Why do I still feel ill?

[Baileysmurph]

Still feeling unwell I went back to the doctors in September and had further thyroid blood tests and a blood cortisol test.

March 2017 TSH 2.75 (0.4-5.0) FT4 16 (9-25)

Sept 2017 TSH 3.54 (0.4-5.0) FT4 14.9 (9-25)

Blood Cortisol 437 (166-507)

I got the same reaction from my GP as I did in March that the results were within normal range.

I decided to use Blue Horizon to get my thyroid retested along with Vitamin B12, D and antibodies as well as a cortisol saliva test.

I struggled getting blood out with the finger prick test and it was mid morning before I succeeded. I was surprised that The TSH result was lower than previously. Maybe this is because the GP ones were done at 8.30am.

Blue Horizon ( The Doctor's Lab)

TSH 1.97 (0.27-4.2) mIU/L

FT4 15.8 (12-22) pmol/L

TT4 96 (59-154) nmol/L

FT3 4.7 (3.1-6.8) pmol/L

Thyroglobulin Antibody <10 ( 0-115) IU/mL

Thyroid Peroxidase Antibodies < 9 (0-34) IU/mL

Vitam B12 383 (197-771) pg/ml

Folate not available - sample haemolysed

25 OH Vitamin D 50 (50-200) nmol/L

Ferritin 63 (13-150) ug/L

C Reactive protein 1.5 ( >5) mg/L

Cortisol Saliva

8-9am 17.8 (6-21) nmol/L

12noon 2.37 (1.5-7.6) nmol/L

4-5pm 3.77 (0-5.5) nmol/L

8-9pm 1.7 (0-2) nmol/L

I just feel cold and tired all the time and sleep makes no difference. I have so many hypothyroid symptoms.

Any feedback from these results would be very welcomed.

[shaws Administrator]

You have now learned that few doctors/endos appear to know very much about the function of the thyroid gland. They mistakenly believe that if our TSH is 'somewhere' in range that's fine and ignore that we are complaining or maybe even feeling worse with clinical symptoms. They fail to understand that once diagnosed and given levothyroxine, the aim is a TSH of 1 or lower.

The blood tests were introduced along with levothyroxine (T4 only) - the purpose being that if we were over the range we were hypo. Your GPs range is 5. Unfortunately in their wisdom the UK seems to be the only country to have the patient's TSH reach 10 before diagnosing. When other countries prescribe when it is 3+.

Before the blood tests and levo were introduced we were all diagnosed upon our clinical symptoms and given NDT (natural dessicated thyroid hormones) until symptoms were relieved. NDT was made from pigs thyroid glands and in 1892 NDT was prescribed for the first time and people didn't die of myxedema coma anymore. Thankfully for that. However I assume they don't have scientific minds nowadays and cannot suss out why some patients aren't recovering. Simple - either they don't understand at all the reason or don't care but are willing to prescribe other medications for the symptom rather than a decent dose of hormones. I will add in SeasideSusie who will comment on your post especially your very low vitamins/minerals.

[Baileysmurph in reply to shaws]

Thanks shaws.

[SeasideSusie Remembering]

Baileysmurph You have another doctor who seems to think that just because your TSH is in range then everything is fine; however, in range doesn't mean that it's the best place for you. Your TSH has been rising and FT4 lowering and that means that your thyroid is struggling and becoming worse.

March 2017 TSH 2.75 (0.4-5.0) FT4 16 (9-25) - FT4 is 43% through range

Sept 2017 TSH 3.54 (0.4-5.0) FT4 14.9 (9-25) - FT4 is 38% through range

and your BH results

TSH 1.97 (0.27-4.2) mIU/L FT4 15.8 (12-22) pmol/L - FT4 is 36% through range

I was surprised that the TSH result was lower than previously. Maybe this is because the GP ones were done at 8.30am.

That's exactly right. Check the first graph in this post and you will see how much higher TSH is at 9am than at 11am. healthunlocked.com/thyroidu...

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Vitamin B12 383 (197-771) pg/ml

Folate not available - sample haemolysed

Do you have any signs of B12 deficiency b12deficiency.info/signs-an... If so then please post on the Pernicious Anaemia Society forum for further advice. If not then you could self supplement.

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."

I keep my level at around 1000. Sublingual methylcobalamin lozenges are what's needed if you wish to self supplement, along with a good quality B Complex to balance all the B vitamins. I would suggest you start with sublingual methylcobalamin 5000mcg and when the bottle is finished change to 1000mcg as a maintenance dose, along with Thorne Basic B as a B Complex.

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25 OH Vitamin D 50 (50-200) nmol/L

The Vit D Council recommends a level of 100-150nmol/L. I would suggest you supplement with D3 softgels like these bodykind.com/product/2463-b... and take 5000iu daily for 3 months then retest. When you've reached the recommended level you will 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 helps D3 to work and 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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Ferritin 63 (13-150) ug/L

For thyroid hormone to work (that's our own as well as replacement hormone) ferritin needs to be at least 70, preferably half way through range. You're not really low enough to need an iron supplement so I would 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...

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Also, selenium is a good supplement as it aids conversion of T4 to T3 so you could take 200mcg selenium l-selenomethionine daily if you wish.

[Baileysmurph]

Hi SeasideSusie. Thanks so much for taking the time to send such detailed comments. I didn’t realise my B12 and Vit. D levels were as low. I think I may also go back to another GP at the practice with these results and all my symptoms and see if I can make any further progress there.