Thyroid UK
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New private blood results contradict the ones from gps. Shall I tell doctor?

Hello, I just got the results from the blood tests I did in Italy while visiting my family, 10 days after the ones I posted about recently were done.

I did these tests because I like to know what my T3 is, but also I have an appointment booked in December with a private endo also in Italy who is trained in functional medicine and he requested some tests I wasn't given by the NHS.

My FBC confirms the results from the UK, with low in range Haemoglobin (in this case, 129 g/L (range 12.00 - 16.50) and low in range Haematocrit

Thyroid hormones:

Italy TSH 2.39 (0.28 - 4.6) UK 1.8 (0.2 - 5.0)

FT3 2.35 (1.4 - 4.2)

FT4 11 (8 - 22) UK 17.7 (9.0 - 24)

Serum Ferritin Italy 34 ng/ml (10 - 284) UK 40 ng/L (13.0-150.0) (NB different range and method)

Vit D3 Italy 27.5 ng/ml which is stated to be in the adequate band (20.1 - 100 adequate, > 100 toxic ) UK 78 mol/L where adequate is > 50

The difference in Vitamin D I think is due to different range and method, but with the ferritin value I seem to have a much lower result also given the different range.

The other tests I was asked to do were:

Zinc 66.4 (68 - 107) deficiency

Magnesium 2.18 (1.6 - 2.5)

And also B12 and Folate which came out respectively mid range and lowish in range but I was already supplementing these so maybe they don't count.

I was really surprised by the improvement in my thyroid values showed in the test done in the UK, and given how I am feeling so crap, the test done in Italy, which shows I am still undermedicated, makes more sense, and is also in keeping with my last results in June, only very slightly worse. But I don't believe the GP would give me any more Levothyroxine given the UK results. I have a box of T3 from a Greek friend, and given I will see a specialist in Italy who does prescribe T3 and even NDT, I am thinking of having a go at self medicating for a couple of months, starting from 1 daily dose of 6 mg liothyronine.

What would you experienced people who use T3 do? I can't afford to do another private blood test now but I will definitely do one when I am in Italy again end of December.

The other question is do I have iron deficiency anaemia, given the low in range ferritin and not very high haemoglobin and haematocrit. Last winter, when my iron levels were 26 ng/ml (10 - 284) a locum GP prescribed Ferrous Sulphate 200 mg, I took them I think for 3 months and it seemed to help. Shall I try to talk to the GP and get them on board with this?

Also, what do people do about zinc deficiency? is it worth mentioning to the doctor or shall I wait to see the functional endo in Italy? 2 months seem such a long time to feel better especially as I'm struggling so much with brain fog and I need to write my thesis like, yesterday!

Just to make this post even longer, on Monday I am going for a routine check up at the Rheumatoid Arthritis clinic. I had loads of tests done last Spring and nothing came out of it. Now GP ordered Plasma C reactive protein and it came out normal. Shall I talk to them about all this?

Thanks so much for any replies and help, it's all very much appreciated and incredibly helpful.

19 Replies
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Assunta - the first thing I thought of when looking at your thyroid results was

Did you have both blood draws at the same time of day? Had you eaten before either of them?

You may have seen advice on the forum for when having blood tests, which is:

1) Book the very earliest appointment of the morning. TSH is highest early morning and lowers throughout the day. Here is a graph showing that healthunlocked.com/thyroidu... (top one). TSH is highest at midnight but as it's not possible to get blood drawn then, 9am should be the latest as that's when TSH starts to lower.

2) Fast overnight (water is allowed). TSH lowers after eating. So earliest possible appointment and breakfast after the blood draw.

3) Leave off Levo for 24 hours. This wont affect TSH very much at all, but if you take your Levo close to the blood draw, then FT4 will be higher (high FT4 can result in lowering of Levo).

So from looking at these results:

Italy TSH 2.39 (0.28 - 4.6) UK 1.8 (0.2 - 5.0)

FT4 11 (8 - 22) UK 17.7 (9.0 - 24)

I'm wondering if that lower UK TSH and higher UK FT4 is the result of you having blood drawn in the UK later in the day and after eating, and the Italy test being done earlier in the day and maybe fasting.

**

Serum Ferritin Italy 34 ng/ml (10 - 284) UK 40 ng/L (13.0-150.0) (NB different range and method)

It doesn't matter that the ranges are different, it's where within the range you fall that matters. You are low in both so you need to address the ferritin, which was discussed in your previous post. Yes, you are lower with the Italy test, maybe when you did the UK test you'd eaten some meat or other iron rich food recently which would have given your level a bit of a boost. Even when eating liver, like supplementing with iron tablets, it's best not to have it in the week before testing.

**

Vit D3 Italy 27.5 ng/ml which is stated to be in the adequate band (20.1 - 100 adequate, > 100 toxic ) UK 78 mol/L where adequate is > 50

The Vit D Council recommends the following levels:

100-150nmol/L

40-60ng/ml

**

Zinc 66.4 (68 - 107) deficiency

Zinc should be about half way through it's range. Look at zinc rich foods. Maybe discuss a zinc supplement with your Italian doctor.

**

Magnesium 2.18 (1.6 - 2.5)

Surprisingly good. Most of us test quite low.

**

B12 and folate

Although you haven't given details, B12 should be at the very top of it's range and folate should be at least half way through it's range.

**

With regard to adding T3, we can only really know how well we convert when we have a TSH of about 1 (or below) and nutrient levels are optimal (which means thyroid hormone can work, sub-optimal means thyroid hormone can't work properly and conversion is impaired).

**

I don't know anything about RA and whether it would affect anything else so can't comment on that.

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hi SeasideSusie thanks a lot for your reply and for all your useful and detailed comments. Re the thyroid results, I did make a point of getting the earliest appointment, at 8:50 am, for the UK blood test, and fasted and did not take my levo. In Italy the nurse came to the house, it would have been an hour earlier, can it make all that difference?. They are religious about fasting before any blood tests in Italy so I was quite surprised it's not the same here.

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As the ranges are very similar, and there will always be natural fluctuations in levels, the actual difference between the UK and Italy result is 0.59 which isn't that great when you consider the width of the range in the UK is 4.8 and Italy is 4.32. There may be a slight difference due to the time blood was taken, but overall they're pretty similar, it's the FT4 that has a big difference.

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yes, the FT4 being so high was a big surprise and didn't make sense. humanbean mentioned biotin in supplements can skew results now I am wondering if this is what happened?

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Oh yes, I always forget to mention that! It will be in a B Complex as either Biotin or B7. If you take B Complex and you didn't leave it off for a few days, check the ingredients and see if B7/biotin is in it.

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it is! apparently it all depends on what process is used by different labs. I am inclined to think that the Italian results is more likely to be correct because it is in line with my usual results, but I took the biotin before both unfortunately :(

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That could be an answer then!

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Assunta79,

Were the thyroid tests done at the same time of day? TSH and FT3 fluctuate according to circadian rhythms and will be higher early in the morning and low from early afternoon.

Ask your GP to increase Levothyroxine dose. The goal of Levothyroxine is to restore the patient to euthyroid status. For most patients that will be when TSH is 0.3 - 1.0 with FT4 in the upper range. FT4 needs to be in the upper range in order that sufficient T3 is converted. Read Treatment Options in thyroiduk.org.uk/tuk/about_... Email louise.roberts@thyroiduk.org if you would like a copy of the Pulse article to show your GP.

If you prefer you can add 1/4 tablet T3 (6.25mcg) to your current Levothyroxine dose.

Ferritin isn't deficient but it isn't optimal either. Optimal is halfway through range. You can raise ferritin by supplementing iron taken with 1,000mg vitamin C to aid absorption and minimise constipation. Ferrous Sulphate and Ferrous Fumarate are available OTC most places except Boots.

VitD is optimal 40-60 ng/ml. I would supplement 5,000iu D3 daily x 8 weeks and then reduce to 5,000iu alternate days and retest in April.

Iron and vitD should be taken 4 hours away from Levothyroxine and T3.

You can buy zinc OTC or ask your GP to prescribe.

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thank you so much for replying Clutter. The bloods were taken pretty much at the same time, with only an hour difference, I had fasted and not taken my levo.

I have the article but I fear this particular GP is a tough cookie. I have spoken to him only on the phone, he doesn't even need to see me to decide my joint pain etc. is because of 'low mood'!

I will try to get an appointment and see if he will at least prescribe iron and zinc but I have also decided to try the T3 dosage that you mention.

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Assunta79,

Perhaps you should consider changing your GP. Undermedication, vitamin D deficiency and low iron can all cause joint pain. Sounds rather lazy to assume lack of Prozac is causing joint pain.

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If you're on medication for the RA then (depending on the drugs involved, DMARDs, steroids etc.) this an have a substantial impact on the FBC, liver enzymes, inflammation markers etc. tho' response varies enormously from one individual to another.

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Hi thanks, but I am not, they did lots of tests on me in the Spring and could not find any signs of RA

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Inflammatory arthritis is a pest and can sometimes make an appearance well in advance of it 'ripening' into a state where it can be diagnosed reliably.

If it's neither seronegative nor seropositive RA (and, seronegative people can convert to seropositive), there are >100 other varieties of inflammatory arthritis (I have Psoriatic Arthritis) and these can be a nuisance to diagnose as they depend more upon imaging than +ve blood work (you tend to be negative for RF, anti-CCP etc. tho' there are some that tend to have high CRP, ESR etc. as well as specific antibodies for Lupus etc.).

I'm just mentioning this in case you have additional symptoms that return in the future and some oddities show up in your blood work (tho' they can disappear again).

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thank you, what kind of oddities should I be looking for? the Haematocrit has been low for more than a year, would that be at all relevant?

I was given scans in my fingers where the pain and swelling was and apparently they were fine. I do hope I don't have this.

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I move in and out of having very odd liver enzymes that are strongly indicative of autoimmune hepatitis tho' these always clear up without intervention (so far :) ).

I move in and out of having a positive ANA - not unusual to find this with auto-immune conditions.

Chronic inflammation tends to result in iron anaemia over time.

assunta79 - If you're due to be in the UK, I wonder if it's worth you looking at this clinical trial to see if you qualify for it if it interests you? nras.org.uk/the-appipra-study

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A comment about zinc - When zinc is low, copper tends to be high, and when zinc is high, copper tends to be low. For reasons I can't remember, zinc and copper have an inverse relationship with each other.

Obviously low zinc is not good, and the suspected high copper is not good either, so if you are taking any supplements that contain copper you should stop taking them. You need to supplement with zinc to raise your level.

You could look up lists of copper-rich foods and avoid them, and look up lists of zinc-rich foods and include them in your diet.

You might find these links interesting :

globalhealingcenter.com/nat...

metabolics.com/blog/a-pract...

.

As for your ferritin, your Italian result is approx 9% of the way through the range, and the UK result is approx 20% of the way through the range, both of which are too low for many people. I discussed your ferritin in your other post yesterday. You will probably feel better with a higher ferritin level, but when you test, do an iron panel, rather than an FBC. It is more explicit about how much iron is actually in your blood.

How often you test your iron and ferritin will really depend on how fast your levels rise. The optimal levels for iron are discussed on this page :

rt3-adrenals.org/Iron_test_...

I mentioned the problem of serum iron going up, but ferritin hardly changing in my post yesterday. This is not common, but is dangerous if you aren't aware that your serum iron is rising, and should stop your supplementing.

A far more common problem is one I suffer with myself. I can get my ferritin to mid-range now, but my serum iron and transferrin saturation are not mid-range they are lower. And in recent months my serum iron and transferrin saturation have been dropping lower and lower while my ferritin rises and rises. This is usually a result of inflammation. I'm noticing breathlessness as a result. So, if you think your ferritin is looking good, but you still think you might be anaemic, it could be because your serum iron is still low. Personally, I won't push my ferritin over the range to try and raise my serum iron.

A document worth reading, written about iron supplementing by helvella, one of the admins on this forum :

dropbox.com/sh/3waycnbzhywi...

Personally, I cope quite well supplementing with ferrous fumarate 210mg. But it always comes down to personal choice and what your gut will tolerate.

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@humanbean thank you so much for all the detailed feedback. This is all incredibly interesting. I am sorry about your problems with ferritin and iron levels. Breathlessness is horrible! I hope you can get to the bottom of it.

I will see if I can get the doctor on board re iron supplementation: I tolerated the Ferrous Sulphate pretty well last year and I might be able to get him to do an Iron panel. Otherwise I will buy my own.

I have been reading a bit about zinc in foods as you suggested and was looking forward to having more oysters, only to then discover that oysters also are a good source of copper!

It looks like many of my favourite foods are rich in copper, including avocados and dark chocolate which I eat a lot of (and which may be the cause of my good magnesium levels).

I read the links and bought a zinc ororate supplement as recommended in the link. I am really confused about what to eat now...

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I'm afraid I'm not an expert! My zinc is low (but not as low as yours) and my copper is over the range. I'm no better at dealing with it than anyone else - and at least you've bought a supplement. I haven't even got that far! :)

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I will let you know how I get one with it then. Can’t believe how many tablets I am taking 😭

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