Thyroid UK

blue horizon results

can somebody explain the following results in laymans terms please

patient result normal range

HbA1c-(IFCC) H 43 20-42 mmol/mol

hs-CRP H 16.80 <5.0 mg/L

Ferritin 161.0 30-400 ug/L new range

magnesium H 1.01 0.66-0.99 mmol/L

New Range

TSH 3.57 0.27-4.2 mlu/l

T4 total 92.1 66-181 nmol/l new range

Free T4 15.0 12-22 pmo/l

Free T3 4.48 3.1-6.8 pmo/l

Reverse T3* 21.0 10-24 ng/dl

Reverse T3 ratio L13.89 normal >15 Ratio

borderline 12-15

low <12

anti-thyroidperoxidase abs H 287.0 <34 kl/ul

anti-thyroglobulin abs H 285 <115 kl/ul

vitamin d (25oh) 83 deficient <25 nmol/l

insufficient 25-5

vitamin b12 241 deficient <145 pmol/l new range


serum folate L 7.92 8.83-60.8 nmol/l

5 Replies


You are undermedicated to have TSH 3.57 while taking Levothyroxine. FT4 and FT3 are both under halfway through range. A Levothyroxine dose increase will raise FT4 and FT3 and reduce TSH.

The goal of Levothyroxine is to restore the patient to euthyroid status. For most patients that will be when TSH is 0.3 - 1.0 with FT4 in the upper range. FT4 needs to be in the upper range in order that sufficient T3 is converted. Read Treatment Options in Email if you would like a copy of the Pulse article to show your GP.

Thyroid peroxidase antibodies and thyroglobulin antibodies are positive for autoimmune thyroid disease (Hashimoto's). There is no cure for Hashimoto's which causes 90% of hypothyroidism. Levothyroxine treatment is for the low thyroid levels it causes. Many people have found that 100% gluten-free diet is helpful in reducing Hashi flares, symptoms and eventually antibodies.

rT3 21 is within range.

rT3 ratio is meaningless. See

HbA1c is a diabetes test. 43 is over range so I would see your GP to discuss.

CRP is an inflammation marker. 16.8 is high so see your GP to discuss.

Ferritin is optimal halfway through range but there's little chance of iron deficiency with ferritin 161.

Magnesium is mildly over range. I doubt it is significant but you can Google "high magnesium" to check it out.

VitD 83 is in the replete range 75 - 200.

B12 is low and in the grey area where you could be deficient. If you have symptoms in you may be deficient and should pop over to to discuss as they are the experts on B12, folate and PA.

Folate is deficient. Your GP should prescribe 5mg folic acid for 2-3 months. B12 deficiency should be ruled out first. If B12 injections are initiated this should be done 48 hours before you start taking folic acid.

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thanks for the advice


First is the high thyroid antibodies means you have Hashimoto's also called autoimmune thyroid disease

Did you know?

Your results suggest you are under medicated to have TSH so high. Usually recommended to have dose increased in 25mcg steps until TSH around one and FT4 towards top of range and FT3 at least half way in range

FT4 is too low, as is total T4, both suggest you need higher dose

FT3 is too low, most find it needs to be in top third to feel well. Increasing Levo should increase FT3 as result

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 print it and highlight question 6 to show your doctor

please email Dionne:

Your B12 is Insufficient. You should ask GP to test for Pernicious Anaemia. Especially as folate is also very low and below range. They may not agree it's low enough for B12 injections.

Do you have B12 deficiency symptoms

If GP won't offer injections then supplementing B12 sublingual lozenges and also a good vitamin B complex often a good idea, one with folate in.

Folic acid supplements should not be started until after first B12 injection or B12 supplements started as improving folate levels before B12 can make B12 deficiency worse.

B12 generally

Vitamin D is slightly low, getting to around 100nmol is good idea, supplement through winter and retest in spring.

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

Low vitamin levels affect Thyroid hormone working

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

Ask GP for coeliac blood test first

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According to the above - level of HbA1C - you are in the pre-diabetic range - you need to talk to your GP - probably means looking at diet and exercise to get result back down.


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