Anaemia

[JoanneG45]

Hi I have coeliac and hasimotos. My consultant says I'm anaemic but not due to iron now ?? But gave me iron tablets before the blood results ( after a normal colonoscopy) and they made my hemmoroids worse which was counterproductive so just taking one. Not seeing him till April ?????

[SlowDragon Administrator]

What are your thyroid results like? TSH, FT3 and FT4

As you have both coeliac and Hashimoto's, low vitamins are especially common

Are you on any other supplements, like vitamin D, B12 or B complex?

For full Thyroid evaluation you need TSH, FT4 and FT3 plus both TPO and TG thyroid antibodies tested. Also extremely important to test vitamin D, folate, ferritin and B12

All thyroid blood tests should ideally be done as early as possible in morning and fasting. Do not take Levothyroxine dose in the 24 hours prior to test, delay and take immediately after blood draw. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

Many Hashimoto's patients with gluten intolerance find they are poor converters of FT4 to FT3. You may need addition of small dose T3 to get FT3 high enough

Iron supplements often cause constipation

Constipation can be common when still hypothyroid

[JoanneG45 in reply to SlowDragon]

I think Tsh is about 5.5, t4 13 and t3 normal.a/b around 300 so not high. On vit D supp. I'm going to restart multi vits as yes need the bs. And marmite I think. How does that sound?! Thank you

[Treepie in reply to JoanneG45]

Always show the ranges for tests as labs differ.A TSH of 5.5 is far too high when on levo ,should be no higher than1.5 ( see Slowdragins reply to ,slopdog) .

" t3 normal" no such thing as normal,just means in range and may be too low.

Multivits have too little of anything to be of use.

[Marz in reply to JoanneG45]

You will see from reading other posts that it is important to post ranges after the results - as labs vary ! Your TSH is far TOO high and needs to be around 1. What dose of T4 are you taking ?

Taking Multi-vitamins is of little benefit as you are unable to have a sufficient dose of some and if you increase you could overdose on others. As suggested both here and on the Gluten Free Guerillas forum it is suggested you have the individual tests done.

I suggest you complete your Bio/Profile page as you have other conditions that may contribute to members replies here eg osteopenia. Saves you having to repeat yourself

[SlowDragon Administrator in reply to JoanneG45]

Can you add the ranges on these results please

TSH should be under 1.5 and FT4 towards in top third of range and FT3 at least half way to be adequately treated. So you are currently VERY under medicated.

How much Levothyroxine are you currently taking?

See GP and request 25mcg dose increase in Levothyroxine and bloods retested in 6-8 weeks

Multivitamins are NOT usually recommended on here. Most contain too little of what we do need and stuff we don't want eg iodine which is best avoided with Hashimoto's

drknews.com/iodine-and-hash...

How low was vitamin D before starting on supplements? How much vitamin D are you currently taking. Has level been retested?

Marmite is NOT gluten free.

Other makes of yeast extract are gluten free - eg Sainsbury's or Asda own brands

B12 and folate. Best to supplement a daily good quality vitamin B complex, one with folate in, not folic acid, may be beneficial. B vitamins best taken in the morning after breakfast

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...

[JoanneG45 in reply to SlowDragon]

Thank you all for your help will take a moment to absorb it all !!

[SlowDragon Administrator in reply to JoanneG45]

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,

"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l.

In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l.

Most patients will feel well in that circumstance. But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l.

This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l)."

You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctor

 please email Dionne at

[e-mail]

Many GP's are not happy to have a TSH under one but new NHS England Liothyronine guidelines November 2018 clearly state on pages 8 & 12 that TSH should be between 0.4-1.5 when on just Levothyroxine

sps.nhs.uk/wp-content/uploa...

Many of us with Hashimoto's and gluten intolerance need addition of small dose of T3. Otherwise we need very high FT4 and suppressed TSH in order to have high enough FT3.

Professor Toft recent article saying, T3 may be necessary for many.

rcpe.ac.uk/sites/default/fi...

Suggest you join Coeliac UK as member. This gives access to very comprehensive electronic food directory of gluten free food and drink. Gluten is hidden in thousands of products

[JoanneG45 in reply to SlowDragon]

Thanks. I understand all that. Been coeliac for over 3 years and know what I'm doing with that but only recently been diagnosed with thyroid problems and still in the process of getting on to the right dose and medication. I am more confused about the ongoing anaemia and why I am on iron tablets when now the bloods say I'm not IDA

[SlowDragon Administrator in reply to JoanneG45]

Having Hashimoto's badly affects gut function. Low B12 and or folate are common

Especially if low vitamin D too

Low ferritin (iron storage) common too. This is not the same as iron

Essential to test all these

Marmite is not gluten free

[JoanneG45 in reply to SlowDragon]

My ferritin levels are good and don't worry I'm very strictly gluten free and read all labels on everything. My coeliac serology is good but my villi is still damaged. I mostly eat naturally GF food anyway. When I say marmite I really mean yeast extract.

[humanbean in reply to JoanneG45]

I am more confused about the ongoing anaemia and why I am on iron tablets when now the bloods say I'm not IDA

You can be iron deficient without being anaemic. In fact doctors are reluctant to treat iron deficiency in my experience, they will often only treat iron deficiency anaemia.

Anaemia is defined by the World Health Organisation as follows :

The World Health Organization defines anaemia as:[1]

Haemoglobin (Hb) <13 g/dL in men over 15 years old.

Hb <12 g/dL in non-pregnant women over 15 years old.

Hb <12 g/dL in children aged 12-14 years.

Source : patient.info/doctor/iron-de...

From personal experience I can say that iron deficiency will make people feel awful. Forcing them to wait for treatment until haemoglobin levels have dropped into the anaemic range is sadistic (in my opinion).

[LAHs in reply to JoanneG45]

Hi Joanne. Before you take any pills for anything get a blood test to see what your levels are. Do not supplement unless you are deficient. A quick and easy test to see if you are anaemic is to go to the mirror and pull down your lower eyelid, if it is white or pale pink then yes, supplement with some iron - then repeat. If it is bright red then you are OK and your malady is not iron deficiency. A better way is to go get a blood test (for iron), look at the results, if you are deficient take some iron pills for about a fortnight then get another blood test - then repeat until your levels are optimum.

Even if it is the (almighty) doc who puts you on a pill, look at your blood test results first, read up on it a bit and if the docs instructions sound OK, only then go ahead - and monitor how you feel. Docs just don't have the time to drill down into the details, that's up to the patient.

[JoanneG45 in reply to SlowDragon]

I'm not,at the stage of considering T3 yet but I do understand that and my friend is on T3 meds but I know its expensive

[SlowDragon Administrator in reply to JoanneG45]

You won't know if you need T3 until TSH is down and vitamins are optimal

Then if you need T3 NHS can and should prescribe. Clinical need has to be diagnosed by NHS endocrinologist

If you get to that stage email Dionne at Thyroid Uk for list of recommended thyroid specialists

[SlowDragon Administrator in reply to JoanneG45]

T3 is cheap to make

Only NHS is getting Ripped off. But that's not the patients' problem

mjauk.org/wp-content/upload...

[JoanneG45 in reply to SlowDragon]

Well it becomes the patients problem as they won't prescribe it

[JoanneG45 in reply to JoanneG45]

I had to really fight for hep c tx