Thyroid UK
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Latest Bloods - Confused and Upset

So I went for some bloods yesterday and the results are back today.

Very confused as after two tests with a tsh of 4.30 it has suddenly come back as 2.8 (0.27-4.20). The GP requested T4, T3, Thyroid Peridoxase and the lab have not done them.

However my B12 is 145 (180-914) and ferritin 10 (13-150)

Got a full blood count and MCV and MCH are both low.

My symptoms still suck and having been skiing and exercising 5 hours a day I still managed to gain 2kg in a week. I’m absolutely baffled and really upset.

Is it possible for tsh to fluctuate that much in a month and could I still be hypothyroid or am I looking in the wrong direction?

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ferritin 10 (13-150)

MCV and MCH are both low.

What's happening about these results?

Was MCHC high? If so then you have iron deficiency anaemia.

You need to speak to your GP about treatment.

**

B12 is 145 (180-914)

You need testing for Pelrnicious Anaemia. Ask your GP to do this.

You also need Folate testing as Folate and B12 work together.

**

To be honest, with just those results alone it's no wonder you feel unwell. And skiing and exercising 5 hours a day wont help while you're so unwell.

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My GP has just said that the bloods are okay and that I should take some over the counter B12 and Vitamin D. Blamed it on my copper coil for causing heavy periods which it doesn’t really.

When I asked what she thought was making me feel so rubbish she said she didn’t know and has told me to wait until my Endo appointment in May (feel like I’m going to end up getting fobbed off there too). When I cried she tried to go down the route of blaming it on depression, I’m not depressed I’m just tired of being fobbed off!

I very much doubt that if I ask for more tests they’ll do them. She sounded pretty done with me to be honest.

I’ve bought some floradix and vitamin d tablets for the meantime.

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You need to see a different GP and insist on full testing for Pernicious Anaemia. Your B12 is dire. You will need loading injections

Post about Loading doses of B12

healthunlocked.com/pasoc/po...

Highly likely due to inadequate treatment for thyroid. Just testing TSH is inadequate and TSH of 2.8 too high anyway if you are on Levothyroxine

NHS Labs often refuse to test antibodies or FT3

You need full testing as soon as you get back

Suggest you order from Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven

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I’m not yet receiving any treatment for my thyroid, my blood tests have been as follows:

Jan 2018: TSH 4.30 (0.27-4.20)

T4 14.30 (12-20)

19/03/18: TSH 4.30 (0.27-4.20)

T4 14.20 (12-20)

9/04/18

B12 145 (180-914)

Folate 8.6 (3.10-20.0)

TSH 2.8 (0.27-4.20)

FBC:

Heamoglobin 124 (120-150)

Total White Cell Count 5.48 (4.0-10.0)

Platelet Count 213 (150-410)

Heamocrit 0.394 (0.36-0.46)

Red Blood Cell Count 4.79 (3.8-4.8)

MCV 82.3 (83-101)

MCH 25.9 (27-32)

MCHC 315 (315-345)

Red Blood Cell Distribution Width 14.2 (11-16)

Neutrophil Count 4.13 (2.0-7.0)

Lymphocyte Count 0.79 (1.0-3.0)

Monocytes Count 0.33 (0.2-1.0)

Eosinophil Count 0.2 (0.02-0.50)

Basophil Count 0.03 (0.0-0.10)

Nucleated RBC Count 0

Erythrocyte Sedimentation Rate 2 (0-12)

Plasma Glucose Level 4.8 (<7.7)

Ferritin 10 (13-150)

Renal Profile:

Serum Sodium 140 (133-146)

Serum Pottasium 4.6 (3.5-5.3)

Serum Creatinine 61 (44-80)

GFR >90 (>60)

Serum C Reactive Protein Level 1 (<5.0)

Calcium Profile:

Serum Calcium 2.22 (2.15-2.55)

Serum Albumin 43 (35-50)

Serum adjusted Calcium Conc 2.2 (2.2-2.6)

The two GPs I have been seeing will not pin my symptoms to my thyroid as apparently I would be having symptoms like I’m having with a TSH only slightly out of range and a normal T4. And they don’t think it’s B12 or ferritin either. In fact my usual GP said that she didn’t know why I was feeling rubbish and is trying to pin it on the back, neck and shoulder pain I’ve been having since I was run over 2 years back. Either that or depression apparently because I cried in front of her because I’m so worn out with feeling like I do!

My nails are so brittle that they bend at the ends and have cracks all over them, my tounge is starting to scallop, constant mouth ulcers, tired all the time, moods all over the place, have cold hands, have dry skin, joints ache, brain fog, clumsy, crave carbs, have a persistent cough and substitutewords without realising. And worst of all my weight has shot from 91-106kg in a year.

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Bubblesmcgee

How can your bloods possibly be OK when ferritin is below range and your B12 is below range.

See a different doctor and point these out. Then make a complaint about the doctor who said there was nothing wrong with these results.

Floradix will not raise your level anywhere near enough, if at all, and it certainly wont treat iron deficiency anaemia if you have that. You say your MCH and MCV are low, what are the actual results, were they below range? And again, was MCHC over range?

Do you have a result for Vit D? You need that testing before supplementing. Excess Vit D is stored and can reach toxicity level, so you shouldn't supplement without knowing if you need it. Also, there are important cofactors needed if taking D3. Post your Vit D result if you have it and I will advise what you should be taking.

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So this is the full set of bloods which came back, missing T4,T3 and TPoAb which the GP said are still outstanding.

The GP (a different one as I could get an appointment with my usual one) who ordered the bloods said there was no point in testing vitamin d as everyone’s is low at this time of year and I should just get some over the counter supplements.

B12 145 (180-914)

Folate 8.6 (3.10-20.0)

TSH 2.8 (0.27-4.20)

FBC:

Heamoglobin 124 (120-150)

Total White Cell Count 5.48 (4.0-10.0)

Platelet Count 213 (150-410)

Heamocrit 0.394 (0.36-0.46)

Red Blood Cell Count 4.79 (3.8-4.8)

MCV 82.3 (83-101)

MCH 25.9 (27-32)

MCHC 315 (315-345)

Red Blood Cell Distribution Width 14.2 (11-16)

Neutrophil Count 4.13 (2.0-7.0)

Lymphocyte Count 0.79 (1.0-3.0)

Monocytes Count 0.33 (0.2-1.0)

Eosinophil Count 0.2 (0.02-0.50)

Basophil Count 0.03 (0.0-0.10)

Nucleated RBC Count 0

Erythrocyte Sedimentation Rate 2 (0-12)

Plasma Glucose Level 4.8 (<7.7)

Ferritin 10 (13-150)

Renal Profile:

Serum Sodium 140 (133-146)

Serum Pottasium 4.6 (3.5-5.3)

Serum Creatinine 61 (44-80)

GFR >90 (>60)

Serum C Reactive Protein Level 1 (<5.0)

Calcium Profile:

Serum Calcium 2.22 (2.15-2.55)

Serum Albumin 43 (35-50)

Serum adjusted Calcium Conc 2.2 (2.2-2.6)

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I am not diagnosing because I can't, I'm not medically trained. So I do as other people can do and that is look up what blood test results mean. and taking the ones that are out of range

Lymphocyte Count 0.79 (1.0-3.0)

Low lymphocyte count can be prescent in autoimmune disorder. Having a quick look through your past posts there seems to be some confusion over whether you have Graves or Hashimoto's. Both are autoimmune disorders.

**

MCV 82.3 (83-101)

MCH 25.9 (27-32)

MCHC 315 (315-345)

Below range MCV and MCH, bottom of range MCHC - all seen in iron deficiency anaemia.

ferritin 10 (13-150)

Already discussed. Seen in iron deficiency anaemia. Discuss urgently with your GP.

NICE Clinical Knowledge Summary for iron deficiency anaemia treatment (which will be very similar to your local area guidelines):

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

How should I treat iron deficiency anaemia?

•Address underlying causes as necessary (for example treat menorrhagia or stop nonsteroidal anti-inflammatory drugs, if possible).

•Treat with oral ferrous sulphate 200 mg tablets two or three times a day.

◦If ferrous sulphate is not tolerated, consider oral ferrous fumarate tablets or ferrous gluconate tablets.

◦Do not wait for investigations to be carried out before prescribing iron supplements.

•If dietary deficiency of iron is thought to be a contributory cause of iron deficiency anaemia, advise the person to maintain an adequate balanced intake of iron-rich foods (for example dark green vegetables, iron-fortified bread, meat, apricots, prunes, and raisins) and consider referral to a dietitian.

• Monitor the person to ensure that there is an adequate response to iron treatment.

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.

You need an iron supplement and as your level is so low you should ask for an iron infusion which will raise your level within 24-48 hours, tablets will take many months.

If given iron tablets, then take each one with 1000mg Vit C to aid absorption and help prevent constipation, and take iron 4 hours away from thyroid meds and 2 hours away from other medication and supplements.

You can help raise your 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 your diet apjcn.nhri.org.tw/server/in...

**

Folate 8.6 (3.10-20.0)

Folate should be at least half way through range so you are a bit on the low side. A good B Complex will take care of that, make sure it contains methylfolate not folic acid and methylcobalamin not cyanocobalamin.

**

The GP (a different one as I could get an appointment with my usual one) who ordered the bloods said there was no point in testing vitamin d as everyone’s is low at this time of year and I should just get some over the counter supplements.

Well that's a load of rubbish. How on earth are you going to know what dose of D3 to take if you don't know your level. You could be severely deficient and need loading doses. You could be at the top of the range and taking D3 would mean it gets stored in your body and reach toxicity level. So test and if the GP wont do it do a private one with City Assays 9an NHS lab in Birmingham who do home fingerprick blood spot tests for the public through the post) vitamindtest.org.uk/

Come back with your result and I will tell you what to buy, the dose and tell you the important cofactors that are needed when taking D3.

**

B12 145 (180-914)

Already discussed and I see you have had the same advice from the Pernicious Anaemia forum.

If you want to know what ignoring this sort of result will do, start watching the first film on this page, you don't need to watch it all

b12deficiency.info/films/

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For full Thyroid evaluation you need TSH, FT4, TT4, FT3 plus TPO and TG thyroid antibodies. Plus vitamin D, folate, ferritin and B12.

Essential to test thyroid antibodies, FT3 and FT4, plus vitamins

Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies

thyroiduk.org.uk/tuk/testin...

Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have money off offers.

All thyroid tests should ideally be done as early as possible in morning and fasting.

Your B12 and ferritin are dire

What about vitamin D and folate?

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I think I will pay for a thyroid check when I get home, am currently stuck on a ship for the next two weeks! Folate was okay but vitamin d wasn’t tested.

Supposedly the go requested TPoAb and T4/T3 but they still aren’t back a week after they were sent?

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So I got a copy of my results from my GP last night:

B12 145 (180-914)

Folate 8.6 (3.10-20.0)

TSH 2.8 (0.27-4.20)

FBC:

Heamoglobin 124 (120-150)

Total White Cell Count 5.48 (4.0-10.0)

Platelet Count 213 (150-410)

Heamocrit 0.394 (0.36-0.46)

Red Blood Cell Count 4.79 (3.8-4.8)

MCV 82.3 (83-101)

MCH 25.9 (27-32)

MCHC 315 (315-345)

Red Blood Cell Distribution Width 14.2 (11-16)

Neutrophil Count 4.13 (2.0-7.0)

Lymphocyte Count 0.79 (1.0-3.0)

Monocytes Count 0.33 (0.2-1.0)

Eosinophil Count 0.2 (0.02-0.50)

Basophil Count 0.03 (0.0-0.10)

Nucleated RBC Count 0

Erythrocyte Sedimentation Rate 2 (0-12)

Plasma Glucose Level 4.8 (<7.7)

Ferritin 10 (13-150)

Renal Profile:

Serum Sodium 140 (133-146)

Serum Pottasium 4.6 (3.5-5.3)

Serum Creatinine 61 (44-80)

GFR >90 (>60)

Serum C Reactive Protein Level 1 (<5.0)

Calcium Profile:

Serum Calcium 2.22 (2.15-2.55)

Serum Albumin 43 (35-50)

Serum adjusted Calcium Conc 2.2 (2.2-2.6)

Missing the cortisol test which I was told was normal but had a note to consider further testing which my GP has said isn’t needed. Appparently thyroid peridoxase antibodies are being tested but the result isn’t back yet.

I saw my GP last night and to be honest I fell to pieces cause I just don’t know what’s making me feel so rubbish and put on so much weight. She blamed the fact that I had an accident 2 years ago and have had constant back, shoulder and neck pain since and that I may have had a couple of symptoms but that being in pain has made me get into a cycle of blowing things up in my head. She then asked me if I felt suicidal which I never had I’m just so tired of being fobbed off and constantly bashing my head against a brick wall trying to get anywhere with my health. The conclusion is that she is completely non plussed about what is causing me to feel rubbish and has told me to wait and see an endocrinologist. In the mean time I’ve been told to take B12, vitamin d and iron supplements bought over the counter to see if they help... just feel completely fobbed off!

Why would my nails be so brittle that they bend at the ends and have cracks all over them, my tounge be starting to scallop, constant mouth ulcers, tired all the time, moods all over the place, have cold hands, have dry skin, joints ache, brain fog, be clumsy, crave carbs, have a persistent cough and be substituting words without realising?

I’m just so worn out with it all!

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I strongly recommend you hop over to the Perncious Anaemia Society forum.

healthunlocked.com/pasoc

That is a level of B12 which needs injections of B12 - not some over the counter oral supplementation. You need treatment urgently as there can be non-reversible nerve damage from untreated low B12.

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I will go back and see the GP again when I get home and see if she will actually listen to me.

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Was this a car accident, if so did you have whiplash?

Or a head trauma

Both can upset Thyroid/pituitary

wellnessresources.com/news/...

nahypothyroidism.org/trauma...

thyroidnation.com/thyroid-h...

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TSH can vary significantly within a day!

thyroiduk.org.uk/tuk/resear... - and follow the link there for more detail.

Time of day alone could easily be contributing half that difference.

2.8 would still be hypothyroid/under-dosed for many of us.

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The GP would not start treatment at 4.30 and will not treat my b12 so I’m still stuck in my loop of misery for now. In fact she doesn’t know what to do with me and so is hoping the endo might have more ideas I think.

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You need to ask advice from PAS healthunlocked on getting your B12 sorted URGENTLY, as soon as you are home

Do NOT take any multivitamins or any supplements containing any B vitamins until you have had FULL testing for Pernicious Anaemia

If necessary take these results to the practice manager and insist on correct treatment

It is totally unacceptable to leave such a low B12 result untreated and not to test for Pernicious Anaemia immediately

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