Hypothyroid and due for second blood test since starting treatment. Apologies for the long post!

[Jojo49]

I was diagnosed Hypothyroid in October 2017. After feeling quite unwell for some months in 2016 I went to see my doctor, as I was having frequent sudden bowel movements, was feeling exhausted and had tingling and numbness in my hands and feet. My hands were often very itchy too. I was feeling very low in mood and anxious. The doctor ordered blood tests 1st November 2016

Serum C reactive protein level 8 mg/L [< 7.0]

Outside reference range

Blood haematinic levels

Serum vitamin B12 level 232 ng/L [130.0 - 800.0]

Serum folate level 3.8 ug/L [4.0 - 20.0]

Outside reference range

Serum ferritin level 70 ug/L [12.0 - 250.0]

I was referred for sigmoidoscopy where they found I had IBS and diverticulitis. I went Gluten Free (mostly) after this. I was asked to return if tiredness etc didn't improve. Went back to see the doctor and had more tests

10th February 2017

Serum TSH level 6.01 mu/L [0.35 - 5.0]

Outside reference range

Thyroid peroxidase antibody level 24 iu/mL [< 49.0]

No significant difference seen on evaluation.

TSH remains slightly raised. Thyroid Abs to follow.

Serum C reactive protein level 7 mg/L [< 7.0] Above Recommended Range

Serum bile acid level 8.3 umol/L [< 14.0]

Serum folate level > 23.7 ug/L [4.0 - 20.0]

Outside reference range

I was put on Folic Acid and asked to return if feeling no better which I did on

10th October 2017

Serum TSH level 9.53 mu/L [0.35 - 5.0]

Outside reference range

Thyroid Antibody Level was ordered at this time but lab wouldn't do it due to negative result in Feb 2017.

I was started on Levothyroxine 50mcg per day at the end of October 2017 and started to feel better initially with more energy and a significant improvement in mood, as I had been feeling very low and disinterested in life until then. My tingling fingers and toes and IBS all improved too. I then had my first thyroid test since starting treatment. See result below:

5th January 2018

Serum TSH level 3.57 mu/L [0.35 - 5.0]

Doctor has said to re-test in 3 months so I have a test coming up next week just for the TSH. I will be speaking to my doctor the following week, but I've noticed in the past few weeks, quite unsettling dreams once or twice a week, headaches like migraine lasting a couple of days and night sweats. Could it be overmedication? Can Hashimotos be ruled out for me due to my negative Antibody result?

I'm also quite exhausted again, even though my TSH is back within the reference range.

I would be interested to hear what others make of my results over the past year or so, as I'd like to be more informed about my condition.

[SeasideSusie Remembering]

5th January 2018

Serum TSH level 3.57 mu/L [0.35 - 5.0]

Could it be overmedication?

No. You are undermedicated and should have had a dose increase.

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, if that is where you feel well.

For your test next week, follow the advice we always give here which is when booking thyroid tests, always book the very first appointment of the morning, fast overnight (water allowed) and leave off Levo for 24 hours. This gives the highest possible TSH which is needed when looking for an increase in dose or to avoid a reduction. TSH is highest early morning and lowers throughout the day. It also lowers after eating. This is a patient to patient tip which we don't discuss with doctors or phlebotomists.

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Can Hashimotos be ruled out for me due to my negative Antibody result?

No. One negative doesn't rule out Hashi's. You'd need a few negative results over time to do that.

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Serum vitamin B12 level 232 ng/L [130.0 - 800.0]

This result was rather low. It might be an idea to retest. Also, check for signs of B12 deficiency here b12deficiency.info/signs-an...

I have read (but not researched so don't have links) that BCSH, UKNEQAS and NICE guidelines recommend:

"In the presence of discordance between test results and strong clinical features of deficiency, treatment should not be delayed to avoid neurological impairment."

And an extract from the book, "Could it be B12?" by Sally M. Pacholok:

"We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550".

"For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."

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Serum ferritin level 70 ug/L [12.0 - 250.0]

Although we need a ferritin level of 70 for thyroid hormone to work, I have seen it said that for females 100-130 is best. It might be an idea to retest this also.

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Vit D is also very important, see if you can get that tested, if not there is a home fingerprick blood spot test you can do with City Assays vitamindtest.org.uk/

[Jojo49 in reply to SeasideSusie]

Hi Seaside Susie

Thank you so much for your insight and advicce. I'll take some time to read up on it and will approach the doctor for retesting on ferritin and B12. I didn't understand the TSH result, doctor just told me it was back within the normal range!

I might also get private full thyroid tests done so I can see the bigger picture.