Please help!! I’m new here...

[Mashworth]

Hi everyone : )

I’m new to this site and I am asking for some help/advice with my recent blood results please.

Short summary: diagnosed with under active thyroid in Nov 2015, fell pregnant with my first child Dec 2015 and as such didn’t really do any research as I had a bit of a rough pregnancy. Started on 25mg levo and it wasn’t until late in my first trimester that I told my GP that I was meant to see a specialist. When the referral was made they told my GP to up my levo straight away to 50mg but that wasn’t relaid to me until my second trimester!!

Anyway, after the birth I experience server post natal depression and as such I’m still on 50mg sertraline. My thyroid results at that point went to over 10 and now my current levo is 100mg.

My TSH levels are 1.51 but I’m experiencing low moods, emotional states, puffy ankles, extream tiredness and other symptoms. Went to the GP who wanted to up my sertraline. I wasn’t happy with this (after becoming a member of this forum and reading lots of posts) without my full bloods being done as they only tested my TSH....and here are the results. Can anyone help?

TSH 1.51 mu/L [0.3-5.6]

Vit D. 14 nonlinear/L [40.0-250.0]

B12 356 pg/mL [180.0-914.0]

Folate 4 Ng/mL [4.0-20.0]

Ferritin 47ug/L [11.0-307.0]

I also have a full blood count and renal profile but not sure these are relavent?

Any guidance would be a real help as I feel that it’s all in my head x

[Nanaedake]

Vit D. 14 nonlinear/L [40.0-250.0] Is your vitamin D level really 14? I don't know what non-linear means but it's well below the range given here. It's no wonder you're depressed!!! If your GP has not offered supplements then visit a different GP and check out the NICE website which recommends that anyone lower than 30nmol vitamin D level should be given loading doses until they reach a sufficient level and then take a maintenance dose.

Your B12 is in range but on the low side if you look at the upper range it could do with a boost toward the top of the range. Folate too is at the bottom of the range. I increased mine by taking 400mcg of methylfolate for 3 months. Now I take a good B complex to maintain my level.

Ferritin which is the iron store is low too. You can increase iron levels by eating iron rich food. This could include liver but no more than 200g a week due to the high vitamin A content.

[Mashworth in reply to Nanaedake]

Thank you Nanaedake for your reply. I did think they all seemed to be on the low end. I am seeing my GP today and have made a note of all of the above to chat it through. When I picked up the results they said that I needed to make a routine appointment with them about the Vit D.

Fingers crossed I’ll start to get somewhere as I don’t feel right and haven’t for such a long time. And to just ‘up’ my anti depressants seems like a cop out on their part to me 🙄

[Phoenix605 in reply to Mashworth]

There are various Vit D tests and they are not all good indicators of your body's access to the vit D, the test you needed was the vit D 25 (OH) test, this is also the test most members are familiar with interpreting. If your GP decides this result is low he is likely to offer you 800iu a day. This is barely enough to maintain levels in a healthy person and will not raise a deficient one in a month of Sundays. Vit D is fat soluble so liquid gel caps containing oil are the best form to take or liquid with a dropper, you may choose to buy your own rather than take the prescribed tablet form.

[Nanaedake in reply to Mashworth]

How did your appointment go?

[Mashworth in reply to Nanaedake]

Went back to the GP Wednesday and they have finally agreed to test my FT3 & FT4, I hope? They have ticked TPOab on the form?

They have given me 200,000ui of Vit D caps to bring that up over the next 3 months. They wouldn’t touch anything else as all within range.

Just happy that I am slowly getting somewhere rather than up ‘upping’ my antidepressants!

Thank you!! x

[Nanaedake in reply to Mashworth]

TPOab is Thyroid Peroxidase Antibody which is useful to know whether you have an autoimmune thyroid condition. Did they tick boxes for FT3 and FT4 too?

Some thyroid patients end up on antidepressants because of poor treatment for thyroid disease. if you're now on a stable dose and you get your vitamin D sorted out you might even find you can reduce your anti-d's or get off them altogether with advice from your doctor.

I hope you get well now.

[Mashworth in reply to Nanaedake]

Sorry for the delay in replying but I was waiting for some more results to come back.

My TPO is 143.7 is/mL [0.0-60.0] this seems high to me? They said no further action was needed.

FT4 10.2pmol/L [6.3-14.0]

But seem to be missing FT3

Have started to have a slight improvement with the Vit D which is good!

[Nanaedake in reply to Mashworth]

It's common for NHS to only test TSH and sometimes FT4 which generally thyroid patients feel is unsatisfactory as without FT3 we haven't got the full picture. However it's good they tested TPO which demonstrates that you have autoimmune thyroid disease as TPO is elevated. There isn't any specific treatment from the NHS for elevated thyroid antibodies but as it's associated with inflammation and affects the gut may people find going gluten free helps greatly. Also taking up to 200mcg of Selenium may help.

Your vitamin D was very low so the more quickly you can increase to a good level the better. Also ensure good levels of calcium in your diet as low vit D along with low calcium causes or exacerbates anxiety.

[ShootingStars]

Hi Mashworth. Do you have a complete thyroid panel? Your thyroid can't be evaluated with just TSH and in absence of two tests called FT3 and FT4. This is because TSH is not a thyroid hormone, but a pituitary hormone. Thyroid hormones are T3 and T4. They are measured by tests called FT3 and FT4. Do you have results for TSH, FT3 and FT4?

Also, thyroid antibodies have to be tested to determine if the cause of your hypothyroid is autoimmune. These tests are called TPOab and TGab.

[Mashworth in reply to ShootingStars]

Hi ShootingStars.

Thank you for your reply. I did ask for the full tests but I can’t see those test/results on there? I am going to the GP today so will ask.

Can only see vit D, B12, Folate, ferritin, TSH, Bone & liver, haematinics and full blood count?

[lisabax in reply to Mashworth]

Unfortunately a lot of NHS doctors won't test free T4 and T3 but those are the important ones, especially the T3 level as this is the active thyroid hormone. You can get these tested cheaply via the Thyroid UK website, so it might be worth doing if your GP won't

[Mashworth in reply to ShootingStars]

Went back to the GP Wednesday and they have finally agreed to test my FT3 & FT4, I hope? They have ticked TPOab on the form?

They have given me 200,000ui of Vit D caps to bring that up over the next 3 months. They wouldn’t touch anything else as all within range.

Just happy that I am slowly getting somewhere rather than up ‘upping’ my antidepressants!

Thank you everyone!! x

[ShootingStars in reply to Mashworth]

That’s great! They are missing the other thyroid antibody, TGab. You might have normal TPO, but TG could be high. Both must be tested.

Depression is often misdiagnosed, when the problem is caused by an under active thyroid. Thyroid gets ignored, but here, have an antidepressant. Meanwhile, the untreated thyroid keeps causing symptoms. Based on your symptoms, there is a goodbye chance that your FT3 and FT4 are too low in the range. You might very well find that once your thyroid levels are where they should be, your depression symptoms go away or are improved. Many people do.

[Mashworth in reply to ShootingStars]

I can’t see a TGab box on the form otherwise I’d tick it 😏 there is only:

RA screen (ccp), ANA, liver abs (ota), GPC Abs (OTA) or coeliac abs....any idea as to whether it’s one of those?

[ShootingStars in reply to Mashworth]

They can still order it. Any doc can. Ask for it.

What does ccp and ota mean? Did they test RA, ANA, and all those others? No, TGab is anti thyroglobulin.

[helvella in reply to ShootingStars]

ShootingStars,

You are not in the UK and perhaps do not appreciate that there can be restrictions on doctors ordering certain tests.

It is also inappropriate to tell people to tick boxes on test requests. Whatever we may think about which tests doctors have requested, these tests do cost money. Just adding tests is quite possibly not the best way of spending NHS funds?

CCP = Cyclic Citrullinated Peptide

[ShootingStars in reply to helvella]

I get that, but so many of these doctors are misdiagnosing, not diagnosing, mistreating and under medicating. This is not ok. When a patient has certain types of symptoms, the only way to eliminate or confirm the cause is to run tests.

Asking for tests is not telling people to check boxes. What about patient health? Is it ok for doctors to keep misdiagnosing, not diagnose, mistreat and under medicate?

[Mashworth in reply to ShootingStars]

Sorry for the delay in replying but I was waiting for some more results to come back. I hope I didn’t get you into trouble as you didn’t tell me to tick any boxes, it was me suggesting it.

My TPO is 143.7 is/mL [0.0-60.0] this seems high to me? They said no further action was needed.

FT4 10.2pmol/L [6.3-14.0]

But seem to be missing FT3

Have started to have a slight improvement with the Vit D which is good!

[Boohbette17]

Hi Mashworth, Im sorry you are feeling so poorly I sooo understand. Besides the other great advice . Take a look at how foods can hurt or help you. I did this & got my TPO go down in half & slowly but surely started getting stronger/feeling like "me" HUGS🌸saragottfriedmd.com/what-to...

[Mashworth in reply to Boohbette17]

Thank you! x

[humanbean]

B12 356 pg/mL [180.0-914.0]

Folate 4 Ng/mL [4.0-20.0]

Ferritin 47ug/L [11.0-307.0]

I also have a full blood count and renal profile but not sure these are relavent?

Any guidance would be a real help as I feel that it’s all in my head

The full blood count might be helpful because it is affected by low iron, low B12 and low folate. I'm not sure whether we'll be able to disentangle the effects of having all three a bit on the low side though, but it is worth seeing them, if you could copy them into a post.

Regarding your Vitamin B12 and your folate I think you should join the Pernicious Anaemia Society (PAS) community here on HU. You'll find them here - you just have to "Follow" them like you did this community when you joined :

healthunlocked.com/pasoc

PAS should be able to help you. Make sure they are aware that you are hypothyroid.

In your shoes I would want to raise my B12 to the top of the range and keep it there if possible. There are disagreements between this forum and the PAS forum about whether this is a good idea though, so you'll have to make up your own mind.

I try to keep my folate level in the top half of the reference range, so with the range you've given that would be 12 - 20 (mid-range to top of range).

Ferritin (a measure of your iron stores) is an awkward one. I try to keep my own ferritin to mid-range or a smidgen higher, which would be 159 - 170 with the range you've given. But there are people who have problems with iron for various different reasons, and a low in range ferritin doesn't always indicate that supplementing iron is a good idea. Usually it is - but not always - and to know which is the case here we really need more info.

Your ferritin is currently 12% of the way through the range - which I would definitely classify as low in range.

If you want to know why iron supplementation is complicated you should read this :

healthunlocked.com/thyroidu...