Help with results please following thyroidectomy for Graves disease

[Argie1]

Please could you lovely people take a look at my blood results. Gp says they are all normal.

Serum T4 12.70 (9.01-19.05)

TSH 0.17 (0.35-4.94)

Serum folate 3.4 ng/mL. (3.1-20.5)

Serum ferritin 23 no/ml (20-204)

Vitamin B12 204 gp/mL (187-883)

I’m currently on 100 mcg of levothyroxine and was wondering if I should take any supplements? I do feel tired a lot of the time. Any advice gratefully received. Many thanks! x

[SeasideSusie Remembering]

Argie1

Your GP is saying they're normal purely because they're in range. However, your vitamin/mineral results are dire.

Vitamin B12 204 gp/mL (187-883)

Do you have any signs of B12 deficiency - check here b12deficiency.info/signs-an... If so, list them and ask your GP to test for B12 deficiency/pernicious anaemia.

Serum folate 3.4 ng/mL. (3.1-20.5)

Folate and B12 work together. Folate should be at least half way through range. However, don't do anything about supplementing for this until further investigation into B12 has been carried out and injections (or other supplementation) has started. Your GP may prescribe folic acid but if not then you can get a good B Complex containing methylfolate which will help raise your folate level (but not before starting B12).

Serum ferritin 23 no/ml (20-204)

This is very low. Ask GP to do a full blood count to see if you have iron deficiency anaemia, and an iron panel too.

It's generally said that ferritin needs to be 70 for thyroid hormone to work. 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...

No Vit D test? That's important too so if your GP wont do it then you can do a home fingerprick blood spot test with City Assays vitamindtest.org.uk/

which is an NHS lab who offer the test to the general public for £29.

[Argie1 in reply to SeasideSusie]

Thank you so much for taking time to reply with such a detailed response. Having looked at the signs of B12 Deficiency, I do have a lot of the symptoms! Need to inwardly digest all this new information and discuss with the gp. Is there a different test for pernicious anaemia other than the vitamin B12? Once again, many thanks x

[SeasideSusie Remembering in reply to Argie1]

Testing for B12 deficiency involves homocysteine and Methylmalonic Acid (MMA) I believe. For pernicious anaemia then intrinsic factor antibodies are tested I believe. You can get more information from the Pernicious Anaemia Society forum healthunlocked.com/pasoc

[SlowDragon Administrator]

Your FT4 is not very high, it's possible your FT3 is too low.

You need your FT3 tested at same time as FT4. But would almost certainly need to do so privately as NHS often refuses to do so

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.

If on Levothyroxine, don't take in the 24 hours prior to test, delay and take straight after. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, GP will be unaware)

Your vitamins are (as SeasideSusie say), far too low. This is possibly due to Levothyroxine being too low

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]

Professor Toft recent article saying, T3 may be necessary for many. Note especially his comments on current inadequate treatment following thyroidectomy

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

[Argie1 in reply to SlowDragon]

Thanks slowDragon for all of the info you gave. It’s a lot to take in! Will email the above and speak to gp x