Thyroid UK
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Seaside Susie and Co ... please can I have some help with results after vitamin supplementing for hypo symptoms? x

Good morning, Thanks for looking at this post.

At the beginning of the year tests showed that my TSH was over 3.6, vit D on the floor and Total T4 86 / Free T3 4.00 / Free T4 13.4 and reverse T3 over range at 26.

Lifelong problems with cold, weight gain, low energy and other hypo symptoms ... couldn't lose weight on various diets.

Consulted Dr S from TUK list of private doctors and was prescribed various supplements plus progesterone cream. I'm late 50s but my problems aren't related to age in my opinion.

Here are the latest results. I have a thyroid scan booked for next week but think maybe I don't need it ...

Dr S said I could perhaps move onto T4/T3 med at a later date if supplements don't work to clear the problems. I haven't shared results with him yet as I feel you folks on the forum are even better informed ...

ENDOCRINOLOGY

Thyroid Function

THYROID STIMULATING HORMONE 2.69 mIU/L 0.27

-

4.20

FREE THYROXINE 13.3 pmol/L 12.00

-

22.00

TOTAL THYROXINE(T4) 82.7 nmol/L 59.00

-

154.00

FREE T3 4.51 pmol/L 3.10

-

6.80

REVERSE T3 24 ng

/dL 10.00

-

24.00

REVERSE T3 RATIO *12.23 15.01

-

75.00

THYROGLOBULIN ANTIBODY <10 IU/mL 0.00

-

115.00

THYROID PEROXIDASE ANTIBODIES <9.0 IU/mL 0.00

-

34.00

HAEMATOLOGY

Vitamins

ACTIVE B12 97.0 pmol/L 25.10

-

165.00

FOLATE (SERUM) 16.02 ug/L 2.91

-

50.00

25

OH VITAMIN D 75.4 nmol/L 50.00

-

200.00

BIOCHEMISTRY

Inflammation Marker

CRP

-

HIGH SENSITIVITY 1.6 mg/l 0.00

-

5.00

Iron Status

FERRITIN 97.4 ug/L 13.00

-

150.00

Any thoughts will be most welcome, especially diet related. I have started Gluten Free diet but not sure it's appropriate as it appears I don't have Hashi's. But I feel encased in

blubber!

Best wishes to all and thanks in anticipation.

A very chubby Demelza.

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Demelza

Are you taking any thyroid meds?

ACTIVE B12 97.0pmol/L 25.10 - 165.00

I'm afraid I can't interpret Active B12 as I don't know what optimal is with that, I've only ever done Serum B12.

FOLATE (SERUM) 16.02 ug/L 2.91 - 50.00

Folate should be half way through it's range, so with that range it should be 26.5 plus

OH VITAMIN D 75.4 nmol/L 50.00 - 200.00

The Vit D Council recommends a level of 100-150nmol/L

FERRITIN 97.4 ug/L 13.00 - 150.00

This is a good level

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Thanks Seaside Susie for your prompt reply, no I’m not taking any medication.

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Love your name ! I have a Greek dog here in Crete having moved from Cornwall. When the vet said it was a girl and what would be her name - my reply was instant - DEMELZA - I shouted. This was some 14 years ago - so memories from the first series !! I once interviewed a real life Demelza who was totally unsuitable for the job - just loved the name ! .... and so life goes on ....

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Thanks Marz, I love living in Cornwall, but Crete is also beautiful and having a puppy dog called Demelza, brilliant! Can I trouble you to give me any advice? I am not on any thyroid meds’ but defo feeling hypo. Best wishes from DP.

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Really cannot add anything to SeasideSusie at the moment. Will give it some thought and get back to you.

Adrenals ?? - and FAM - Fat around the Middle - sounds like me !!

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Well, your TSH is probably higher than usual for someone who is 'healthy', your FT4 is low but not surprising as Total T4 isn't particularly good, and your body is doing it's best to push out a reasonable amount of FT3 but that wont last forever. And you probably know that those results wouldn't get you a diagnosis with an NHS doctor. It will be interesting to hear what your private doctor is going to do.

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Thanks Seaside Susie, that’s really helpful. But I think private doc is going to take his cue from me and I don’t know what to say or do - as it looks a pretty borderline set of results, the vitamins may have helped a tiny bit ... but eating less and exercising more may make them worse.

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acive B12 is well into range implying that B12 is very unlikely to be an issue.

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Thanks Gambit62, I’m now looking into mucin and water retention, perhaps I’m not fat at all!

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Thanks Gambit62 At what level would Active B12 be considered to be low enough that it might need improving?

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the test, like serum B12, isn't one that you can use as a single marker - its just too indirect a measure of what is going on - so really its a question of looking trying to find as many other markers as possible - which includes symptoms (difficult if someone has thyroid, diabetes, iron deficiency ..... because of the overlap in symptoms).

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Ah, OK, I was just wondering at what sort of level it would be prudent to direct members to the PA forum for further advice. We're seeing more and more Active B12 now.

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this is what the British Committee for Standards in Haematology says about the active B12 test (also known as holotranscobalamin

Holotranscobalamin (HoloTC), the ‘active’ fraction of plasma cobalamin, may be more specific than serum cobalamin levels, and an immunoassay for this fraction is now available. In clinical research studies, the HoloTC assay performs better than the serum cobalamin assay in assessing deficiency based on MMA levels (Miller et al, 2006; Nexo & Hoffmann-Lucke, 2011) and red cell cobalamin levels (Valente et al, 2011) as reference assays. However, arguments have been raised against accepting this (Schrempf et al, 2011; Carmel, 2012a), given that even MMA or red cell cobalamin may not be regarded as gold standard tests for determining deficiency. Despite this, the assay has a smaller ‘grey zone’ (uncertainty range) than serum cobalamin assays and better sensitivity and specificity characteristics.

The expected values for HoloTC in healthy individuals are 35–171 pmol/l. Lower and upper reference intervals for plasma HoloTC range from 19–42 pmol/l and 134–157 pmol/l, respectively (Refsum et al, 2006; Brady et al, 2008; Sobczynska-Malefora et al, 2014). A recent multicentre study suggested a cut-off point of 32 pmol/l of HoloTC for screening for cobalamin deficiency based on a MMA level >0·45 μmol/l (Heil et al, 2012). The GWG recommends that individual laboratories should either determine their own reference ranges dependent upon the particular HoloTC assay used or implement the manufacturer's reference range where a suitable study has been conducted.

Further studies are needed to evaluate the clinical utility of HoloTC in assessing cobalamin deficiency in a routine high output laboratory testing. It may cut down the percentage of indeterminate results, particularly in patients over the age of 65 years. There is the added advantage of use in pregnancy and in patients on oral contraceptives as the HoloTC fraction of cobalamin does not seem to be subject to the physiological drop seen in total serum cobalamin over the course of pregnancy (Greibe et al, 2011).

That would suggest that something around 42, possibly up to 50 pmol/L

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You obviously need some Levo your FT4 is too low

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