Help with test results please

[MrsR1412]

Please can I have some advice on my latest set of test results? I requested the Vit D, ferritin, folate and B12 to be done alongside my normal thyroid. I am currently taking 25mcg of Levo, started in December. Not sure why there is no T4 result. My TSH has come down slightly since December test.

Serum total 25-OH vit D level

33.000 nmol/L

50 - 374 nmol/L

Serum TSH level

4.080 mu/L

0.55 - 4.78 mu/L

Serum ferritin

148.000 ug/L

10 - 291 ug/L

Serum iron tests

Serum iron level

25.500 umol/L

12.5 - 25 umol/L

Serum transferrin

2.440 g/L

1.8 - 3.2 g/L

Percentage iron saturation

40.000 %

15 - 50 %

Full blood count - FBC

Haemoglobin estimation

134.000 g/L

120 - 160 g/L

Total white cell count

4.900 10*9/L

4 - 11 10*9/L

Platelet count

196.000 10*9/L

150 - 500 10*9/L

Red blood cell (RBC) count

4.300 10*12/L

3.8 - 5.8 10*12/L

Haematocrit

0.423 L/L

0.36 - 0.47 L/L

Mean corpuscular volume (MCV)

98.300 fL

76 - 103 fL

Mean corpusc. haemoglobin(MCH)

31.100 pg

27 - 32 pg

Mean corpusc. Hb. conc. (MCHC)

317.000 g/L

300 - 360 g/L

Red blood cell distribut width

12.700 %CV

11 - 16 %CV

Percentage hypochromic cells

1.300 %

0 - 2.5 %

Neutrophil count

3.140 10*9/L

1.5 - 8 10*9/L

Lymphocyte count

1.180 10*9/L

1.3 - 4 10*9/L

Monocyte count

0.340 10*9/L

0.2 - 0.8 10*9/L

Eosinophil count

0.100 10*9/L

0 - 0.8 10*9/L

Basophil count

0.050 10*9/L

0 - 0.3 10*9/L

B12 AND FOLATES

Serum vitamin B12

328.000 ng/L

211 - 911 ng/L

Serum folate

8.390 ug/L

3.38 - 23.9 ug/L

Many thanks in advance

[Clutter]

MrsR1414,

You are undermedicated to have TSH 4.08 and should request a Levothyroxine dose increase. The goal of Levothyroxine is to restore the patient to euthyroid status. For most patients that will be when TSH is 0.2 - 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 thyroiduk.org.uk/tuk/about_... Email [e-mail] if you would like a copy of the Pulse article to show your GP.

VitD 33 is considerably below range. Has your GP offered treatment?

Ferritin and iron results are good.

Eosinophil count is mildly elevated. The rest of the FBC is within range (normal) so it's unlikely to be significant but you can Google "Eosinophil high" to check for possible causes.

B12 328 can be deficient. If you have symptoms in b12deficiency.info/signs-an... go to healthunlocked.com/pasoc for advice, otherwise you can supplement 1,000mcg methylcobalamin 4-5 times a week to raise B12.

Folate could be higher. Eating leafy green veg increases folate and you could add a B Complex vitamin which has a little folic acid or methylfolate, particularly if you supplement methylcobalamin.

[SlowDragon Administrator]

You need 25mcg dose increase in Levothyroxine and retested in 6 weeks

TSH needs to be low in range on Levothyroxine

Nice guidelines saying how to initiate and increase

Note standard starter dose is 50mcgs and most patients end up somewhere between 100mcg and 200mcg

cks.nice.org.uk/hypothyroid...

Official NHS guidelines saying TSH should be between 0.2 and 2.0 when on Levothyroxine

(Many of us need TSH nearer 0.2 than 2.0 to feel well)

See box

Thyroxine replacement in primary hypothyroidism

pathology.leedsth.nhs.uk/pa...

Essential to improve vitamin D to at least 80nmol and many find around 100nmol best

B12 can be too low for some on Levothyroxine

b12deficiency.info/signs-an...

Supplementing daily B12 sublingual lozenge and/or good vitamin B complex may help

Only make one change at a time though

You know you have Hashimoto's and I think are already gluten free?

[MrsR1412 in reply to SlowDragon]

Thanks so much for replying. Well remembered on the Hashimoto’s and that I have already gone gluten free.

I have spoken to the doctors and they’ve said I need to have a vitamin D retest. I asked them to test T4 and my antibodies again. The doctor said that she wouldn’t increase my Levo because my T4 was 17 when it was tested in December and she doesn’t want this to go too much higher, she said this is irrespective of the TSH... that they are now claiming is normal as it’s under 5!!!

She also requested a test that is something to do with my bones and another one that I didn’t understand what she said was being tested. I will ask when I go to get bloods done on Wednesday.

So frustrated that I’m back to being told your TSH is normal 🙁

[SlowDragon Administrator in reply to MrsR1412]

Suggest you see a recommended thyroid specialist of the Thyroid UK list then

Or print out the link I gave you that's Leeds endocrinologist specialist thyroid department official guidelines - clearly states if a TSH is over 2 you are under medicated

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 at

[e-mail]

Plus the list of recommended thyroid specialists

Professor Toft recent article saying, T3 may be necessary for many otherwise we need high FT4 and suppressed TSH in order to have high enough FT3 (the only active hormone)

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

[SlowDragon Administrator]

If you start or 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...