Help/suggestions with BH thyroid test results

[Cherj]

I have just received the results from my Blue Horizon thyroid +11 test today. Blood test was taken first thing in the morning, finger prick method, fasting. I have not been diagnosed yet with a thyroid disorder, but am pretty sure that's the case as my mother has and grandmother had thyroid disease.

Can anyone please give any suggestions in addition to the following doctor's comments? I have an appointment next Wednesday with my gp to discuss these results. Also, if anyone can recommend a good Endo in the Merseyside area, can you please pm me? Thanks in advance...

Results of test:

Doctor’s Comments

The Thyroid Stimulating Hormone (TSH) is elevated and the free T4 level is low . If you are already taking a form of thyroxine, it is possible that that your dose is too low or that you have forgotten to take it on occasion. It may be that an increase in dose is in order – if adjusted it would be sensible to repeat thyroid function (TFT) testing in around 2 months’ time. A normal free T3 level (in this scenario) could be a sign that you are taking liothyronine instead of levothyroxine. Is this the case? If so, it looks as though you will need upwards dose adjustment. However, if you are not taking thyroxine already, this result is likely to represent a new diagnosis of hypothyroidism (underactive thyroid gland). I advise you to discuss this result with your usual doctor as treatment, or adjustment is indicated. The positive thyroid antibody result, however, increases the possibility of your having or ultimately developing autoimmune thyroid disease, such as Hashimoto's thyroiditis or Grave's disease.

The High Sensitivity CRP level is elevated. Although an elevated level of this protein can be linked to increased risk of heart disease, more generally a high CRP (C reactive protein) is associated with inflammation (as seen for example with arthritis or infection) from some cause. It is not an exact test, and is non specific. Although the rise in your case is marginal, an elevated CRP is not a normal finding and its presence should lead to further investigation to establish the cause. It would be sensible to repeat this test around 4-6 weeks following this test as it may just be a temporary rise, but if persistently elevated it would be sensible to discuss this finding with your doctor.

The vitamin B12 level is very low. Some experts believe levels of 400-500 are desirable and that levels below this may lead to symptoms. Low Vitamin B12 levels can lead to Pernicious Anaemia (PA), a state of deficiency of the red blood cells in which there is reduced quality and number. Characteristically, the red blood cells are enlarged in this state (if the deficiency is severe and longstanding). A Full Blood Count is needed to check for this state, which is known as megaloblastic anaemia. Vitamin B12 is commonly found in many foods, particularly meats. Deficiency can develop if intake of the vitamin is reduced or if absorption from the gut is impaired. Poor absorption owing to a deficiency of Intrinsic Factor (IF) is the underlying reason for PA. Vitamin B12 deficiency in the longer run can lead to nervous system disorders - with sensation changes, loss of power or co-ordination, gut disorders and (rarely) dementia or mental illness. Lower level deficiency has been associated with a range of symptoms such as fatigue, memory impairment, irritability, depression and personality changes. Please discuss this finding with your usual doctor, supplementation and possibly further investigation is advisable.

There is significant Vitamin D insufficiency. Vitamin D is manufactured in our skin as a direct result of sunlight exposure. One potential complication of prolonged Vitamin D lack is osteomalacia, a disease which causes severe structural deformities to the skeleton. Lower level Vitamin D deficiency can lead to a number of non-specific symptoms, including possibly chronic fatigue (experts have for many years noted an association between sufferers of chronic fatigue syndrome or myalgic encephalitis (CFS or ME) and low blood levels of Vitamin D). It has been estimated that between 50-70% of people living in the northern Europe (where daylight length reduces your chances of receiving adequate sunlight in the winter) are deficient in this vitamin by March each year. Symptoms of vitamin D deficiency include chronic pain, weak bones, frequent infections (recent research has detected an association between vitamin D deficiency and severe pneumonia), depression and fatigue. Supplementation may be beneficial, I suggest you discuss this finding with your usual doctor.

The folate (folic acid) level is low. Folate is one of the B group of vitamins found in green vegetables in particular. The body's reserves of folate, unlike vitamin B12, are low and only sufficient for about four months. Causes of deficiency include reduced intake from the diet or from poor absorption through the gut; increased demand for folate (eg pregnancy) and side effects of some medication (eg methotrexate). Symptoms include fatigue, mild sensation changes and depression. Prolonged lack of folate results in megaloblastic anaemia (in which the red blood cells are characteristically large). Supplementation would be advisable - I advise you to discuss this result with your usual doctor.

[SeasideSusie Remembering]

Cherj

The Doctor's comments are actually very helpful and you should follow them.

TSH over 10 confirms primary hypothyroidism, along with below range FT4. You should be started on Levo 50mcg unless you are elderly or have a heart condition then it should be 25mcg. Protocol is to retest/increase dose every 6-8 weeks until your levels are where they need to be for you to feel well. 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 antibodies are raised and confirm autoimmune thyroid disease aka Hashimoto's.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. Supplementing with selenium l-selenomethionine 200mcg daily can also help reduce the antibodies, as can keeping TSH suppressed.

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

stopthethyroidmadness.com/h...

stopthethyroidmadness.com/h...

hypothyroidmom.com/hashimot...

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

Point out the following to your GP:

Vit D is below the level where you should be started on loading doses - see 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 that he treats you according to the local guidelines or this summary and prescribes 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.

B12 is extremely low and you could have B12 deficiency/Pernicious Anaemia. List any symptoms of deficiency you may have from this list b12deficiency.info/signs-an... and show your GP, ask for further testing. You will probably need B12 injections.

Folate is deficient and you need folic acid prescribing. Don't start taking that until further testing of B12 has been carried out and B12 injections started. Folic acid masks signs of B12 deficiency.

Ferritin is good.

Your dire nutrient levels have undoubtedly been caused by gut/absorption problems due to the Hashi's. Check out SlowDragon 's reply near the bottom of this thread for information and links on how to address these problems

healthunlocked.com/thyroidu...

[Cherj in reply to SeasideSusie]

Thanks for that SeasideSusie. I will mention this info to my gp. I hope she will take into account the test I got from BH, but I imagine she will ask me to go in again for a blood test to confirm. It has been such a battle to be diagnosed because of the NHS limitations for a thyroid disease diagnosis. I hope I can finally get the diagnosis and start treatment, at the very least they will see that my vitamins are low and need to be addressed.

[SeasideSusie Remembering in reply to Cherj]

Cherj

When discussing with your GP, you could say you took advice from NHS Choices recommended source of information for thyroid disease (which is ThyroidUK), don't mention internet or forums, they don't like that.

If you have to do more tests for your GP, make sure that you do everything you can to get the highest possible TSH. We always advise to 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 a diagnosis, an increase in dose or to avoid a reduction. TSH is highest early morning and lowers throughout the day. It can also lowers after eating. These are patient to patient tips which we don't discuss with doctors or phlebotomists.

If your GP tests come back with a TSH of less than 10 with raised antibodies and your GP says she wont treat you, use the following information from ThyroidUK's main website

thyroiduk.org/tuk/about_the...

Diagnosis > Guidelines for the Use of thyroid Function Tests

The 'UK Guidelines for the Use of Thyroid Function Tests' state that, "There is no evidence to support the benefit of routine early treatment with thyroxine in non-pregnant patients with a serum TSH above the reference range but <10mU/L (II,B). Physicians may wish to consider the suitability of a therapeutic trial of thyroxine on an individual patient basis." If your TSH is above the range but less than 10, discuss a therapeutic trial of thyroxine with your doctor.

Subclinical hypothyroidism (where there are elevated TSH levels, but normal FT4 levels, possibly with symptoms) has been found in approximately 4% to 8% of the general population but in approximately 15% to 18% of women over 60 years of age.

Subclinical hypothyroidism can progress to overt hypothyroidism (full hypothyroidism with symptoms) especially if there are thyroid antibodies present.

If thyroid antibodies are found, then you may have Hashimoto's disease. If there are thyroid antibodies but the other thyroid tests are normal, there is evidence that treatment will stop full blown hypothyroidism from occurring.

Dr A Toft, consultant physician and endocrinologist at the Royal Infirmary of Edinburgh, has recently written in Pulse Magazine, "The combination of a normal serum T4 and raised serum TSH is known as subclinical hypothyroidism. If measured, serum T3 will also be normal. Repeat the thyroid function tests in two or three months in case the abnormality represents a resolving thyroiditis.2 But if it persists then antibodies to thyroid peroxidase should be measured.

If these are positive – indicative of underlying autoimmune thyroid disease – the patient should be considered to have the mildest form of hypothyroidism.

In the absence of symptoms some would simply recommend annual thyroid function tests until serum TSH is over 10mU/l or symptoms such as tiredness and weight gain develop. But a more pragmatic approach is to recognise that the thyroid failure is likely to become worse and try to nip things in the bud rather than risk loss to follow-up."

If you would like a copy of the article where Dr Toft mentions nipping things in the bud then email Dionne

[e-mail]

It is mentioned in answer to Question 2.

Come back and let us know how you get on.