I wonder if you could help. I went to the GP with concerns about my memory, weight gain, extreme fatigue and forgetfulness. My mum and gran have under active thyroid so they suggested bloods. Today I got a letter saying I need repeat bloods but wouldn't say why. I asked for my results for my first test and it says -
THS - 4.9mu/L (0.30 - 6.00)
Ferritin - 55ug/L (10.00 - 291.00)
Folate - 3ug/L (3.00 - 20.00)
B12 - 243ng/L ( 160.00 - 1000.00)
See pic for full detail.
The only thing highlighted was low lymphocytes at 1.3 (range 1.50 - 4.0010*9/L)
Does anyone have a clue why they want repeats?
Also I had this test at 2pm. From reading this board I have a feeling I should have had it early morning?
Sick of this unexplained exhaustion I'm only 30 xx
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TF87
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0.3-6.00 is quite a wide range for TSH, unfortunately you are well within it and would have to be over range for your GP to consider even subclinical hypothyroidism and over 10 for primary hypothyroidism to be diagnosed.
If you can't get FT4 and thyroid antibodies tested by your GP then I would consider doing a private test with Medichecks or Blue Horizon that includes the full thyroid panel:
Although it says "normal - no action" I really do think it worth discussing with your GP that it is at the very bottom of the range and 0.1 lower and you'd be below range and technically deficient. Your GP could possibly prescribe folic acid. If s/he wont then I would supplement yourself * see below *. Folate is best at least half way through range (although GPs wont acknowledge this, in range is all they are concerned about).
B12: 243ng/L (160-1000)
This is low. Do you have any signs of B12 deficiency? Check here b12deficiency.info/signs-an... If so, list them and discuss with your GP, request further testing for B12 deficiency/pernicious anaemia. *In this case do not start supplementing with folic acid/folate until further testing of B12 has been carried out, supplementing with folic acid masks signs of B12 deficiency.*
I have read (but not researched so don't have links) that BCSH, UKNEQAS and NICE guidelines recommend: "In the presence of discordance between test results and strong clinical features of deficiency, treatment should not be delayed to avoid neurological impairment." And an extract from the book, "Could it be B12?" by Sally M. Pacholok: "We believe that the 'normal' serum B12 threshold needs to be raised from 200 pg/ml to at least 450 pg/ml because deficiencies begin to appear in the cerebrospinal fluid below 550". "For brain and nervous system health and prevention of disease in older adults, serum B12 levels should be maintained near or above 1000 pg/ml."
Ferritin: 55 (10.00-291.00)
For thyroid hormone to work (that's our own as well as replacement hormone) ferritin needs to be at least 70, preferably half way through range. 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...
Vit D needs testing. If GP wont do it then you can do this with a private fingerprick blood spot test with City Assays vitamindtest.org.uk/
So helpful thank you I am going to read those links now yes I have lots of symptoms of b12 deficiency. To be honest I have never considered this. I am so similar to my mum I just assumed it might be thyroid. She ended up very poorly and in hospital before she was treated
Ah right maybe not b12 deficient then. A friend said docs look at MCV when looking at B12 result. I googled but couldn't understand it. Maybe look in t morning when my brain wakes up. Just wish they would give a reason for requesting repeat tests. Nothing in my results point at why. Hate having bloods I always faint!
A friend said docs look at MCV when looking at B12 result.
I only know of it's significance where iron deficiency anaemia is concerned.
If you look around the B12 deficiency site I linked to, at the testing page, it says something about B12 deficiency can't be ruled out in the absence of high MCV
MCV is low in iron deficiency anaemia and high in B12 deficiency. Put both conditions in the same body and the MCV result may look entirely normal. The table on this page is very helpful :
It is in my abbreviations and acronyms document. Mean corpuscular (or cell) volume. How big our red blood cells are.
Simplistically, iron deficiency results in small cells; B12 or folate deficiency results in large cells. Having both at the same time can result it in “normal” MCV but the Red cell Distribution Width is usually high.
I never really grasped what the practical use of RDW was until I read your post. I find it bizarre that the NHS has never, ever measured mine.
I've had it measured by Blue Horizon quite a few times and the results are strange. Up to and including Mar 2015 my RDW was very high in range or over the range (96% of the way through the range or over). The next time it was measured was in Jan 2016 and it was quite low in range and it has remained there ever since. I have no idea what changed it. In May this year it was only 8% of the way through the range.
I'm not expecting you to comment on this, but I wish I understood why it had changed so dramatically. I actually wonder if they changed their test machine or their testing protocol and the change in my results is an artefact of that.
RDW is a somewhat odd thing - I simply do not understand what physiological processes cause some red cells to be small and others big - at the same time.
Why don't the two factors (low iron and low B12, say) simply mean all red cells are "average" size? What detailed processes mean some are big and some small?
The red blood cell distribution width (RDW) obtained from a standard complete blood count (CBC) is a convenient and inexpensive biochemical parameter representing the variability in size of circulating erythrocytes. Over the past few decades, RDW with mean corpuscular volume (MCV) has been used to identify quite a few hematological system diseases including iron-deficiency anemia and bone marrow dysfunction. In recent years, many clinical studies have proved that the alterations of RDW levels may be associated with the incidence and prognosis in many cardiovascular and cerebrovascular diseases (CVDs). Therefore, early detection and intervention in time of these vascular diseases is critical for delaying their progression. RDW as a new predictive marker and an independent risk factor plays a significant role in assessing the severity and progression of CVDs. However, the mechanisms of the association between RDW and the prognosis of CVDs remain unclear. In this review, we will provide an overview of the representative literatures concerning hypothetical and potential epidemiological associations between RDW and CVDs and discuss the underlying mechanisms.
With these symptoms - unexplained exhaustion & weight gain etc - and also family history I would be asking GP for a referal to an Endocrinologist.
He/she would (hopefully ) arrange Thyroid Antibodies and Thyroid Function blood tests.
If refused ask why, given your symptoms and family history ?
If still refused then politely insist on full testing, including TPO and Tg (Thyroid Peroxidase and Thyroglobulin ) say you wish to eliminate or confirm Autoimmune Thyroiditis (Hashimoto's disease ).
Also ask for FT3, FT4, T4 and Vitamin D as you have never has these tested.
You could ask first what the repeat bloods include.
You could also ask for an Ultrasound scan of your Thyroid. Do you have any neck/ throat / swallowing symptoms? Intermittent problems? Lumpiness, tenderness?
Are your symptoms more apparent after a cold or any infection? Does the weight suddenly increase then?
Take your temperature first thing every morning and make a note if it's ever low, then add to list of symptoms.
Are you cold intolerant? Any bowel problems - constipation is a symptom of Hypothyroidism.
With your Folate bottom of range and your B12 very low in range I would query further testing (Intrinsic factor etc ) to eliminate Pernicious Anemia. You could put a post on the Pernicious Anemia forum also for further comment before seeing GP.
I am surprised GP didn't prescribe Folic Acid 5mg. If they do, don't start it till you've tried to get further testing. Look up NHS choices - symptoms of B12 & B9 (Folate) deficiency.
Thank you. Yes I have constipation and always have had. I am intolerant to cold and again always seem to have been. Causes a constant battle over the heating in my house! My hair is also falling out. I have anxiety, am irritable and as pale as a ghost. I have been anemic in the past but the ferrous sulfate they gave me made me more constipated than usual which made me feel sick so I try to eat lots of iron rich foods. In fact I really try to eat a healthy varied diet so the weight gain and finding it hard to shift is upsetting. I have felt like this for years but I have really noticed a decline in my memory/concentration which is a nightmare at work and bothering me.
The only comment my doc has made so far is she wants repeat bloods then to see me after the second test. That comes to my original question thou, what are the repeats for. Maybe she is doing further tests. They weren't willing to say on the phone so guess I will have to wait and see x
I would definitely make an appointment asap to see your GP. The most approachable and agreeable one!
Write a full list of all your symptoms, take it to GP and ask for urgent referal to an Endocrinologist.
Go round all the GPs at the practice if you have to and keep making appointments until they refer you.
You have to be prepared to go into "polite" battle. It's an uphill struggle, but you need a diagnosis. You have a right to a diagnosis and prognosis . You have a right to treatment and appropriate care. The wheels of the NHS grind on very slowly - you don't need me to tell you that.
Rest a while, but don't give up or feel embarrassed or intimidated when asking for GP appointments. Keep pestering. It's your health, your life.
If your GP won't fully investigate Autoimmune Thyroiditis Hypothyroidism then you could say something like ' well, what could it be then ? I can't be left to carry on like this how can I get a diagnosis - these are my symptoms ' Ask about Adrenals, maybe?
I was ill in my thirties. The weight starting to increase mid twenties and I was often tired and had constipation. A Consultant queried my Thyroid when in my 30's. I'd been referred to him with my swollen ankles, swollen legs & phlebitis. He thought I had Myxoedema, Thyroid function tests came back in range but he said he wasn't happy and she " needed keeping an eye on" In letter to GP.
I didn't see this letter till I requested copies of my hospital records many years later.
Wasn't diagnosed till I was 58 and only then by getting more recent copies of records and asking GP for the Ultrasound scan after phoning a Thyroid helpline and taking advice.
Start taking your temperature early morning. When I told my Endocrinologist it was 35 I could tell by his reaction, as he noted if down, that he knew the significance.
When I get symptoms now I check my temperature and if low (35 to 36) I put being unwell down to being Hypo (as I have other conditions too). Still struggling to get higher dose Levothyroxine and possibly T3 but starting to get somewhere.
Hi there. I feel for you. I’m going through a similar situation to you right now and really needing to be my own advocate. I couldn’t take the iron tablets either but found liquid iron so much better. It didn’t make me constipated and it’s eadier for the body to make use of. It’s works much more quickly too. Flo radix is s good one and there are cheaper versions in health food shops, boots. Spa tone tastes awful though and isn’t the dose needed daily. I’m healing myself using the medical medium protocols, mainly celery juicing and all through diet. I’m feeling much better from this. Google medical medium thyroid. Hope this helps. I’m hearing you and hope things get better and the docs take it seriously. X X
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xx
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