Interpreting lab results

[Jlangley]

Hi folks,

Would love some help with my bloods please. Background: was diagnosed early last year as hypo and started off on 25mg eltroxin. That stood me in good stead for quite a while, but then over the last few months there’s been rounds of illness around my house (including shingles for me among other minor ailments. Thanks to my petri-dish kids!). Anyway, couple of weeks ago I asked GP to do full range of bloods for me, which she happily did (lab ignored some of the tests she requested. Twice! So still haven’t got TPOs which is driving us both mad!):

Here’s what I know:

- TSH was 3.3 during first round of bloods and 5.1 on second round a couple of weeks later (I’d taken my eltroxin on the morning of the first bloods but not the second and in both cases couldn’t get morning appointments for bloods to be drawn). Range 0.27-4.2

- fT3 (second bloods only, ignored request first time!) was 3.5 range 3.1-6.8

- fT4 (second bloods only, ignored request first time!) was 13.9 range 12-22

- TPOs request ignored. Twice! (By lab, not GP!)

- tTG 0.4 range 0-6.9

- VitD 82.7 range 30-125

- VitB 317 range 197-772

- Folate 3.8 ug/L (no range)

- Ferritin 19 range 13-150

Next Steps:

- She gave me a B12 shot yesterday.

- She’s upped my eltroxin to 50mg but told me to get back to her if I feel hyper and we can try alternating days 25/50.

- She reckons from above results that I’m low risk for Hashi’s and is chasing up TPOs for me

- She says I’m good for VitD at the mo but start a small supplement in winter

- She said to start Galfer for Ferritin/iron and try to increase dietary protein, iron and VitC to avoid constipation etc from Galfer.

- Can’t remember what she said re Folate. Think she advised supplement!

- She also advised zinc/selenium/magnesium (already taking magnesium citrate)

Questions:

- Can you recommend a good Folate supplement please?

- i saw someone mention somewhere recently (can’t find it now!) that magnesium citrate isn’t a good idea. Anybody know why please? Google hasn’t helped.

- Any recommendations re zinc/selenium supplementation please? Brands, dosage, etc?

- I love/trust my GP, but would be interested to hear others thoughts on my numbers above and whether we’re missing anything and what your general impression of my numbers is please...

- Lab won’t do my rT3 for us, and have no idea what TPO really indicates and how much extra insight I’ll get from it. Thoughts please?

Thanks folks, really appreciate insights!

J

[Mary-intussuception]

GP can prescribe Folic Acid 5mg. I didn't realise that Tropicana Orange juice contains a good amount until I started to drink it to help with absorption of iron from my morning banana and porridge. I can't take iron tablets due to extreme bowel conditions.

It's possible that your GP is waiting until your B12 is treated and improved before starting the Folic acid supplements. Have you been tested for Pernicious Anemia?

TPOs:

The Thyroid Peroxidase Antibodies test result will reveal whether or not you have Hashimoto's Autoimmune Thyroiditis which is the most common cause of Hypothyroidism. So if yours are raised then it means you do have Hashimoto's.

Sounds like you have a good GP. If the lab continue to refuse to do the TPO blood test for GP - then you'll just have to be referred to an Endocrinologist who will get it done.

[Jlangley in reply to Mary-intussuception]

Thanks for that. She gave me a 3month hit of B12 injection yesterday and I’ll be going back for more bloods in October. She said I don’t have pernicious anaemia. I’ll look into folate supplements and give her a buzz on the TPOs! Thanks for your advice re orange juice! Will start looking at packaging !!

[SlowDragon Administrator]

All your vitamins are dire because your Levothyroxine dose was far too small

NHS guidelines saying standard starter dose is 50mcgs of Levothyroxine and it should be increased in 25mcg steps. Most patients eventually need somewhere between 100mcg and 200mcg

beta.nhs.uk/medicines/levot...

If you have high TPO or high TG antibodies then this confirms Hashimoto's.

Hashimoto's also trashes vitamins as it affects the gut and leads to low stomach acid and then low vitamins are the result

Low vitamin levels affect Thyroid hormone working, keeping TSH artificially low. Improving vitamins likely to increase TSH so that you can get Levothyroxine dose increased further

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten.

GP should prescribe folic acid, but it should not be started until had a few B12 injections

Presumably you are having loading injections...which is several injections over few days

healthunlocked.com/pasoc/po...

[Jlangley in reply to SlowDragon]

Thanks for your reply! Initially when I was diagnosed my bloods were only slightly off hence the very low dose. I was also on other meds so she wanted to start really slowly and told me to come back a few weeks later and we’d see how things were. Actually the low dose seemed to do the trick for me, so we continued as was. It was only more recently after a few rounds of illness in the house (including shingles) that i became symptomatic again.

Re injections, she gave me one the other day and told me that will be enough for 3m. Didn’t ask about dosage etc of the shot, but she told me it will make a difference but over the next few week sort myself out with a good quality supplement to keep it elevated and she will test again when I go back in October for the thyroid panel.

Having a look at leaky gut at the moment actually. On strict no sugar/alcohol/gluten diet for a few months plus probiotics etc to try and give my body a reboot. Hoping by the time I go back figures will be significantly improved. Then I might go back on gluten (smaller amounts/gradually), to see if that has an impact on my next round of numbers (do hate this gluten free diet, so if I find I can tolerate it, I’d rather do that!)

Fingers crossed I don’t have Hashi’s. She thought from the other results I have that it’s possible I don’t have it. Tapping our fingers waiting for lab to get back on why they haven’t given us TPOs!!!

Thanks again for your reply!

[SlowDragon Administrator in reply to Jlangley]

If you have symptoms of low B12 then loading injections are recommended

b12deficiency.info/signs-an...

However your GP seems pretty proactive as B12 was not that low so likely a daily good quality vitamin B complex will do the trick. One with folate in not folic acid eg Igennus Super B complex is good as nice small pills, good quality ingredients. Full dose is two per day. Suggest starting with just one per day and see how you get on

Other options are Jarrow B-right or Thornes B

If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 3-5 days before any blood tests, as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

Difference between folic acid and folate

chriskresser.com/folate-vs-...

Personally I just take magnesium citrate - calm vitality magnesium powder - its cheap and easy to use. Good for constipation. Can cause diarrhoea if take too much. Best to start on small dose!

Other people on here prefer different magnesium options

Gluten free, low sugar etc all likely to help heal gut so well done on that

[Jlangley in reply to SlowDragon]

Really appreciate all that info! Thx so much!

[Mary-intussuception in reply to Jlangley]

" . . . . . after a few rounds of illness in the house . . . . "

This sounds like Hashi's.

Whenever we have an infection, as our antibodies increase to fight it then our Thyroid comes under more severe attack. Hence, more Hypo symptoms. I have frequent upper respiratory tract infections and the consequence is more Hypo symptoms.

[Jlangley in reply to Mary-intussuception]

Ah Pooh! I’ve been hoping it’s not. Doc still chasing lab for me. Must ring and see if any update... thx for tip!

[greygoose]

- The TSH is highest early in the morning, and drops throughout the day. It also drops after eating (Patient-to-patient tip). If your two tests weren't done under the same circumstances, you can't compare them. But, even 3.3 is too high for someone on thyroid hormone replacement. It needs to be brought down to 1 or under - wherever you feel best. Both your Frees are much too low to feel well.

- You're hardly likely to feel hyper on 50 mcg levo with that low FT3! It's low T3 that makes you hypo and yours is very low. Your increase to 50 mcg (a normal starter dose) is long over-due.

- If you are having B12 shots, folic acid is not what you want. You want a B complex with 400 mcg methylfolate, daily. The Bs all work together and need to be kept balanced.

- Impossible to comment on your risk for Hashi's. I don't even know what test - tTG 0.4 range 0-6.9 is, but it doesn't look like an antibody test because the range is too narrow. You really do need a TPO test, and if that is over-range, you have Hashi's. But, if it's not over-range, that doesn't mean you don't have it for two reasons : a) antibodies fluctuate all the time, and you might just catch them on their day off! b) some people have Hashi's without ever developing high antibodies, and are only diagnosed by an ultrasound after a certain amount of damage has been done.

- Your ferritin is very low, and just taking iron pills might not be enough. More investigation into why it's so low is called for - an iron panel at least should be done.

- It was reallyfedup123 that commented on magnesium citrate. You'll find her comments/responses here : healthunlocked.com/user/rea...

- No point doing an rT3. It's a very expensive test, so not done on the NHS, and doesn't give you any useful information. Yours is probably high because your ferritin is so low. So, it's the ferritin that needs looking into, not the rT3.

[Jlangley in reply to greygoose]

Thanks a million for all this info!!!!

- TSH yeah she got a shock when she saw how much it had gone up in a few days.

- Finding it hard to get info on where my T3’s SHOULD be, how far up the range should they be? Top half/Top quarter? I don’t know what’s considered optimal... Thanks

- Yes re increase, long overdue, but actually I was feeling great on the 25 for a long time. Recent rounds of illness in the house (and resulting stress) made me symptomatic again, so I went back looking for bloods to be done.

- Thx so much for info re folate! It’s great to get specifics like that! Not sure if she plans on giving me shots every few months, she just wanted to do it yesterday to give me a head start/boost. I was veggie for 20yrs and on a crap diet most of that time, so I suspect I have long been deficient. Wonder if this could have been contributing to / causing thyroid (and other) issues? Ironically, only diagnosed after I started back on meat.

- I’ll ask for iron panel at next appointment, thanks for that! Going to try Galfer in the meantime and see if it makes a diff.

- thx for link to citrate comment and rT3 heads up!! Really useful

So much appreciate your time and insight! THank you!

[greygoose in reply to Jlangley]

Optimal is not a number. It's how you feel. Your FT3 should be in a place that makes you feel well, not any particular place in the range, and that varies from person to person. But, most hypos find they need it up near the top of the range to feel well. Some even need it over the top of the range.

I don't think being veggie/having low B12 can cause thyroid problems, but low B12 can certainly make you feel bad. You'll have to ask her about the shots, but if she says no, then you need to take B12 supplements. Was that B12 result before the B12 shot?

If I were you, I wouldn't try anything to raise your iron before getting the iron panel, because you'll skew the results.

[Jlangley in reply to greygoose]

Thanks grey goose! Brill info! Yep result was pre-shot! Got shot when went in to review/discuss results with her.

Good stuff re iron. I’ve a pile of stuff to start taking so I’ll leave that for now and get stuck into the b12 complex and higher eltroxin and zinc and so on...

Jeez you fall into some serious rabbit holes researching all this stuff don’t ya??? Lol

[greygoose in reply to Jlangley]

It is complicated, yes.

I'm surprised she gave you a B12 shot with that level. Most doctors would say it was fine! Good for her!

Be careful to only start/increase one thing at a time. Leave about 2 week between each introduction of something new.

[Jlangley]

You guys are amazing! Thanks! Xxx

[Jlangley]

Have to say it again. You lot are amazing. Thx so much!!!! Amazing support here! Love it! Xxx