Test results including vitamins, full blood count and liver function

[Helliefish]

Hi, I would really appreciate any insight that anyone might have on these test results.

Asked gp to test iron, b12, folate and ferritin, and she decided to order a bunch of other stuff too.

Full blood count, everything came back within range except for Mean Cell Haemoglobin level 26.8 pg [27.0-33.5] I think this may indicate low iron? I’m not sure.

Serum B12 321.0 ng/L [211.0-911.0]

Serum ferritin level 33.8 ug/L [10.0-291.0]

Serum folate level 5.64 ug/L [>5.38]

Serum total 25-hydroxy vitamin D level 64.1 nmol/l

Liver function tests; serum albumin level, serum total bilirubin level, serum alkaline phosphate level all within range, but serum alanine aminotransferase level 64U/L [7.0-40.0]

She also ordered urea and electrolytes, and HBA1C which were all normal.

I have been told that no further action is required.

My last thyroid test results were tested in August on 100mcg of thyroxine

TSH 4.81 mU/L [0.35-5.5]

Free T4 14.7 pmol/L [10.0-19.8]

Have now increased to alternating between 100mcg and 125mcg everyday, as I was still feeling unwell, and waiting to retest.

Any advise on whether I should be supplementing vitamins and iron, and how much, would be appreciated. I realise the other tests are not ones that you commonly see on here, but if anyone has any knowledge of liver function or blood count results, I’m a little confused?

Thanks

[Mary-intussuception]

1) Your B12 looks low, if this were my result then I would be asking GP to test for Pernicious Anemia. What are your present symptoms?

2) August TFTS results:

TSH 4.81

This is too high. What is your target therapeutic level of TSH? My Endocrinologist wrote my GP that mine is maximum 2. However I've learned on here of the opinion that a maximum of 1 is ideal. Was any action taken following this result?

3) Have now increased to 100mcg /125mcg . . . . . Am I correct in assuming that you did not know of the August result until recently? I would be asking for repeat Thyroid function tests now - and again in 6 weeks.

[Mary-intussuception in reply to Mary-intussuception]

2nd reply

ps

About the Liver Function results. I would try not to be too anxious about the abnormal one. You could Google search it. Wikipedia item is easy you read. Probably other info on net. Or you could ask GP about it.

Mind were raised also with a few more abnormalalities than yours. But that was before I was on my Levothyroxine. Was under a Gastroenterologist at the time and had Ultrasound scan. They thought it was fatty liver but scan showed it as normal so it wasn't. If I was an alcohol drinker they probably would have said it was that! Main thing is that they are back to normal now.

Did you ever have Adrenals checked out?

Hope you get sorted with correct dose of Levothyroxine and get better soon. xx

[Helliefish in reply to Mary-intussuception]

Hi, Mary-intussuception

When they did that test in August the gp told me that TSH of 4.81 was in range and so nothing further needed to be done, so I just accepted that. But then after a few months I didn’t feel any better so I went back and said that I thought it should be lower, maximum 1, and the gp agreed to increase the dose. I have only been on that increase for a few weeks now so will retest when it has been six weeks.

Thanks for the insight into liver function, I did google the result and found that the above range result for alanine aminotransferase could indicate liver damage, so I was a little surprised that the doctor wasn’t concerned about this. But I guess if they’re not worried about it then I shouldn’t be either.

[Mary-intussuception in reply to Helliefish]

Just keep an eye on the Liver function tests as well as Thyroid maybe? See if they'll repeat that as well. Maybe it will improve as mine all did. See what GP says about it.

If you've only been on 100mcg Levo a few weeks wouldn't it best to stay on that a few more till next test?

Hope you feel better in the coming weeks. xx

[Helliefish in reply to Mary-intussuception]

Yes, will keep an eye on it.

Sorry, I was unclear. So I was on 100mcg Levo from June to August, and then in August TSH was 4.81, but gp said this was fine and to continue on that dose so I did until recently. Went back to see a different gp and she agreed to increase to alternating between 100 and 125mcg. That was just a few weeks ago so now I will retest again when it has been six weeks.

[Mary-intussuception in reply to Helliefish]

OK, sorry. I'm a bit tired!

x🐥

[SlowDragon Administrator]

Your vitamin levels might not be dire but they are not brilliant

Vitamin D recommended to be at least 100nmol

Vitamin D mouth spray is easy to use, comes in various strengths. Perhaps try 1000iu strength. Two sprays daily and retest in 2-3 months

Vitamindtest.org.uk £28 postal kit

You may need higher dose in winter to summer. Government recommends 800iu dose as minimum Oct to April for everyone

Ferritin at least at 70. If you like liver aim to eat once a week. Alternatively you can buy iron supplements. Take with vitamin C to improve absorption and 4 hours away from Levo

B12 best towards top of range

A good vitamin B complex would improve folate too

If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 3-5 days before any blood tests, as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

Don't start more than one supplement at a time

Read lots of SeasideSusie detailed replies on vitamin supplements

GP won't prescribe anything as they are not bad enough

Do you have Hashimoto's? Diagnosed by high thyroid antibodies

[Helliefish in reply to SlowDragon]

Hey, thanks for the recommendations! And yes, I do have hashimoto’s.

[SlowDragon Administrator in reply to Helliefish]

So are you on strictly gluten free diet?

Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels

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...

All thyroid tests should be done as early as possible in morning and fasting and don't take Levo in the 24 hours prior to test, delay and take straight after. This gives highest TSH, lowest FT4 and most consistent results

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 articles from Thyroid UK email [e-mail]. print it and highlight question 6 to show your doctor.

Prof Toft - brilliant article just published

rcpe.ac.uk/sites/default/fi...