Advice on interpreting Thyroid ultravit results

[TSH110]

A friend has been poorly for at least 7 years and I have always suspected it is hypothyroidism. Here are some details of her problems:

Issues are debilitating GI issues, low mood & energy & possible lichenschlerosis.

Explorations over the yrs have included colonoscopy, endoscopy, celiac test, trying FODMAP diet. Gastro unit blood tests found ferritin 4.2 (plus high inflammatory markers, sometimes poor kidney function etc). A couple of iron fusions raised ferritin to normal levels & allieviated a number of symptoms (absolute exhaustion, pica, tinnitus, confusion, restless leg etc etc). Debilitating GI issues continue & now referred to gynaecologist to rule out endometriosis. She understands that GI can cause low folate, b12 etc. and does not seem to believe it has anything to do with her thyroid.

I have posted her previous results for comment, her TSH was slightly elevated, so it was not obviously thyroid disorder, but her latest more comprehensive results show TSH rising and free’s at the bottom of range. Oddly she has not had positive antibodies showing. The vitamin etc stuff means little to me. The doc has told her to take B12 and folate supplements - not sure what that was based on - and referred her to dermatology and gynaecology to investigate for endrometrisis. The ultra vit test results came back too late to show doc. NHS have done extensive referrals for all sorts of problems but no diagnosis has been forth coming from any of them. Sounds oh so familiar.

Any comments would be most welcome to advise on what the tests reveal and on what action is best for her to take in light of these latest results.

Thanks in advance.

[SlowDragon Administrator]

Her B12 and folate are extremely low. She should take these results back to GP for further testing for Pernicious Anaemia. She should be prescribed folic acid supplements and probably B12 injections

Also post these on here for B12 advice or Gambit62 may be along to comment too

healthunlocked.com/pasoc

Her vitamin D is borderline. Supplementing to improve to around 100nmol

Her TSH likely to rise as vitamins improve, then she can get started on Levothyroxine

Not everyone with Hashimoto's has raised antibodies. She could request ultrasound of thyroid

heyhashi.org/hashimotos-low...

thyroidpharmacist.com/artic...

[TSH110 in reply to SlowDragon]

Thanks that is great advice 😉

[Gambit62]

Thanks SlowDragon

TSH110 - the results above indicate a clear folate deficiency. The B12 result is inconclusive but if you have problems absorbing folate then likely you will also have problems absorbing B12 - please post, as suggested on the PAS forum

healthunlocked.com/pasoc/posts

lots of advice and support there specific to B12.

[TSH110 in reply to Gambit62]

Thanks for that wise suggestion to use PAS forum. She has had repeated iron deficiency and did get injections for a while.

[SlowDragon Administrator in reply to TSH110]

All of which suggests poor gut function, low stomach acid and/or gluten intolerance or coeliac

Persistent low vitamins with supplements suggests coeliac disease or gluten intolerance

gluten.org/resources/health...

[TSH110 in reply to SlowDragon]

I think she was tested for coeliac as it had been mooted as a possible diagnosis. I know she did FODMAP but digestive symptoms persisted even going gluten free as well nothing dietary seems to alleviate them. This is why I thought there must be an underlying reason for all her problems which were similar to some I had which were due to hypothyroidism in my case. Thanks for this info it is really helpful.

[TSH110 in reply to SlowDragon]

I have added some details of the problems and investigations she has had. She thinks once the vitamins etc are sorted out the TSH wil normalise and she will be fully better with no hypothyroidism. I told her its for life and can’t be reversed, and it said the TSH would go down and then levothyroxine could be started which is not a total recovery...but am I right?

[SlowDragon Administrator in reply to TSH110]

We often see on here that once vitamin levels are supplemented to improve to optimal levels that TSH rises, as body finally realises that there is lack of thyroid hormones.

Low vitamins can mask the thyroid issue

Has she looked at low stomach acid. Common when hypo and a cause of low vitamin levels

An ultrasound of thyroid may reveal Hashimoto's (Thyroid looks granular on ultrasound) or can be small, or shrivelled up (Ord's thyroid)

Vitamin D needs to be around 100nmol

Getting full testing for Pernicious Anaemia before starting any B vitamins

Can test homocysteine and MMA here

nutris.viapath.co.uk/pages/...

B12 and folate need substantial improvement. Good quality daily vitamin B complex, one with folate in not folic acid

Plus a daily sublingual B12 if GP won't start B12 injections

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...

Ferritin at least half way in range. Eating liver or liver pate once a week should help

Other things to consider as result of poor gut function

Daily vitamin C

Selenium supplements

Testing magnesium, zinc and selenium possible

[TSH110]

Thanks that is most helpful 😊 I had no idea the TSH rose once vitamin etc deficiencies were addressed I thought it would go down - I have learned something important there. Are there any vegetarian alternatives to liver/liver pate?