Thyroid UK
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Results interpretation needed please

Hi could someone please help me to interpret results for thyroid please? I see GP on Tuesday.

! Serum TSH 6.7 mIU/L (0.2 - 4.2)

Serum Free T4 12.7 pmol/L (12 - 22)

Diagnosed hypothyroid 2013. I am 28 years old, female and have symptoms of upset stomach, dizziness, tinnitus, tiredness, feeling sick, pins and needles, dry skin, hair falling out. Hypothyroidism runs in the family.

Thanks

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We need the lab ranges to help you interpret them. Could you add them please?

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Sorry they are added

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! Serum TSH 6.7 mIU/L (0.2 - 4.2) Your TSH is above the top of the range showing that you are hypothyroid and need a dose increase. Levothyrxoine should be altered by 25mcg at a time and retest in 6 weeks time. MOst people don't feel well until their TSH is around 1 or a little lower.

Serum Free T4 12.7 pmol/L (12 - 22) Your FT4 is very low, only 7 above the bottom of the range so you don't have enough FT4. If you do not have enough FT4 then you cannot convert it to T3 which is the active thyroid hormone needed to lock onto T3 receptors. You will continue to have symptoms unless you increase your FT3 level. You really need an FT3 test too but NHS may refuse to do it (ridiculous I know).

Ask your GP to test for thyroid antibodies if not already done so. Although NHS treatment will be the same, if you have antibodies there is a lot you can do to help yourslef from advice on diet, improving gut function and managing mineral deficiencies.

dizziness, tinnitus, tiredness, feeling sick, pins and needles, these are symptoms of B12 deficiency. dizziness could also be iron deficiency.

Hair problems may be iron and/or mineral deficiencies.

Hair loss

healdove.com/disease-illnes...

People with thyroid disease and who are hypothyroid with not enough thyroid hormone commonly have vitamin deficiencies due to gut dysfunction caused we think by low stomach acid or disturbance to good gut bacteria. Please insist that your GP test the following.

B12

Folate

Ferritin

Vitamin D

these must be optimal for thyroid hormone to work effectively. When you have the results post them here. GP's will often say ok when they're not.

B12 symptoms of deficiency

b12deficiency.info/signs-an...

Take a list of symptoms to your GP when you ask for vitamins to be tested.

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Hi I have TPO antibodies of 1000 IU/mL (<34) and I have results of vitamins and minerals, will post

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Yes, you have Hashimotos. You can read more about it on Thyroid UK's website

Thyroid UK’s website information on Hashimotos

thyroiduk.org.uk/tuk/about_...

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Ok so vitamins and minerals are

Dec 2017

Ferritin 11 ug/L (30 - 400)

Folate 2.39 ug/L (2.50 - 19.50)

Vitamin B12 247 pg/L (190 - 900)

Vitamin D total 46.2 nmol/L

(<25 severe vitamin D deficiency. Patient may need pharmacological preparations

25 - 50 vitamin D deficiency. Supplementation is indicated

50 - 75 vitamin D may be suboptimal, and long-term may lead to clinical effects. Advise on safe sun exposure and diet. Supplementation may be indicated

>75 adequate vitamin D)

GP wants me to increase iron to 2 ferrous fumarate from 1 ferrous fumarate, take 5mg folic acid and increase my vitamin D from 800iu a day to 1600iu a day

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Ferritin 11 ug/L (30 - 400) Ferritin is dire, the correct treatment for your iron deficiency would be either an iron infusion or ferrous fumerate 3 times a day I believe.

You need ferritin to be at least 70 or mid-range for your own thyroid to function properly. Have you had a full iron panel because if not, your GP needs to do one.

Iron deficiency anaemia NICE guidelines

cks.nice.org.uk/anaemia-iro...

Vitamin D total 46.2 nmol/L You need to aim for a level around 100nmol. Vitamin D needs testing every 3 months while supplementing until you find the right dose for you. 1,600iu sounds reasonable. Too little vitamin D will take a long time to increase levels and too much vitamin D can build up to toxicity as it's not water soluble which is why you need to retest.

cks.nice.org.uk/vitamin-d-d...

You need to take magnesium and K2-MK7 with vitamin D3 in order to absorb the vitamin D effectively. Magnesium citrate is ok but there are other choices for magnesium.

naturalnews.com/046401_magn...

Vitamin B12 247 pg/L (190 - 900) You need to raise B12 levvels to higher than 500 or near to top of range to ensure sufficiency. Have you got symptoms of B12 deficiency because if so, I advise you to post your B12 and folate results along with an outline of your thyroid condition and symptoms, low ferritin etc on the HealthUnlocked Pernicious Anaemia forum healthunlocked.com/pasoc and ask their advice.

B12 symptoms of deficiency

b12deficiency.info/signs-an...

B12 The Guidelines Doctors follow

onlinelibrary.wiley.com/doi...

onlinelibrary.wiley.com/doi...

It's advisable to take a good B complex while supplementing B12 and folate to keep all the B's in balance. Try to find one with the B's in methylated forms for best absorption.

Folate 2.39 ug/L (2.50 - 19.50) Folic acid should not be supplemented until any B12 deficiency has been investigated as it can mask B12 anaemia. Folic Acid should be started a week after B12 supplementation has started if needed I believe but check with Pernicious Anaemia forum.

The importance of vitamins and thyroid function

americannutritionassociatio...

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Hi the GP said the iron panel wasn't very conclusive, neither was the complete blood count

Iron 9 (6 - 26)

Transferrin saturation 13 (12 - 45)

RBC 4.38 (3.8 - 5.8)

WBC 7.11 (4 - 11)

MCV 80.2 (83 - 98)

MCHC 389 (310 - 350)

MCH 28.1 (28 - 32)

Haemoglobin 118 (115 - 150)

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Your iron is too low. I bet you can't run for the bus.

The question though is why are you so low in so many minerals and vitamins? Is it the low thyroid or is it the diet? Are you having absorption problems or are you just not eating a diet that provides what you need?

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I think I have absorption problems. My diet is ok

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It takes a long time to raise ferritin levels. Only a very short length of small intestine absorbs iron. No one (at least I didn't notice) recommended to take iron with something acidic like orange juice or vitamin C.

One of the staff at work had a low ferritin like that. She also has heavy periods. She's been taking iron for 4 months and the latest result was 37. So I guess at that rate it will take a year. Unlike you though, her hemoglobin was 135.

Just follow the logical advice from people here in regards to taking supplements and encourage the doctor to raise your levothyroxine dose. Once your dosage is correct, you will likely absorb nutrients better. If not, check for coeliac disease. One auto-immune disease tends to beget another.

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B12 is seriously low too

All 4 must be at least halfway in their ranges

Have you gone gluten free because something is causing low vitamin levels

Are you taking any other meds

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Hi not gluten free, wasn't aware I needed to be until now. No other meds

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Many Hashimotos patients are either coeliac or just gluten sensitive ...a blood test for coeliac would be a start but after that i would suggest you go totally gluten free for at least 3 months and see if that improves matters especially the vitamins

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You are extremely under medicated. The aim of thyroid hormone replacement is to increase dose in 25mcg steps until TSH is around one and FT4 towards top of range and FT3 at least half way in range.

So you need 25mcgs dose increase and retesting after 6-8 weeks

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

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

Low vitamin levels stop Thyroid hormone working

Obviously your results are absolutely dire

GP should run blood test for coeliac (though it's very unreliable) endoscopy is only reliable test, but it's often a wait for months.

Ask for referral to haematology for iron infusion.

Essential to be tested for Pernicious Anaemia and you should push for B12 injections

Getting vitamins increased is essential

Here is similar post with detailed advice from SeasideSusie

Low vitamins due to under medication

healthunlocked.com/thyroidu...

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...

Low stomach acid can be an issue

Lots of posts on here about how to improve with Apple cider vinegar or Betaine HCL

thyroidpharmacist.com/artic...

drmyhill.co.uk/wiki/hypochl...

scdlifestyle.com/2012/03/3-...

healthunlocked.com/thyroidu...

Other things to help heal gut lining

Bone broth

thyroidpharmacist.com/artic...

Probiotics

carolinasthyroidinstitute.c...

Importance of magnesium

hypothyroidmom.com/two-vita...

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If those are your latest results you are very seriously undermedicated

If correctly treated TSH should be 1.0 or below freet4 around 19 and free t3 around 5.5

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