Please help me understand my blood tests.

[Simplesista]

Hi. Ive been diagnosed with hypothyroidism since February even though I had a TSH of 7.2 last August, but was told this is subclinical(!). I had been having severe pain in my hip since February 2017 and had gone to seek treatment for this. I also had several other symptoms, eg joint pain, hair loss, feeling down etc, which I now recognise as symptoms of hypothyroidism. In February my TSH was 10.5(0.2-4.0) and prescribed 50mcg of Levo, increased to 75mcg after 5 weeks because I had developed terrible muscle weakness in my left arm, including two of the fingers on my left hand and shoulder. This problem is still ongoing, although feels slightly better. My most recent blood tests(results received yesterday) are these-Serum TSH level 0.19miu/L (0.2-4.0)

T4 level 19.1 pmol/L (10.0-20.0)

Vitamin D 119nmol (75.0-250.0)

B12 625ng/L (211.0-911.0)

Ferritin 24ug/L (10.0-322.0)

Folate 19.2 ug/L (5.4-25.0)

It has been recommended that my levothyroxine is reduced but I still have the muscle weakness in my arm/hand/shoulder. My GP hasn’t done this yet because the lab did not test for my antibodies even though she asked them too. I’m having another test to check antibodies next week. They were 1300(<100) in February. Thanks to this forum, I’ve concluded that I have Hashimotos and I’m following a gluten free diet etc. No impact felt yet.

So advice please, am I over medicated with the above results?

Thank you in advance.

[SeasideSusie Remembering]

Simplesista

No, you're not overmedicated, you FT4 is within range. Your doctor is only looking at TSH. Ask for FT3 to be tested and if that is in range you aren't overmedicated.

You do have a problem with your Ferritin level though. Ferritin needs to be at least 70 for thyroid hormone to work, preferably half way through range. Eating liver regularly can help raise your level, maximum 200g per week.

[Simplesista in reply to SeasideSusie]

Thank you both so much, my GP did ask for T3 to be tested, along with my antibodies, but they didn’t test them. I’m gaving another blood test next week to check for these. I will increase ferritin containing foods, should I take supplements to help my levels? I have started taking selenium, magnesium etc since following this forum. My GP has given me an increased dose of levo too,100mcg, and said to try that to see if it will help my symptoms(despite the advice from the lab to decrease). I didn’t take the increased dose today though as I was scared it might make me worse. Thank you once again for your support and advice.

[SeasideSusie Remembering in reply to Simplesista]

Iron is complicated and much more than just Ferritin which is the iron store. If your serum iron was high you wouldn't want to be taking iron tablets so really you need an iron panel and maybe a full blood count before supplementing. So maybe your GP will test those as well. But for now I would stick to liver and other iron rich foods.

[Simplesista in reply to SeasideSusie]

The GP said all my vitamin levels are in range so don’t need to be tested further at the moment. I know from following this forum that this is incorrect but I was unsure how bad my levels were; which is why I sought advice. I will certainly try the liver. Stupid question coming up(sorry!), do you mean chicken liver ? Also should I take the increased 100mcg of Levo to see if it will help the weakness in my arm or should I continue with 75mcg? I will admit that the weakness in my arm has really frightened me, much more so than the other issues I’ve had even though they’ve been more painful, and I apologise if I sound overly dramatic, but I’m at a loss as to what to do.

[SeasideSusie Remembering in reply to Simplesista]

Chicken liver is good, also lamb's liver or calf liver is mild tasting.

If you increase your Levo dose it will take your FT4 over range and lower your TSH and then your GP will say you are overmedicated and reduce your dose again. I honestly don't know if your weakness in your arm is due to your hypothyroidism. You could try an increase of 12.5mcg rather than 25mcg.

[Simplesista in reply to SeasideSusie]

Regarding the advice from the poster above, do you think I need T3? Will the NHS prescribe this if I do? I am sticking to 75mcg Levo for now, thank you for your advice about that, it has helped to clarify my own thinking.

[SeasideSusie Remembering in reply to Simplesista]

Simplesista

You cannot possibly know if you need T3 unless you have FT4 and FT3 tested at the same time. It would be at best foolish and at worst dangerous to use T3 until you have this information.

Also, nutrient levels need to be optimal first because no thyroid hormone can work if they're not. Your Ferritin needs to be at least 70 as mentioned.

It's very difficult to get T3 on the NHS at the moment. It can't be prescribed in primary care, an endo has to prescribe it originally and not every endo supports T3, even if they do the cost is horrendous so many CCGs won't allow it for new patients.

[Simplesista in reply to SeasideSusie]

Thank you for all your advice, my plan of action is this:

I will continue with 75mcg Levo for the timebeing

I will try to raise my nutrient levels via liver and the b12 supplements recommended

I will continue to follow an anti inflammatory diet to help with the antibodies

I’ll keep my fingers crossed that the lab check everything they’ve been asked to when I go for a test next so I can move forward better informed!

Thank you all very much.

[ElizabethBeth in reply to Simplesista]

Hi there, I’ve just read your post and wanted you to know that when I was really hypo following supplementing with iodine and finding out that my TSH was 56.2!! I had terrible muscle weakness in my right arm and milder muscle weakness in my left arm and legs. I could hardly lift my arm up high enough to clean my teeth! Once my TSH went down and all the other numbers started coming back ‘in line’ this all subsided. It is really frightening isn’t it, but just be a bit patient and try not to worry about it and let your body sort itself out because it dies take time for things to settle down. All the best

[Simplesista in reply to ElizabethBeth]

Thank you for this, I’m not taking an iodine supplement and stopped taking a multivitamin when I realised they weren’t doing me any good, so no iodine from there either. I’m glad you’re feeling better and it also gives me hope.

[Angel_of_the_North in reply to Simplesista]

Any liver (but not polar bear - that has too much vit A): beef, chicken. lamb.

[thyroidthelma in reply to SeasideSusie]

Thank you SeasideSusie for I didn't know that eating liver could raise my ferritin levels. Would that be pork or beef (or both)? I just added Vitamin D3, and what a difference this is making cognitively, etc.

[SeasideSusie Remembering in reply to thyroidthelma]

It's difficult to find a table that compares iron content of all livers, but taking bits from different articles this is what I've found although I dare say other sites would have different values

Pork liver - 75g - 13.4mg iron

Chicken liver - 75g - 9.2mg iron

Lamb's liver - 75g - 6.1mg iron

Beef liver - 75g - 4.8mg iron

Canned liver pate - 75g - 4.1mg iron

I've only ever had lamb's liver and it's quite mild tasting.

Liver is high in Vit A so it's important to have no more than 200g liver per week.

Did you test your Vit D level before supplementing? It's very important to take the correct amount as excess gets stored and can build up to toxicity level. Then there are the important cofactors necessary magnesium and K2-MK7. Magnesium helps the body use D3, K2-MK7 directs the increased calcium uptake from food to bones and teeth and away from arteries and soft tissues.

[Simplesista in reply to SeasideSusie]

In the test that I had in September my vitamin d was low, I don’t have the print out of those results so I can’t post the exact results. The GP said it was below range and that I should supplement it myself. I also take all the nutrients you mention above as well as selenium, zinc, vitamin c and fish oil, vitamin b complex. I also take turmeric in powder form, half a teaspoon a day sprinkled over food. I’m sure I must rattle when I walk!

[SeasideSusie Remembering in reply to Simplesista]

Simplesista

My reply above asking about Vit D level was to Thyroidthelma.

[greygoose]

Have you been supplementing your B12 to get it up to that level? The weakness in your arm could be due to low B12. Your level isn't too bad at the moment, but perhaps you need it higher, or need to continue on a maintenance dose and give it more time.

[Simplesista in reply to greygoose]

Hi, I take a vitamin b supplement which has all of the different vitamin b elements in it. Do you think I should take just a b12 supplement? I know from reading this forum that 75mcg Levo is a small amount to take so I was very surprised when my TSH levels fell from 10.5 to 0.19 so quickly on a small amount. The intense pain in my hip has mostly gone since I started Levo but the muscle weakness in my arm is a bit of a mystery.

Ps you are one of the people whose posts I’ve really followed since last September and they’ve been of great help to me; thank you for the trouble you go to to offer advice. The same goes for so many of the posters on here, I make notes of the advice given here before I see my GP and I find it so helpful to go in armed with some knowledge at least.

[greygoose in reply to Simplesista]

Glad to be of help.

Regards the B12, if I were you, I would try taking methylcobalamin sublingual lozanges of 1000 mcg on top of your B complex for a while, and see if your arm improves.

[Simplesista in reply to greygoose]

Thank you, I’ve ordered these.

[greygoose in reply to Simplesista]

Good.

[Quasarlis]

Sadly a few doctors know this but the endo’s know it all too well in my opinion.

I feel for you simplesista as I also have Hashimoto’s. Levo-Thyroxine never worked for me, backwards and forwards for years with no help! Self medicate with T3 now and feel better.

I hope you get it all sorted! Read what seaside susie has to say, she has great knowledge about our disease 👊🏻👊🏻

[Mino40]

I was diagnosed at 4.67 and I'm on 75mcg Levo with no issues but then I didn’t have an antibodies test.

[thyroidthelma]

I see that you're on Levothyroxine...and I had no luck on this synthetic thyroxine hormone drug. I am now on Naturethroid and it works for me. Did I read the above correctly that your antibodies (I assume your TPO antibodies) were 1300 in February? That is your major reason for why you feel so badly. No doubt about that . Hopefully, you'll have them tested straight away again and high TPO antibodies says that your body is dealing with inflammation and with Hashimoto's this means it is attacking not just your thyroid tissue but your brain, etc. You need to get your TPO antibodies down! ASAP. Read about Dr. Datis Kharrazian on-line and on FB; he is genius and knows tons of information about TPO antibodies and autoimmune disease. And be your own and best advocate. I am.

[thyroidthelma]

Agreed, on that TSH of 7.2; at that rate it's enough to make one feel like they are in slow motion and it also slows the metabolism, the heart, the brain, etc. down as well.

[Angel_of_the_North]

No, your free T4 is within range and your free T3 hasn't been tested. No evidence that you are overmedicated BUT your ferritin is poor - needs to be over 70 to use thyroid hormone correctly. What is your GP doing about it?

[Simplesista in reply to Angel_of_the_North]

Nothing. She said it’s in range. She doesn’t seem to be knowledgeable about thyroid issues. I read this forum, take the excellent advice from it and write it down to discuss with her when I go. In her defence, she does ask for the tests I say I need but the lab won’t do them! Apart from that one time in February when I was very ill with my arm. They also said my vitamin levels are being tested too often as they are all in range I shouldnt ask to have them tested for “about 6 months at least”!

I dread to think what condition I’d be in if I hadn’t found this forum when googling thyroid conditions. Although she was very happy to prescribe me statins if I’d wanted those as when my TSH was at 10.5 my cholesterol levels were above range. I refused them. My cholesterol levels are now within “normal range”.

[Furface in reply to Simplesista]

They are happy to prescribe statins (nice little incentive for them) a pity they refuse to prescribe thyroid treatment that actually makes patients feel better.

[JaclynB]

Hi I had a thyroid ablation in Jun of 2011 and I am completely dependent on levothyroxine now. When ever my Tsh goes below 1.00 my arms go week and I get severe pains in my arms and bad joint pains. Based on your dose of meds and your tsh level I think the perfect dosage for you would be to alternate 50 mcg with 75 mcg. Every other day. If you become to overmedicated it causes muscle wasting which is probably what your feeling

[Clarrisa]

Hi, I had what I would call severe pain in a hip too last year. I was already scheduled for a yearly breast examine with a breast surgeon & mentioned the hip pain. He said he hears this all the time & finds out it is actually back pain (referred I gather). I did not believe him but when the hip pain finally went away I felt a ache in my lower back so he may have been right. If you have had back pain in the past don't rule that out as the origin of your hip pain. If this seems at all plausible avoid lifting more than 25 pounds for now.