoms abate, you feel well and your results are where they need to be for you to feel well.

    **

    As for the Hashi's, 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_...

    **

    Hashi's and gut/absorption problems go hand in hand and dire nutrient levels are very often the result. SlowDragon has information and links to help there.

  • I do hope you haven't been on only 25mcg since 2012. If you have either your doctor or endo should be sacked.

  • Hi I have been on a higher dose which was 175mcg levothyroxine results below

    TSH 1.80 (0.2 - 4.2)

    Free T4 18.7 (12 - 22)

    Free T3 3.9 (3.1 - 6.8)

  • Even though on a higher dose, i.e. 175mcg, your Free T3 was very, very low, and that's what has been the reason you haven't been feeling well.

    It seems to me, and I am not medically qualified, that you cannot convert T4 into sufficient T3 as your FT4 is o.k.

    I think you should have T3 added to a reduced T4 and in the following link you will see the reason for knowing the FT4 and FT3.

    thyroiduk.org.uk/tuk/testin...

    T4 is an inactive hormone. It has to convert to T3. T3 is the only active hormone required in all our receptor cells as it is the 'battery' for our energy.

    Your levo dose at present, if 25mcg, is far too low and you urgently need increases.

  • Thanks I tried to add T3 in but without any guidance from endo or doctor this wasn't possible

  • Maybe an increase in T4 might work to lower your TSH to 1 or below and increase your T3 a bit.

    Do you always have the blood test at the very earliest time, fasting, and a gap of 24 hours between your last dose of levo and the test?

  • Yes

  • Many people when levo is at an optimum for them it relieves their symptoms and they feel better.

  • Am seriously confused as Dr recently gave me results of blood test but nothing refers to Hashimotos (which I requested tests for too )So back to surgery and have a copy of original test results but have been told by a GP at practice that top reading is Hashimotos result.

    Test shows:

    20 Sep 2017 Se Thyroid peroxidase AB conc - SHH190)= <4 lu/mL <25.00 iu/mL'

    Normal no action

    20Sep-2017 Serum free T4 level - (SIP) -Normal no action 17 .2 pmol/L 12.00-2200pmol/L

    20 Sep -2017 !Serum TSH Level-)SIP)-pn to sar 5.21mu/L.......0.27-4.20 mu/L

    The Levothyroxine was increased from 50 to 75 Mcg on this reading and have a printout of Vitamin tests from May 2017 and was prescribed VIT D 800 iu

    (my reading was 41.9 nmol/L)

    (Note followed: New Vitamin D method in use from 22nd November 2016. To protect muscoskeletal health, 250HVit D should not fall below 25 nmol a5t any time of year. 25-50 nmol/L may be insufficient for some people.

    Levels >200nmol/L:Increased risk of toxicity.

    All rest seem normal-No action But still feeling odd.

  • Diddums, copy and paste onto a new post for more comments on your results.

  • Have done ....thanks!

  • Just to agree with jimh111 - emphatically, yes. Do you have an appointment booked?

    Do you have any other blood test results to share, like vitamin and minerals (iron, B12, vitamin D, folate, ferritin etc.) and, if so, could you add them, along with their reference ranges, please?

  • Hi no appointment booked I am under an endo and he is adjusting my dose I will add the other results as well thanks

  • Are you seeing your endocrinologist quite soon as it looks like you're in need of a dose adjustment in that case?

    What are you taking and what is the dosage? Are you currently taking any supplements, if so - which and their dosages?

  • Hi I take 25mcg levothyroxine diagnosed 2012 and no supplements and I am not due another endo appointment for another 6 - 8 weeks

  • Phone his Secretary as I advised above.

  • That is a tiny dose of levo. so I'd not be surprised if your endocrinologist raises it and then instructs your GP to start testing every six weeks to tweak the dosage for you unless there are contraindications that we don't know about.

    Your vitamins and minerals look like they're in dire need of some suggestions from SeasideSusie. You're either below the reference range or just scraping in for some of them. Amongst several items that leap out are your folate and B12 levels - you need to discuss B12 deficiency with your GP/and or endocrinologist.

    I'm a little twitchy about your ferritin and iron levels - those in combination with your B12/folate results mean that it can start being tricky to disentangle what is happening.

    ETA: You might want to read some of the pinned posts about B12 deficiency in this forum: healthunlocked.com/pasoc

  • Tried to supplement with T3 but would be taking it without guidance from doctor and endo

  • It's difficult for thyroid hormones to work effectively (either your own or supplemented ones) if your vitamin and mineral status is poor. To some extent, you might need to address these deficiencies before tweaking your prescription hormones to add in another one.

    It would be helpful to know if you have an absorption issue (common with Hashimoto's and your antibody results would support that) or something else that is resulting in your vitamin and mineral results.

  • Thanks I hope to speak to doctor today about what is going on

  • Blue_89

    Ferritin 27 (30 - 400)

    Below range ferritin. This needs to be at least 70 for thyroid hormone to work, preferably half way through it's range. You are in dire need of an iron infusion which will raise your level within 24-48 hours. Fight for one and ask why this result has been ignored.

    You can also 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...

    MCV 76.2 (80 - 98) MCHC 377 (310 - 350) MCH 28.2 (28 - 32) Haemoglobin 116 (115 - 150)

    This all suggests iron deficiency anaemia, again ask why this has been ignored. Ask for appropriate treatment - see 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.

    **

    Folate 2.3 (2.5 - 19.5) Vitamin B12 154 (180 - 900)

    Folate deficiency plus B12 deficiency. Do you have any signs of B12 deficiency, check here b12deficiency.info/signs-an...

    Please go to the Pernicious Anaemia Society forum for further advice healthunlocked.com/pasoc and quote your folate, B12, ferritin, iron results, plus any signs of B12 deficiency you may be experiencing. You will probably need testing for Pernicious Anaemia and may need B12 injections. Don't underestimate how serious this can be. See what they say then discuss with your GP and ask why he has ignored these results.

    **

    Vitamin D 22.7 (<25 severe vitamin D deficiency)

    Severe Vit D Deficiency, you need loading doses of D3, accept nothing less, and ask your GP why he has ignored this result.

    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. Do not accept 800iu, it must be the loading doses.. Once these have been completed you will need a reduced amount (not a paltry 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.

    **

    Your doctor has been extremely negligent regarding these absolutely dire levels. I suggest you see a different GP, get appropriate treatment sorted, then make a formal complain against this negligent GP - you wont be the only one who he is mistreating.

  • Hi thanks I have a double appointment to discuss things with doctor today as he has called me in to speak about them and some other things which have cropped up

  • Well, I hope he realises how dire they are and suggests the proper treatment, if not you now have some knowledge to ensure you are treated appropriately.

  • Me too as the vitamin and mineral results were done by previous GP and didn't suggest anything so I have high hopes for this GP

  • I hope it's a useful discussion - Good Luck!

  • Thanks will post back I am a bit nervous about the appointment

  • I'm confused. You were on 175 mcg but it is now 25 mcg. How did this happen? What was the reason to go to such a low dose?

  • Yes reduced in one go and no reason given

    TSH 1.28 (0.2 - 4.2)

    Free T4 15.9 (12 - 22)

    Free T3 3.2 (3.1 - 6.8)

    Should I make a complaint?

  • Yes you should, levo should be adjusted up or down in 25mcg increments, the minimum is 4 weeks and 6-8 is standard. If you had only just been dropped a bigger initial increase might have been in order but as its been a while this may not be possible. Also your dose should not have been dropped at all. It is usually below range TSH which panics GPs into doing this but yours wasnt even close to bottom of the range let alone suppressed. If anything a 25mcg raise would have been in order to get your FT3 off the floor.

    If this was done by your endo you seriously need to dump him as he doesnt even have basic thyroid knowledge and in my opinion is dangerous, he is supposed to be an expert. Most endos are diabetes specialists not thyroid but even they know better than this.

    If you are seeing a new GP take a couple of symptom lists with you, one of how you were on 175 and one of how much worse you are now as he has no experience of you to base decisions on. Always try to quantify things, I needed 8 hours but now need 11 hours sleep is better than just tired all the time. I am eating X number of calories but instead of losing/maintaining I am now gaining weight and have put on X number of lbs rather than I cant lose weight/Im gaining weight.

    Definately follow SeasideSusies advice, I had poor conversion due to nutrient deficiencies and her advice got me converting well. A lot of deficiency symptoms mirror hypo symptoms so you also need to find out what is truly down to hypo. I felt considerably better just fixing the nutrients, a lot of tiredness and joint/muscle aches and pains completely went.

    I personally wouldnt self medicate T3 until you get those deficiencies fixed, you may not need it and it would mask improved conversion. Also it tends to suppress TSH and we know how GPs tend to react wrongly to that! We cannot process thyroid hormones properly without good nutrient levels, our own natural hormone or synthetic.

    I am now on NDT but I fixed my nutrients and got levo optimised so I at least gave the conventional route the best chance of working first, levo may still suit you, it does many and at the end of the day it is easier to obtain and free.

    Good luck and let us know how you get on at appt in a new thread.

  • So did you actually add some T3 when also taking 175mcgs T4

    If so was there then an futher blood test showing suppressed TSH

    Failing to understand why dose was reduced from 175mcgs, when the result shows you were under medicated and needing addition of small amount of T3

    Did you try T3 at any stage? Is this why dose was reduced

    T3 nearly always suppresses TSH, but as long as FT4 and FT3 are within range this is Ok

    But it's essential to have good vitamins and to address hidden food intolerances- by far most common is gluten

    Changing to a strictly gluten free diet may help reduce symptoms.

    thyroidpharmacist.com/artic...

    thyroidpharmacist.com/artic...

    amymyersmd.com/2017/02/3-im...

    chriskresser.com/why-changi...

    scdlifestyle.com/2014/08/th...

    Low stomach acid can be an issue

    Lots of posts on here about how to improve with Apple cider vinegar or Betaine HCL

    thyroidpharmacist.com/artic...

    Other things to help heal gut lining

    Bone broth

    thyroidpharmacist.com/artic...

    Probiotics

    carolinasthyroidinstitute.c...

  • Dose reduced in one go and no reason given

    TSH 1.28 (0.2 - 4.2)

    Free T4 15.9 (12 - 22)

    Free T3 3.2 (3.1 - 6.8)

    Should I make a complaint?

    Never added T3 was worried about going over medicated

  • Absolutely you should make a complaint.

    This result was already too low, as is obvious from very low T3

    How long have you been left on 25mcgs? Is there anything in writing from endo saying this is the dose to take?

    Email Louise at Thyroid Uk for list of recommended thyroid specialists

    Louise.roberts@thyroiduk.org.uk

  • Been on 25mcg since August 2017, letter from endo says this is the correct dose to take

  • Then you have written evidence to complain about endocrinologist

    Also previous GP was extremely negligent to not flag up to endocrinologist your current results, or to suggest you increase in Levo, or to start you on any vitamin supplements

    gmc-uk.org/How_to_complain_...

    nhs.uk/NHSEngland/complaint...

  • Hi, some of your results seem to be very had GH and other normal. I am not very familiar with these things. I am sure your GP can explain better. If you are not satisfied, ask him to refer you to the endocrinologist who is a specialist.

    Wishing you all the best.

    Harrietx

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