Am I anaemic?

[Lauren10]

Hi I am new I have hypothyroid but been told this is under control and nothing to worry about. Am I anaemic and do I need iron? I have been told I look ill and tired and pale thank you

FERRITIN 12 (15 - 150)

[SeasideSusie Remembering]

Lauren

You need more than ferritin tested to know if you are anaemic. Low ferritin tells you that your iron store is low.

You need a full blood count and iron panel.

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. So you need something done about your below range ferritin, ideally an iron infusion which will bring the level up within 24-48 hours. 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...

**

I have hypothyroid but been told this is under control and nothing to worry about

That might be your doctor's opinion but how do you feel?

Post your most recent thyroid test results, with their reference ranges, and tell us what thyroid meds you're taking. Ideally we need to see TSH, FT4, FT3 and thyroid antibody results.

I think it's a safe bet that your hypothyroidism is not under control and is something to worry about, because your thyroid meds can't be working with a ferritin level of 12.

**

Have you also had B12, Folate and Vit D tested? All vitamins and minerals need to be optimal, and as your ferritin is so dire I wouldn't be surprised if your others are low or deficient.

[Lauren10 in reply to SeasideSusie]

TSH 6.3 (0.2 - 4.2)

FREE T4 12.9 (12 - 22)

FREE T3 3.0 (3.1 - 6.8)

Taking 50mcg diagnosed 2012 thank you

[SeasideSusie Remembering in reply to Lauren10]

Lauren

TSH 6.3 (0.2 - 4.2)

FREE T4 12.9 (12 - 22)

FREE T3 3.0 (3.1 - 6.8)

I have hypothyroid but been told this is under control and nothing to worry about

I think your doctor has just won ass of the day award!

No way on earth is your hypothyroidism under control. You are very undermedicated to have an over range TSH, an extremely low in range FT4 and a below range FT3. See a different doctor because this one is keeping you ill.

The aim of a treated hypo patient generally is for TSH to be 1 or below or wherever it needs to be for FT4 and FT3 to be in the upper part of their respective reference ranges when on Levo.

You need an immediate increase of 25mcg Levo, retesting in 6-8 weeks time and then another 25mcg increase, and repeat until you feel well. In support of your request for an increase see thyroiduk.org.uk/tuk/about_... > Treatment Options:

Dr Toft (past president of the British Thyroid Association and leading endocrinologist) states in Pulse Magazine, "The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance.

But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."

You can obtain a copy of the article by emailing [e-mail] print it and highlight question 6 to show your doctor.

Also, according to the BMA's booklet, "Understanding Thyroid Disorders", many people do not feel well unless their levels are at the bottom of the TSH range or below and at the top of the FT4 range or a little above. The booklet is written by Dr Toft. It's published by the British Medical Association for patients. Avalable on Amazon and from pharmacies for £4.95 and might be worth buying to highlight the appropriate part and show your doctor. However, I don't know if this is in the current edition as it has been reprinted a few times.

**

Taking 50mcg diagnosed 2012

Have you always been on this dose or has it been changed, if so why was it changed and do you have the results from those times.

Have you had thyroid antibodies tested - were they high - Hashimoto's?

[Lauren10 in reply to SeasideSusie]

Was on as much as 100mcg then it was reduced thanks

[SeasideSusie Remembering in reply to Lauren10]

Why was it reduced?

Results at the time that prompted reduction?

Endo or GP reduced dose?

Have antibodies been tested - high? Hashimoto's?

[Lauren10 in reply to SeasideSusie]

Do I post dose changes on this thread, I have high antibodies yes

[SeasideSusie Remembering in reply to Lauren10]

Yes, keep everything together otherwise a new thread will mean questions from other members who haven't seen this thread that are already answered here.

[Lauren10 in reply to SeasideSusie]

Jan 17 (100mcg levo)

TSH 1.80 (0.2 - 4.2)

Free T4 15.9 (12 - 22)

Free T3 4.0 (3.1 - 6.8)

Jul 16 (75mcg Levo)

TSH 3.89 (0.2 - 4.2)

Free T4 18.1 (12 - 22)

Free T3 4.2 (3.1 - 6.8)

May 15 (50mcg levo)

TSH 5.01 (0.2 - 4.2)

Free T4 13.3 (12 - 22)

Free T3 3.8 (3.1 - 6.8)

Nov 14 (75mcg levo)

TSH 7.3 (0.2 - 4.2)

Free T4 15.7 (12 - 22)

Free T3 3.9 (3.1 - 6.8)

May 14 (50mcg levo)

TSH 5.60 (0.2 - 4.2)

Free T4 16.8 (12 - 22)

Free T3 3.7 (3.1 - 6.8)

Mar 14 (50mcg levo)

TSH 3.77 (0.2 - 4.2)

Free T4 13.8 (12 - 22)

Free T3 3.1 (3.1 - 6.8)

Mar 13 (25mcg levo)

TSH 2.60 (0.2 - 4.2)

Free T4 15.4 (12 - 22)

Free T3 3.5 (3.1 - 6.8)

Aug 2012

TSH 100.6 (0.2 - 4.2)

Free T4 9.3 (12 - 22)

Free T3 2.7 (3.1 - 6.8)

All done by GP

[SeasideSusie Remembering in reply to Lauren10]

Lauren

It seems very strange that you were on 75mcg levo in Nov 14 with these results:

TSH 7.3 (0.2 - 4.2)

Free T4 15.7 (12 - 22)

Free T3 3.9 (3.1 - 6.8)

and your GP reduced your dose to 50mcg, the most logical thing to do would be to increase it to try and lower your TSH and increase your free Ts. I don't think he really knows what he's doing.

And the fact that 50mcg Levo gave two very different sets of results in May 14:

TSH 5.60 (0.2 - 4.2)

Free T4 16.8 (12 - 22)

Free T3 3.7 (3.1 - 6.8)

and Mar 14:

TSH 3.77 (0.2 - 4.2)

Free T4 13.8 (12 - 22)

Free T3 3.1 (3.1 - 6.8)

makes me wonder why your GP hasn't noticed these?

However, results can only be compared accurately if conditions were the same for every blood test, and we always advise having appointments for blood draw at the very earliest time of the morning, fast overnight and leave off Levo for 24 hours. Maybe yours were taken at different times of the day, TSH will be higher in the early morning and it lowers during the day, it also lowers after eating.

Anyway, the fact that you have high antibodies confirms 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.

This can account for why you are getting different results on the same dose of Levo, if the tests were done at the same time.

Doctors generally attach no importance to antibodies but don't realise how they affect the patient, nor how it affects the test results (and symptoms). You should read and learn about Hashi's so that you can understand and help yourself.

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 tend to go hand in hand and very often end up trashing nutrient levels, which has obviously happened in your case. It's important to address this, poor absorption means that vitamins and minerals wont be absorbed, thyroid hormone can't work unless vitamins and minerals are optimal, so take a look at SlowDragon 's reply to this post which gives information and links on how to help healthunlocked.com/thyroidu...

[Lauren10 in reply to SeasideSusie]

Results done at same time which as early morning and I fasted and left levo 24 hours before blood test

[SeasideSusie Remembering in reply to Lauren10]

So the Hashi's is causing the fluctuations in your test results.

So much needs addressing, follow all the suggestions given.

[Lauren10 in reply to SeasideSusie]

MCV 76.1 (80 - 100)

MCHC 384 (310 - 350)

HAEMOGLOBIN ESTIMATION 110 (115 - 150)

MCH 27.9 (28 - 32)

RBC COUNT 4.41 (3.8 - 5.8)

WBC COUNT 7.13 (4 - 11)

PLATELETS 251 (150 - 400)

HAEMATOCRIT 0.41 (0.37 - 0.47)

IRON 5.3 (6.0 - 26.0)

TRANSFERRIN SATURATION 15 (12 - 45)

[SeasideSusie Remembering in reply to Lauren10]

Lauren

MCV 76.1 (80 - 100)

MCHC 384 (310 - 350)

HAEMOGLOBIN ESTIMATION 110 (115 - 150)

MCH 27.9 (28 - 32)

IRON 5.3 (6.0 - 26.0)

All this suggests iron deficiency anaemia. Has your GP said anything?

[Lauren10 in reply to SeasideSusie]

Thanks nothing been said

[SeasideSusie Remembering in reply to Lauren10]

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.

Needs discussing with your GP.

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.

[Lauren10]

VITAMIN B12 147 (180 - 900)

FOLATE 2.3 (2.5 - 19.5)

VITAMIN D TOTAL 25.5 (25 - 50 VITAMIN D DEFICIENCY. SUPPLEMENTATION IS INDICATED)

[SeasideSusie Remembering in reply to Lauren10]

Lauren

VITAMIN B12 147 (180 - 900)

FOLATE 2.3 (2.5 - 19.5)

VITAMIN D TOTAL 25.5 (25 - 50 VITAMIN D DEFICIENCY. SUPPLEMENTATION IS INDICATED)

Anything been said or done about these by your GP?

Please go over to the Pernicious Anaemia Society forum and post your B12, Folate, Ferritin and iron/full blood count results, also mention any signs of B12 deficiency you may be experiencing from this list b12deficiency.info/signs-an...

healthunlocked.com/pasoc

I think it's quite likely that you will need intrinsic factor antibodies testing, you may have pernicious anaemia and may need B12 injections. You definitely need folic acid for your folate deficiency but don't start that until other investigations have been carried out, and B12 needs to be started before folic acid.

See what they say then discuss with your GP.

**

VITAMIN D TOTAL 25.5 (25 - 50 VITAMIN D DEFICIENCY. SUPPLEMENTATION IS INDICATED)

You are 0.5 away from severe deficiency and should be having loading doses. If not then please speak to your GP and discuss 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 maintenace treatment of about 800 IU a day. Higher doses of up to 2000IU 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 regims 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 (more than 800iu so post your new result as the time for members to suggest a dose) 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 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.

[Lauren10 in reply to SeasideSusie]

Nothing being done or said thanks

[SeasideSusie Remembering in reply to Lauren10]

Then you need to discuss each and every result with your GP, you now have the levels needed, the guidelines for your GP to follow, and if you get advice from the PA forum you'll know what to do about your B12/folate, so make sure that you get the appropriate treatment for everything. If necessary see a different GP, point out that all these results have been ignored, get the ball rolling on treatment and then give consideration to making a formal complaint against this one who has been negligent.

[SlowDragon Administrator in reply to Lauren10]

If you can see a different GP at the practice.

Take all these results in and ask for correct treatment

Agree totally with SeasideSusie once you are sorted, your need to consider formal complaint against current GP

[Clutter in reply to Lauren10]

Lauren10,

You need to click on the Reply tab underneath SeasideSusie 's post to alert her you have replied.

[SlowDragon Administrator]

So your antibodies are high, this is Hashimoto's, also known by medics here in UK more commonly as autoimmune thyroid disease.

About 90% of all hypothyroidism in Uk is due to Hashimoto's

With Hashimoto's, until it's under control, our gut can be badly affected. Low stomach acid can lead to poor absorption of vitamins. Low vitamin levels stop thyroid hormones working.

your vitamins are obviously dire, in the main because you are on far too small dose of Levothyroxine.

But also with Hashimoto's very many of us also need to look at diet and food intolerances

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

But don't be surprised that GP or endo never mention gut, gluten or low vitamins. Hashimoto's is very poorly understood

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

thyroidpharmacist.com/artic...

thyroidpharmacist.com/artic...

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

chriskresser.com/the-gluten...

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

drknews.com/changing-your-d...