Time to visit GP but need info to back my case ... - Thyroid UK

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Time to visit GP but need info to back my case for an underactive thyroid​, can you help?

kaz90
kaz90

It has been a while since I last posted for help but I feel now is the time to get things sorted and have booked an appointment with my GP. Over the past 2 years, I have monitored my TSH levels through blood tests which show how my thyroid has been performing. Here are my latest results with the ranges:

TSH 7.19 (0.27-4.2)

T4 Total 92 (59-154)

Free T4 13.9 (12.0-22.0)

Free T3 6.6 (3.1-6.8)

Thyroglobulin antibody <10.0 (0-115)

Thyroid peroxidase 13.0 (0-34)

Ferritin 43.6 (13-150)

Vit D 59 (insufficient 30-50)

Vit B12 - 402 (insufficient 145-250)

Folate 13.10 (8.83-60.8)

Could anyone help me with interpreting these results and any links that I could print off to show my GP that it would be beneficial to me to be given thyroid medication. I am so fatigued. Any advice would be welcomed.

14 Replies
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Hi kaz90, your free T3 is quite close to the top of the range so this suggests that you are able to convert your T4 to T3 well. Your tsh is raised and we’d expect that to be the case if your thyroid hormones were too low for you. I wonder what previous results were like - are there any trends? Although your free T4 is low in range, this may be because you’ve converted it T3. It’s very individual. I’d be fine with fT3 and fT4 like you, but not with tsh that high ( but that’s me).

Your vitamin d and vitamin b12 are too high, I wonder how this would affect how you feel?

Alternatively, wonder if you may have another illness that is affecting your thyroid hormone levels? Perhaps that is a question for GP?

MaisieGray
MaisieGray
in reply to Aurealis

Aurealis No, you have that wrong, they are not too high. The ranges given for Vits D and B12 are the insufficient range, not the "normal" range; so her levels are above being insufficient, but not high per se. The OP hasn't given units, but the "Could it be B12" book advises "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".

Aurealis
Aurealis
in reply to MaisieGray

Sorry I know nothing, just went by ranges

kaz90
kaz90
in reply to Aurealis

Thanks for your reply, my B12 is fine but I do struggle with my ferritin and vitamin D levels even when taking supplements.

SeasideSusie
SeasideSusieAdministrator

kaz90

The first thing you should do is address the problems showing with your nutrient levels.

Ferritin 43.6 (13-150)

For thyroid hormone to work (that's our own as well as replacement hormone) it's said that 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, also liver pate, black pudding, and including lots of iron rich foods in your diet apjcn.nhri.org.tw/server/in...

Vit D 59 (insufficient 30-50)

As you are in the UK this I expect the unit of measurement is nmol/L.

The Vit D Council recommends a level of 125nmol/L and the Vit D Society recommends a level between 100-150nmol/L.

To raise from your current level to the recommended level, the Vit D Council suggests a daily supplement of 3,700iu D3 daily. They also recommend taking 5,000iu daily on the days we don't sunbathe. So you should be fine taking anywhere between those two amounts, then retest in 3 months.

When you have reached the recommended level 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/

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 such as hardening of the arteries, kidney stones, etc.

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. We need Magnesium so that the body utilises D3, it's required to convert Vit D into it's active form. So it's important we ensure we take magnesium when supplementing with D3.

Magnesium 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 (some of which can be obtained from food).

Vit B12 - 402 (insufficient 145-250)

This is the serum B12 test which tests total B12 - both inactive and active. Active B12 is between 10-30% of the total B12 and you can have a normal serum B12 result but still have deficiency.

As symptoms of B12 deficiency can overlap with symptoms of hypothyroidism, you can check signs and symptoms of B12 deficiency here

b12deficiency.info/signs-an...

If you have any then list them to discuss with your GP and ask for further testing for B12 deficiency/pernicious anaemia.

If no signs, then you might want to improve your B12 level by taking sublingual methylcobalamin lozenges 1000mcg along with a good B Complex to balance all the B vitamins.

If you do have any signs of B12 deficiency, then don't start the B Complex until after further investigation into B12 has been carried out and supplementation (or B12 injections) started, as folate/folic acid masks signs of B12 deficiency.

Folate 13.10 (8.83-60.8)

This is too low, the recommended level is at least half way through it's range so that's 35.5+ with that range. Eating folate rich foods can help, as can a good B Complex containng methylfolate rather than folic acid - consider Thorne Basic B or Igennus Super B.

As your nutrient levels are pretty poor, I'm wondering whether you have raised antibodies which would confirm autoimmune thyroid disease aka Hashimoto's. Hashi's can cause gut/absorption problems which leads to low nutrient levels. Have you ever had Thyroid Peroxidase/Thyroglobulin antibodies tested?

kaz90
kaz90
in reply to SeasideSusie

Thank you for the reply, I have had antibodies tested and they are always in the normal range as above in my post. I do take supplements but I have always felt that my body struggles to absorb some nutrients my ferritin has been a problem for over 20 years, highest I have got is to 56. The same with Vit D,59 is the highest reading I have had in two years when I started it was 51 so it is progress. I will go and source some additional supplements to boost these levels.

SeasideSusie
SeasideSusieAdministrator
in reply to kaz90

Sorry Kaz, I missed your antibody results before. Have they every been higher than these latest ones?

They are low but you can have Hashi's without raised antibodies.

It certainly sounds as though you might have an absorption problem and if so then taking more supplements will be a waste until you sort out the absorption problem.

SlowDragon has information and links about gut/absorption problems so hopefully she will pop along with some ideas.

kaz90
kaz90
in reply to SeasideSusie

My highest antibodies readings SeasideSusie are as follows :

Anti-Thyroidperoxidase 19 range <34

Anti-Thyroglobulin 20.3 range <115

I don't know what else to do or to look.

SeasideSusie
SeasideSusieAdministrator
in reply to kaz90

So you've never had over range antibodies, but it is possible to have Hashi's without raised antibodies.

You say in reply to Aurealis that you B12 level is fine, but it isn't. According to the book "Could it be be B12", the low threshold should be at least 450pg/ml and deficiencies begin to appear in the cerebrospinal fluid below 550, so on that basis yours is too low. That book also says "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."

But as I explained in my previous post, it's Active B12 that can indicate if you are B12 deficienct.

TSH 7.19 (0.27-4.2)

T4 Total 92 (59-154)

Free T4 13.9 (12.0-22.0)

Free T3 6.6 (3.1-6.8)

Your TSH is over range and coupled with your low FT4 this indicates subclinical hypothyroidism, which can be diagnosed when TSH is begween 4 and 10 and the patient is symptomatic. However, your FT3 is a bit of an enigma which I can't explain. But as doctors only tend to look at TSH and maybe FT4, they may not make much of it.

Read the following, I have quoted relevant parts:

NICE Clinical Knowledge Summary - Hypothyroidism - Diagnosis

cks.nice.org.uk/hypothyroid...

........

Suspect subclinical hypothyroidism (SCH) if TSH is above the reference range and FT4 is within the reference range. In non-pregnant people repeat TSH and T4 (ideally at the same time of day) 3–6 months after the initial result to exclude transient causes of a raised TSH (such as intercurrent illness) and to confirm the diagnosis of SCH.

........

Management Subclinical hypothyroidism (non-pregnant)

cks.nice.org.uk/hypothyroid...

........

If TSH is between 4 and 10 mU/L and FT4 is within the normal range

◾In people aged less than 65 years with symptoms suggestive of hypothyroidism, consider a trial of LT4 and assess response to treatment 3–4 months after TSH stabilises within the reference range — see the section on Prescribing information for further information on initiation and titration of LT4. If there is no improvement in symptoms, stop LT4.

........

You could discuss this all with your GP.

I would also discuss the fact that your nutrient levels don't rise much and you would like some investigation into absorption problems. The gut can be involved in many illnesses.

kaz90
kaz90
in reply to SeasideSusie

My FT3 2 years ago was 4.23 (test range 3.1-6.8) and has steadily risen to the now 6.6.

kaz90
kaz90
in reply to SeasideSusie

Update SeasideSusie, good news !! my GP has listened and looked at my evidence and has agreed to a trial on levothyroxine starting on 25mg. Then they said, " if my body tolerates this" she will up the dose to 50mg and see what happens.

SeasideSusie
SeasideSusieAdministrator
in reply to kaz90

That is good news. Just so that you are aware, many people feel worse on 25mcg so don't let your GP tell you that your trial has failed. Normal starting dose is 50mcg so you will need at least that before you probably feel any improvement. Also, it takes 6 weeks to be full effective so make sure your trial is long enough, I'd say minimum 3 months, retesting every 6 weeks with increases in dose until your TSH gets down to nearer 1.

You've had great advice about vitamins, and also some of the NICE guidelines. These are the rules doctors are supposed to follow when treating us, so you should get the treatment suggested there. Be careful when showing them to your doctor because they can take offense if it looks like you know their job better than they do.

Your thyroid results look a little strange, and it does make me wonder if something else is going on. Maybe you already know this, but to explain a little, TSH is thyroid stimulating hormone. This is a checmical signal produced by the pituitary in your brain to call your thyroid into action and make more hormone. Often doctors base all their diagnosis and treatment on this, so you're lucky that its quite high. Some doctors will refuse to treat until it reaches 10, which is horrible and is probably the trap you're in right now. People can be very sick even with a TSH of 3 or lower.

T4 is the hormone that is produced in the greatest quantity by a healthy thyroid. It's a storage hormone, and your body has to convert it into T3, the active form, which is needed by every cell and organ in your body as part of the process to make energy.

The freeT4 and freeT3 blood tests show how much of these hormones are available in your blood. These tests both give results in a 'normal curve'. This means the largest number of healthy people will be right in the centre of the range, and the further you are to one side or the other, the more unlikely it is.

The average healthy person would have both in the middle of the range. But for yours the freeT4 is rock bottom, and the freeT3 is top of the range. The low freeT4 tells us your body is sturggling to produce enough hormone. FreeT3 is the number that best predicts symptoms once we're on hormone replacement treatment. But some of the pattern you have is common in people before diagnosis - your body is struggling by every means it can to keep T3 levels up by converting extra efficiently, because there isn't enough T4 to keep the levels up.

I've never seen such an extreme result as yours before. It's more common to see freeT4 well below the middle of the range and a freeT3 hovering around the middle. Also the TSH will often not be quite as high as yours. I'm not sure what to conclude. Everyone is different, and there can be all kinds of variation. Or it could be that you're a slightly complicated person and you've got other things going on (which many of us are).

It's pretty clear your body is asking for more thyroid hormone (with the high TSH), but your thyroid isn't able to comply (the freeT4 is very low). So there's good evidence there that you need some hormone replacement, not matter what's going on. Although a doctor will not be able to look into it in that much detail, something to keep an eye on as you hopefully get treatment. The low vitamins could turn out to be an explanation.

This doesn't really address your question of how to get treatment, but hopefully there is somethung useful for you in what I've written.

kaz90
kaz90
in reply to SilverAvocado

Thank you SilverAvocado for your detailed response, you have explained it so well. My husband would agree with you I am a complicated case. I have had a few medical issues over my 48 years from precocious puberty, DVT in pregnancy and Intracranial abnormal fluid pressure all hormone linked but now I am menopausal, my body is telling me it needs help.

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