Improving but still tired, do these blood resul... - Thyroid UK

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Improving but still tired, do these blood results indicate any reason why?

Foxtrot89 profile image
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I wondered if someone knowledgeable may be kind enough to help me and look through these results to see if there is any reason I'd still be getting tired easily.

These are the thyroid results, 6th March 2019

Thyroid Stimulating Hormone (TSH) 0.681 mIU/L0.27 - 4.3 mIU/L

Free Thyroxine (FT4)15.6 pmol/L12.0 - 23.0 pmol/L

Triiodothyronine (FT3)4.99 pmol/L3.1 - 6.8 pmol/L

* Anti-Thyroidperoxidase antibodies59.5 kIU/L0.0 - 34.0 kIU/L

Thyroxine (T4)83.4 nmol/L66.0 - 181.0 nmol/L

Anti-Thyroglobulin antibodies (TGAB)27.3 kU/L0.0 - 115.0 kU/L

I also have HbA1c, iron, VitD, active folate, active B12, cholesterol, liver function and a full blood count if any of those help. I spotted low-ish neutrophils and high-ish lymphocytes which apparently can mean a viral infection?

Thanks in advance! :)

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SeasideSusie profile image
SeasideSusieRemembering

Can you tell us if you have a diagnosis, are on any replacement hormone, vitamin/mineral supplements. A quick glance through your previous post titles mention adrenal cortex and other things. If we have the complete picture we can try and make sense of your current results. You could post your other results too, but do mention if you are taking anything or have any diagnosis of deficiencies/low levels.

Foxtrot89 profile image
Foxtrot89 in reply to SeasideSusie

The Doctor I most recently saw mildly acknowledged that I had less than ideal thyroid results back when I saw her in September 2018 but told me she mainly thought I had depression (I think partly because I cried through frustration at not being properly listened to) and said she didn’t think the NHS would offer thyroxine (she wrote to an endocrinologist for me, who refused it).

I take Metavive, 2 x 15mg each morning, 1x Thorne adrenal cortex (50mg) and a variety of vitamins and minerals to support thyroid function, with extra B complex and B12 (all 3 types).

Myoinositol powder

Igennus Vegepa (omega 3)

CoQ10 as ubiquinol

Foxtrot89 profile image
Foxtrot89 in reply to Foxtrot89

And I am gluten free :)

SeasideSusie profile image
SeasideSusieRemembering in reply to Foxtrot89

OK, thanks, that makes it clearer :)

she mainly thought I had depression (I think partly because I cried through frustration at not being properly listened to)

So many of us can relate to that, unfortunately :(

Assuming that you've been taking Metavive for 6 weeks or more, and we have to bear in mind that Metavive doesn't market itself as NDT or disclose any T4 or T3 content (but as it is a whole thyroid glandular we assume it contains all the hormones of a pig's thyroid):

Thyroid Stimulating Hormone (TSH) 0.681 mIU/L 0.27 - 4.3 mIU/L

Free Thyroxine (FT4) 15.6 pmol/L 12.0 - 23.0 pmol/L

Thyroxine (T4) 83.4 nmol/L 66.0 - 181.0 nmol/L

Triiodothyronine (FT3) 4.99 pmol/L 3.1 - 6.8 pmol/L

These results reflect what one might expect to see when taking NDT. I assume you are taking 2 x Metavive l (I think that's the only one that comes as 15mg capsules) and there is room for your FT3 to be higher in range.

* Anti-Thyroidperoxidase antibodies 59.5 kIU/L 0.0 - 34.0 kIU/L

Anti-Thyroglobulin antibodies (TGAB) 27.3 kU/L 0.0 - 115.0 kU/L

Your raised TPO antibodies suggest autoimmune thyroid disease aka Hashimoto's which is where the thyroid is attacked and gradually destroyed. I'm assuming you know this as you mention that you are gluten free.

Before starting on Metavive (or any thyroid replacement hormone), if you had an over range TSH, but below 10, this would be classed as Subclinical Hypothyroidism, and if your antibodies had been raised at that time then an enlightened doctor would have prescribed Levo.

1x Thorne adrenal cortex (50mg)

Did you do a 24 hour saliva test to test cortisol and DHEA, did it show that you had low cortisol? How long have you been taking it? Have you retested to see if it is helping raise your levels?

a variety of vitamins and minerals to support thyroid function

What exactly? Does anything contain iodine?

It would be useful to see current levels of Vit D, B12, folate and ferritin.

You mention that you get tired easily, this could be due to the fact that your FT3 is stil fairly low in range or it could be low ferritin.

Foxtrot89 profile image
Foxtrot89 in reply to SeasideSusie

Thanks Susie I really appreciate you taking the time to go through my results. It is frustrating dealing with the doctors as they seem to just assume mental health issues simply because I have struggled in the past.

I've been on Metavive I since the end of September and started out with just one capsule but raised it to 2 capsules around 6 weeks ago (I'd have to check the date). Do you think I should raise it again once it's been 6 weeks if I'm still tired?

These are my iron results from the same date as the thyroid results:

T.I.B.C. 48.67 umol/L (41.0 - 77.0 umol/L)

Transferrin Saturation 50.07 % (20.0 - 55.0 %)

Ferritin 73.4 ug/L (13.0 - 150.0 ug/L)

Iron 24.37 umol/L (5.8 - 34.5 umol/L)

Unsaturated iron binding capacity (UIBC) 24.3 umol/L (24.2 - 70.1 umol/L)

And the others...

Vitamin B9 & B12 (Active)

Folate 45.0 nmol/L (8.83 - 60.8 nmol/L)

* Active B12 300.0 pmol/L (25.1 - 165.0 pmol/L)

* 25-hydroxy Vitamin D 104.0 nmol/L (50.0 - 100.0 nmol/L)

My antibodies were higher before so hopefully things are getting better. I definitely don't feel as bad now, before I felt awful 100% of the time.

Iodine I have 75mcg most days. Selenium 200mcg an hour after my Metavive.

It is also difficult to make proper improvements as my dad is terminally ill (we found out at the end of October) and was predicted to have 3 months to live in January, so it's a stressful time and I wish I was better to be able to actually help more, but I currently can't work due to lack of energy, and can only socialise for about an hour in a quiet environment otherwise I get wiped out.

I haven't ever tested DHEA, I did a cortisol only saliva test nearly a year ago which showed a low morning value and slightly high at night.

I get scared about stopping the adrenal cortex as I worry that the Metavive will cause adrenal issues without it. Am I right in thinking that or should the adrenals be ok after a while? Maybe I should test it.

SeasideSusie profile image
SeasideSusieRemembering in reply to Foxtrot89

I've been on Metavive I since the end of September and started out with just one capsule but raised it to 2 capsules around 6 weeks ago (I'd have to check the date). Do you think I should raise it again once it's been 6 weeks if I'm still tired?

There's room for a raise, go by FT3 - it's only 51% through range.

**

Optimal iron results:

Serum iron: 55 to 70% of the range (higher end for men) - yours is 24.37 umol/L (5.8 - 34.5 umol/L) so that's 65%

TIBC: Low in range indicates lack of capacity for additional iron, high in range indicates body's need for supplemental iron - yours is 21% through range so on the low side and doesn't suggest supplementing

Transferrin Saturation: 35 to 45% - yours is on the higher side at 50%

UIBC - yours is 24.3 umol/L (24.2 - 70.1 umol/L). This is not included in the table I refer to when looking at iron panels. All I know is that low UIBC can be associated with chronic inflammatory conditions. Unfortunately I have no further information on that.

Ferritin 73.4 ug/L (13.0 - 150.0 ug/L)

This is pretty good, half way through range is recommended (with a minimum of 70 for thyroid hormone to work properly) so it's just a case of maintaining this level - maybe iron rich foods, such as liver every 2 or 3 weeks, black pudding or liver pate, other iron rich foods here apjcn.nhri.org.tw/server/in...

**

Iodine I have 75mcg most days.

Is that as a supplement? If so then I'd stop taking it unless you've tested and have found to be deficient. If you are taking it for deficiency, then monitor it with testing. Iodine used to be used to treat an underactive thyroid, it's not recommended for us Hypos (unless deficient and then should be taken under the guidance of an experienced practioner and monitored) and particularly not recommended when Hashi's is present. Iodine that comes in our diets - milk, yogurt, white fish, etc, is fine.

**

Selenium 200mcg an hour after my Metavive.

I would take this 2 hours away from Metavive. I wouldn't take anything closer than 2 hours where any thyroid meds are concerned, just in case it affects absorption. Two hours is recommended for Levo, and there has to be some T4 in Metavive.

**

Folate 45.0 nmol/L (8.83 - 60.8 nmol/L)

This is good.

**

* Active B12 300.0 pmol/L (25.1 - 165.0 pmol/L)

Wow! Way over range. Do you supplement or take B12 injections? If you aren't prescribed B12 injections for B12 deficiency or PA, then you don't need to supplement, you're wasting your money. If you're simply supplementing B12 then I'd suggest you leave it off for 4-5 months then retest for a baseline to see how much you're holding on to.

**

* 25-hydroxy Vitamin D 104.0 nmol/L (50.0 - 100.0 nmol/L)

The Vit D Council recommends a level of 125nmol/L and the Vit D Society recommends a level of 100-150nmol/L so this is just about right.

**

I get scared about stopping the adrenal cortex as I worry that the Metavive will cause adrenal issues without it. Am I right in thinking that or should the adrenals be ok after a while? Maybe I should test it.

As you're taking adrenal cortex, I'd retest to see what effect it's having. Personally, I'd recommend the 24 hour saliva cortisol/DHEA test with Regenerus

thyroiduk.org/tuk/testing/r...

Foxtrot89 profile image
Foxtrot89 in reply to SeasideSusie

Thanks a lot Susie! Yes I’m supplementing B12 so maybe I can stop and see how it goes. I will also bear in mind all your other suggestions.

Since I raised my Metavive (from 15mg to 30mg) I feel a lot better on the whole, so perhaps all that’s needed it to carry on with most other things (other than stopping the ones you mentioned, and spacing out the Selenium further away) and then try another raise, to go to 45mg (3 x 15mg) per day.

I measure my temperature daily and it’s still not quite there.

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