Latest results

[Catlover3]

Good Morning

These are the latest results for my daughter whom is suffering with extreme fatigue, brain fog, eyesight deterioration, very poor concentration. She has B12 injections every other day and takes Ferritin 210mg, methylfolate 400mcg, D3 3000iu spray, biotin, contraceptive pill, every day. She appears to be getting worse not better and I am at a loss as to what to do with her.

hs-CRP 4.06 <5.0 mg/L

Ferritin 50.6 13 - 150 ug/L New range

Thyroid Function

TSH 1.45 0.27 - 4.20 mIU/L

T4 Total 158.0 66 - 181 nmol/L New range

Free T4 14.70 12.0 - 22.0 pmol/L

Free T3 4.68 3.1 - 6.8 pmol/L

Immunology

Anti-Thyroidperoxidase abs 19.6 <34 kIU/L

Anti-Thyroglobulin Abs 28 <115 kU/L

Vitamins

Vitamin B12 H >1476 Deficient <145 pmol/L New range

Insufficient 145 - 250

Consider reducing dose >569

Serum Folate 29.20 8.83 - 60.8 nmol/L

Cortisol (Saliva) Waking 7.97 6.0 - 21.0 nmol/L

<6.0 Possible Addison's

Cortisol (Saliva) 12:00 5.43 1.5 - 7.6 nmol/L

Cortisol (Saliva) 14:00 3.65 0 - 5.5 nmol/L

Cortisol (Saliva) 16:00 2.77 0 - 5.5 nmol/L

Cortisol (Saliva) 18:00 2.48 0 - 4.5 nmol/L

Cortisol (Saliva) Before Bed 1.56 0 - 2.0 nmol/L

>5.0 possible Cushing's

Any ideas anyone?

Regards Catlover3

[SlowDragon Administrator]

Did she stop taking biotin 3-5 days before these tests?

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...

Is she taking Levothyroxine? And/or T3?

There's no vitamin D result

Is she strictly gluten free? Or considered this

Brain fog is linked to leaky gut and gluten often involved

Has she had glandular fever or got any obvious gut symptoms?

[Catlover3 in reply to SlowDragon]

Hi. Yes we remembered to stop the biotin before the tests. Made that mistake the last time which was very costly! She isn't on any thyroid medication at all. She is gluten free now and dairy free for many years. Tested for h-pylori and was negative. She definitely has absorption problems as if she stops taking supplements despite having a good diet her levels drop. She won't be treated by doctor for thyroid as she is in range and they just want to put her back on anti-depressants which she won't do, so we are very much having to self treat which isn't ideal. Anti-depressants didn't do a thing for her although they chopped and changed her medications and increased to the maximum dose. Her energy levels have always been low but have now decreased dramatically. Her sister was diagnosed with ME at 16 and I wonder if it is genetic. Regards

Catlover 3

[SlowDragon Administrator]

Just seen on previous post low vitamin D. She may need higher dose that 3000iu. Plus good idea to supplement magnesium and vitamin K2 Mk7 as well

When having B12 injections might also consider a good vitamin B complex, rather than just biotin

Her FT4 is on low end of range and FT3 not brilliant either

[SeasideSusie Remembering]

For the adrenal test, cortisol should be highest in the morning and lower throughout the day, following a curve like in this sample report - green being where the results should lie gdx.net/uk/core-uk/sample-r...

Cortisol (Saliva) Waking 7.97 6.0 - 21.0 nmol/L

<6.0 Possible Addison's

Cortisol (Saliva) - this is very low for the waking sample but not low enough to worry about Addisons

The next 4 have lowered as they should be without plotting on a graph we don't know how well they follow the normal curve

12:00 5.43 1.5 - 7.6 nmol/L Cortisol (Saliva)

14:00 3.65 0 - 5.5 nmol/L Cortisol (Saliva)

16:00 2.77 0 - 5.5 nmol/L Cortisol (Saliva)

18:00 2.48 0 - 4.5 nmol/L Cortisol (Saliva)

Before Bed 1.56 0 - 2.0 nmol/L

>5.0 possible Cushing's

- Although in range, I imagine this is higher than it should be as it's about 75% through the range. Obviously you don't have to worry about Cushings.

I'm not an expert but the only two not really 'normal' are the waking one and the bedtime one.

Dr Myhill's interpretation of adrenal test results drmyhill.co.uk/wiki/Adrenal...

She has lots of information on her website about all sorts of things, you might find more to do with the adrenal gland.

**

Ferritin 50.6 13 - 150 ug/L New range

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. She can help raise her 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 her diet apjcn.nhri.org.tw/server/in...

**

TSH 1.45 0.27 - 4.20 mIU/L

T4 Total 158.0 66 - 181 nmol/L New range

Free T4 14.70 12.0 - 22.0 pmol/L

Free T3 4.68 3.1 - 6.8 pmol/L

She has a good Total T4 but this is not reflected in her FT4 which is on the low side, as is FT3. 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. I would be looking for an increase in Levo if those were my results.

See thyroiduk.org/tuk/about_the... > Treatment Options:

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 Anthony Toft, past president of the British Thyroid Association and leading endocrinologist. 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.

Also -

Dr Toft 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 her doctor.

Raising ferritin also might help.

[Catlover3 in reply to SeasideSusie]

Thank you for your reply. My daughter is not on any thyroid medication and I doubt will be able to get any treatment with the test results being in the normal range. I have bought some selenium for her to take to support her thyroid in the hope that it helps. We will continue to keep taking the ferrous fumerate to bring her ferritin up along with all the other supplements. I will do more reading regarding the adrenals but find it all a bit over whelming. I self treat my own hashi's with ndt after giving up on the useless gp's I have had over the years but would really prefer not to have to. Regards Catlover3