New results!: Hi thanks for responding to my... - Thyroid UK

Thyroid UK

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New results!

emma_kate1
emma_kate1

Hi thanks for responding to my first post, so just come back from GP practice since GP wants to see me about my new results. Turns out I am hypothyroid. I have been given Levothyroxine and instructed to take as follows:

25mcg for 3 weeks

50mcg for 3 weeks after that

75mcg for 3 weeks after that and then retest after that

Please see my new bloods

TSH 45.2 (0.2 – 4.2)

FT4 10.7 (12 – 22)

FT3 2.8 (3.1 – 6.8)

THYROID PEROXIDASE ANTIBODY 441 (<34)

FERRITIN 15 (30 – 400)

FOLATE 2.3 (2.5 – 19.5)

VITAMIN B12 207 (190 – 900)

VITAMIN D TOTAL 31.5

(<25 SEVERE VITAMIN D DEFICIENCY. PATIENT MAY NEED PHARMACOLOGICAL PREPARATIONS

25 – 50 VITAMIN D DEFICIENCY. SUPPLEMENTATION IS INDICATED

50 – 75 VITAMIN D MAY BE SUBOPTIMAL AND LONG-TERM MAY LEAD TO CLINICAL EFFECTS. ADVISE ON SAFE SUN EXPOSURE AND DIET. SUPPLEMENTATION MAY BE INDICATED

>75 ADEQUATE VITAMIN D)

RED BLOOD CELL COUNT 4.46 (3.80 – 5.80)

WHITE CELL COUNT 4.12 (4.00 – 11.00)

MCV 78.5 (80 – 98)

MCHC 375 (310 – 350)

MCH 28.1 (28 – 32)

HAEMOGLOBIN ESTIMATION 122 (110 – 150)

HAEMATOCRIT 0.42 (0.37 – 0.47)

PLATELETS 231 (140 – 400)

IRON 9 (6 – 26)

TRANSFERRIN SATURATION 15 (12 – 45)

Also been given folic acid to take once a day, ferrous fumarate to take once a day and to continue taking the vitamin D 800iu supplement I have been taking for 4 years. I am guessing the low iron is from my heavy periods which sometimes are so heavy I look like I have been murdered! My period for this month has come early by 3 days, usually it’s on the dot or a day late and this one is very painful, can’t concentrate at work, got pain behind my eyes, blood is very dark and is rushing out, stomach unsettled and mood is just really low. Might be the cause of my swollen ankles too.

Other symptoms:

Symptoms -

Tiredness

Hard stool

Kidney infections

Bladder infections

Pins and needles

Neck swelling

Making errors at work

Weight gain

Dizziness

Anything further needed on my part or anything the GP needs to do next please?

Thank you!

3 Replies
SeasideSusie
SeasideSusieAdministrator

emma_kate1

25mcg for 3 weeks

50mcg for 3 weeks after that

75mcg for 3 weeks after that and then retest after that

Sounds sensible. When booking thyroid tests, always book the very first appointment of the morning and fast overnight (water allowed) . 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 can also lower after eating. Also, take your Levo after the blood draw because if you take it before then your FT4 will reflect this and show higher than what is normally circulating. We usually advise 24 hours between last dose of Levo and blood draw so if you take your Levo in the morning then delay until after the test, or if you take it at night then delay that dose until after the test.These are patient to patient tips which we don't discuss with doctors or phlebotomists.

Take your Levo on an empty stomach, one hour before or two hours after food, with a glass of water only, no tea, coffee, milk, etc as they affect absorption.

Your TSH will gradually lower and your Free Ts will gradually 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.

THYROID PEROXIDASE ANTIBODY 441 (<34)

Raised antibodies confirm autoimmune thyroid disease aka Hashimoto's which is where antibodies attack the thyroid and gradually destroy it. The antibody attacks cause fluctuations in symptoms and test results.

Most doctors dismiss antibodies as being of no importance and know little or nothing about Hashi's and how it affects the patient, test results and symptoms. You need to read, learn, understand and help yourself where Hashi's is concerned.

You can help reduce the antibodies by adopting a strict gluten free diet which has helped many members here. Gluten contains gliadin (a protein) which is thought to trigger autoimmune attacks so eliminating gluten can help reduce these attacks. You don't need to be gluten sensitive or have Coeliac disease for a gluten free diet to help.

Gluten/thyroid connection: chriskresser.com/the-gluten...

stopthethyroidmadness.com/h...

stopthethyroidmadness.com/h...

hypothyroidmom.com/hashimot...

thyroiduk.org.uk/tuk/about_...

Supplementing with selenium l-selenomethionine 200mcg daily can also help reduce the antibodies, as can keeping TSH suppressed.

Hashi's and gut absorption problems tend to go hand in hand and can very often result in low nutrient levels or deficiencies and this has happened to you. You need to address the gut problems, check out SlowDragon's reply near the bottom of this thread where there is information plus links to help healthunlocked.com/thyroidu...

You need to optimise your nutrient levels.

FERRITIN 15 (30 – 400)

MCV 78.5 (80 – 98)

MCHC 375 (310 – 350)

These suggest iron deficiency anaemia and 1 x ferrous fumarate daily is not the correct treatment. I suggest you see your GP again to discuss. The correct treatment for iron deficiency anaemia is 3 x ferrous fumarate daily but with a below range ferritin you really should have an iron infusion. Also 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...

Take each iron tablet with 1000mg Vit C to aid absorption and help prevent constipation. Take iron 4 hours away from thyroid meds and 2 hours away from other medication and supplements as it will affect their absorption.

VITAMIN B12 207 (190 – 900)

FOLATE 2.3 (2.5 – 19.5)

B12 is far too low and your GP should have noticed this. Do you have signs of B12 deficiency - check here b12deficiency.info/signs-an...

If so list them and go back to your GP and ask to be tested for B12 deficiency/Pernicious Anaemia. You may need B12 injections.

Do not start your folic acid until you have had further investigations/tests regarding your B12, folic acid masks symptoms of B12.

Do not take folic acid until after B12 injections have been commenced or B12 supplementation in another form started.

VITAMIN D TOTAL 31.5 and to continue taking the vitamin D 800iu supplement I have been taking for 4 years

Your GP has blinkers on. 4 years taking D3 and you are still deficient. What was your level originally? If it was <30 you should have been given loading doses totalling 300,00iu over a number of weeks. In fact I would insist that because your level is only 1.5 over that you are given these now. Refer your GP to NICE treatment summary for Vit D deficiency:

cks.nice.org.uk/vitamin-d-d...

"Treat for Vitamin D deficiency if serum 25-hydroxyvitamin D (25[OH]D) levels are less than 30 nmol/L.

For the treatment of vitamin D deficiency, the recommended treatment is based on fixed loading doses of vitamin D (up to a total of about 300,000 international units [IU] given either as weekly or daily split doses, followed by lifelong maintenace treatment of about 800 IU a day. Higher doses of up to 2000IU a day, occasionally up to 4000 IU a day, may be used for certain groups of people, for example those with malabsorption disorders. Several treatment regims are available, including 50,000 IU once a week for 6 weeks (300,000 IU in total), 20,000 IU twice a week for 7 weeks (280,000 IU in total), or 4000 IU daily for 10 weeks (280,000 IU in total)."

Each Health Authority has their own guidelines but they will be very similar. Go and see your GP and ask for the loading doses. Once these have been completed you will need a reduced amount (more than 800iu so post your new result at the time for members to suggest a dose) to bring your level up to what's recommended by the Vit D Council - which is 100-150nmol/L - and then you'll need a maintenance dose which may be 2000iu daily, maybe more or less, maybe less in summer than winter, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. You can do this with a private fingerprick blood spot test with City Assays vitamindtest.org.uk/

Your doctor wont know, because they are not taught nutrition, but there are important cofactors needed when taking D3 as recommended by the Vit D Council -

vitamindcouncil.org/about-v...

D3 aids absorption of calcium from food and K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems.

D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds.

Magnesium helps D3 to work and comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds

naturalnews.com/046401_magn...

Check out the other cofactors too.

Thanks.

I won't start my folic acid just yet until B12 investigations are done. I will go back to GP too about the ferrous fumarate, yes my level was below 30 when diagnosed so will go back about this too.

Just one point. Don't test 3 weeks after starting the 75 mcg, leave it for six weeks. 3 weeks is too soon, and the levo will not be fully sythesised in that time, so the results won't be accurate. :)

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