Fatigue and anxiety - please advice on my test ... - Thyroid UK

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Fatigue and anxiety - please advice on my test results - hashimotos


i have had hashimotos for a couple of years which the doctor diagnosed from elevated TSH and high antibodies

Since then my results have never been in the range however my doctor has just told me that it is now acceptable.

Feeling total fatigue all the time I decided to get a full thyroid panel done at Medichecks and these were my results (I see that all my thyroid related levels now look good but the rest of the levels tested didn’t look good. Can anyone suggest what I should do to improve these? I eat a great balanced diet and exercise regularly so I can’t understand why I wouldn’t be getting the right vitamins from my diet

TSH 1.01 range (0.27 - 4.2)

T3 5.5 range ( 3.1 - 6.8)

T4 20 range (12 - 22)

Ferratin 10 u/gl range (27 - 150)

Folate serum 3 u/gl range (2.9 - )

Vitamin b12 32 range ( 25.1 - 165)

Vitamin d 28 range nmol ( 50 - 200)

These don’t look very good to me? Or is it normal to be low if one is low does it affect the other

14 Replies

Oh and Thyroid perioxidase antibodies

209 iu/ml range >34


Hashi's and gut absorption problems tend to go hand in hand and can very often result in low nutrient levels or deficiencies, and it is very obvious that this has happened in your case.

Are you addressing the Hashi's at all? Most doctors dismiss antibodies as being of no importance and know little or nothing about Hashi's and how it affects the patient, test results and symptoms. You need to read, learn, understand and help yourself where Hashi's is concerned.

You can possibly help reduce the antibodies by adopting a strict gluten free diet which has helped many members here, although there is no guarantee.

Gluten contains gliadin (a protein) which is thought to trigger autoimmune attacks so eliminating gluten can help reduce these attacks.

You don't need to be gluten sensitive or have Coeliac disease for a gluten free diet to help.

Gluten/thyroid connection: chriskresser.com/the-gluten...





Supplementing with selenium l-selenomethionine 200mcg daily can also help reduce the antibodies, as can keeping TSH suppressed.

Ferratin 10 u/gl range (27 - 150)

You need to speak to your doctor about your below range ferritin. You need to ask for an iron panel and full blood count to see if you have anaemia, I strongly suspect you might have and will need treatment. If you are offered iron tablets, try for an iron infusion as that will raise your ferritin in 24-48 hours, tablets can take many months.

Vitamin b12 32 range ( 25.1 - 165) - This is Active B12

Active B12 below 70 suggests testing for B12 deficiency. See


Reference range: >70*; * between 25-70 referred for MMA

Check for signs of B12 deficiency here:


List any to discuss with your doctor and request further testing.

Folate serum 3 u/gl range (2.9 - ) - you haven't put the top of the range

You are 0.1 above the low limit of the range, so close to folate deficiency you should ask your GP if he will prescribe folic acid.

Folate should be at least half way through it's range.

Vitamin d 28 range nmol ( 50 - 200)

You are Vit D deficient. See NICE treatment summary for Vit D deficiency: cks.nice.org.uk/vitamin-d-d...

"Treat for Vitamin D deficiency if serum 25-hydroxyvitamin D (25[OH]D) levels are less than 30 nmol/L.

For the treatment of vitamin D deficiency, the recommended treatment is based on fixed loading doses of vitamin D (up to a total of about 300,000 international units [IU] given either as weekly or daily split doses, followed by lifelong maintenace treatment of about 800 IU a day. Higher doses of up to 2000IU a day, occasionally up to 4000 IU a day, may be used for certain groups of people, for example those with malabsorption disorders. Several treatment regims are available, including 50,000 IU once a week for 6 weeks (300,000 IU in total), 20,000 IU twice a week for 7 weeks (280,000 IU in total), or 4000 IU daily for 10 weeks (280,000 IU in total)."

Each Health Authority has their own guidelines but they will be very similar. Go and see your GP and ask that he treats you according to the local guidelines or this summary and prescribes the loading doses. Once these have been completed you will need a reduced amount so you should make sure that you are retested after you have finished the loading doses so that you know how much you should then take going forward. Most doctors, if they continue prescribing, only give 800iu daily which isn't enough. If GP wont retest then do this privately (link below) and post your new result at the time for members to suggest a dose) to bring your level up to what's recommended by the Vit D Council/the Vit D Society - which is 100-150nmol/L - and then you'll need a maintenance dose to keep it there, 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 an NHS lab which offers this test to the general public:


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

Your GP won't know, because they're not taught nutrition, but there are important cofactors needed when taking D3 as recommended by the Vit D Council -


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 if taking tablets/capsules/softgels, no necessity if using an oral spray

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 if taking tablets/capsules, no necessity if using topical forms of magnesium.


Check out the other cofactors too (some of which can be obtained from food).

I am actually amazed that your thyroid test results are so good considering your dire nutrient levels.

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

Wow that’s so informative thanks so much I feel much more aware on to sort this situation now.

As I said this is the first time in like 2+ years my TSH has been below 4 so I’m pretty pleased that they have managed to get the dosage right on my Levo now at least this is been maintained properly but I couldn’t understand why I was continuing to feel terrible, if not even more fatigued before and terrible anxiety and sleep problems.

Thanks for the advice

SlowDragonAdministrator in reply to Theangelthatisamy

How much Levothyroxine are you currently taking?

Is it always the same brand?

Clearly your results suggest seriously poor gut absorption

Do you have any gut symptoms?

Improving vitamins is absolutely essential as outlined so excellently by SeasideSusie

See GP urgently

Insist on coeliac blood test too before starting strictly gluten free diet

Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels. Low vitamin levels affect Thyroid hormone working

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

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps, sometimes significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies

Ideally ask GP for coeliac blood test first or buy test online for under £20, just to rule it out first

Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse







I’m on Levo thyroxine I have always been on this I take 112mg daily. I was taking 50 mg then 75mg then 100mg and now this final increase seems to have worked!

I don’t have celiacs because when I first was diagnosed with hashimotos I was having lots of stomach issues that they said was IBS. I do have a slight dairy intolerance.

I have aches and pains everywhere but my sides seem to hurt it’s strange but the sides of your stomach where you would get pains from laughing.

Hopefully that will go when my levels improve

SlowDragonAdministrator in reply to Theangelthatisamy

Yes realise you are on Levothyroxine

If you have dairy intolerance are you on Teva brand of Levothyroxine l this is only one that is lactose free. But this brand does upset many people. However a few love it


Yes obviously most Hashimoto's patients are (or should be ) tested for coeliac disease

Only 5% test positive for coeliac disease

But a vast number with Hashimoto's find that they are gluten intolerant

The only way to know if that includes yourself is to try it.

You might be astonished at the improvement

I will try going gluten free for abit and see if if it improves the symptoms. Is it likely to bring up the b12/vit d/follate and ferratin levels or will it just lower the antibodies? Sorry if this was a stupid question but I do not know enough about it as to what affects what

From what I can gather is,

it looks like you are low in Vitamin D

which can make you feel crappy

and low in iron

This may mean , you should check to see if

you are dealing with anemia

Good luck

I was just reading the other comments that you may be low in other vitamins

Are you having difficulty absorbing vitamins?

Maybe this is something you could ask the doctor about.

Hi - well I am no expert but your results do suggest that you lack iron and vitamin D both of which can cause fatigue and depression . I think you should take these results to your GP and ask for a full blood count and other tests for vitamin d and iron defficiency.

Btw do you Mind me asking if you have been treated for hashimotos in order to get your results back in range and if so how?

I have just been diagnosed with it following a hemithyroidectomy for suspected cancer . No cancer thank goodness but the lobe removed was damaged by Hashimotos so I am waiting for a few weeks before having more thyroid tests to see if I need medication - I have to say I feel ghastly which is why I went to the GP in the first place and that’s not been changed by the operation though weirdly my pre-op results for TSH and T4 were just in the so called normal range. ( i suspect they had been dropping for a while from what had been a higher ‘normal’ for me which is why I was getting symptoms.)

Message me if you prefer

SlowDragonAdministrator in reply to smwdorset


Strongly suggest you get FULL Thyroid and vitamin testing 6-8 weeks after your hemithyroidectomy

Presumably not on any Levothyroxine at moment?

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

Low vitamin levels are extremely common, especially if Thyroid antibodies are raised

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and fasting. (Last Levothyroxine dose should be 24 hours prior to test, (taking delayed dose 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)

Private tests are available. Thousands on here forced to do this as NHS often refuses to test FT3 or antibodies or all vitamins


Medichecks Thyroid plus ultra vitamin or Blue Horizon Thyroid plus eleven are the most popular choice. DIY finger prick test or option to pay extra for private blood draw. Both companies often have special offers, Medichecks usually have offers on Thursdays, Blue Horizon its more random

If you have blood test results from BEFORE the op put these on a new post of your own

smwdorset in reply to SlowDragon

Wow this is really helpful thanks - especially the tip about timing for tests and asking for vitamins as well as Thyroid tests. And thanks for the tip re private tests . I have asked the surgeon to send me the pre-op results but not received them yet.

No am not on anything yet. My GP referred me straight to cancer clinic because fo cough and voice

Im just being treated with Levo I take 112 mg a day. But I’m considering now a gluten free diet if it’s going to help further

Whoa! Those are some of the worst vitamin levels I have ever seen.

Your thyroid numbers look okay. You came to a thyroid forum, so of course, you're going to get thyroid suggestions. I suggest you note these but work on your other red flags first.

If you feel bad, then do it as quick as possible. This is what I would do if I was you:

- Get a b12 shot. Or if not available, get a 1 mg b12 tablet a few times a day. It's tough to go overboard here, especially since you have documented evidence of a poor level.

- Get some folic acid or folate - 1 mg/day for a month or so. I personally don't think the form matters much, but others may suggest a methyl-folate form.

- Your ferritin is inadequate. Some form of infusion would be ideal, but if that isn't possible, then supplement 100-200 mg of elemental iron per day for a week or two and then gradually lower the dose to 50-100 mg/day. Aim for middle of the range ferritin- 100-150. You are far too low to try and eat your way to iron adequacy. That will take a year, if it works.

- Get vitamin D up. 1-4,000 iu per day in colder environments is a good maintenance dose. The half life is ~21 days, meaning it will take a bit to get your levels up. So, you could double dose for a few weeks then gradually lower. Try to eat liver or make sure there is vitamin A in your multi- these two lock the receptors together and your need for them are intertwined.

I would also try some other form of multivitamin and multi-mineral supplementation. You tested 4 nutrients and have a poor status for all 4. That doesn't look good. You are likely low on others as well. So get a multivitamin and all the other nutrients which won't be in it: a calcium/magnesium supplement, and maybe some choline. With your vitamin D that low, there's a chance your calcium metabolism is deranged too, so you might want to up your calcium intake for a bit and see if you notice anything. Make sure you eat enough protein and fat as well.

You may also want to look for something systematically wrong with your digestion, such as a stomach acid test. You could also get some betaine hcl to assist with digestion in case you are low on stomach acid.

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