Doctors order a new blood test.

[Haze1975]

Hi all does any one have any I’d. The doctor order a full blood work up. Due to a lot of problems. They cut my medication in January from 175 to 150 and now down to 125 at the end of March. There trying to raise my T3 from 0.1 last blood test was in March before cut down to 125. Was T3 still at 0.1 but T4 is at 17.7. T4 is great and back to were it should be. But T3 didn’t move like they hope so. These are the results. Don’t have proper test results for the last blood test. Due to it was taken by the hospital and there not on my doctors notes. Results as follows.

Mean cell haemoglobin level (XE2pb) 29.8 pg [27 - 32]

Mean cell haemoglobin concentration (429..) 31.3 g/dL [32 - 35.9]

Haematocrit (X76tb) 0.435 [0.36 - 0.441]

Mean cell volume (42A..) 95.2 fL [80 - 100]

Serum bilirubin level (44E..) 5 umol/L [0 - 21]

Urea and electrolytes (X77Wi)

Nucleated red blood cell count (4266.) 0 10^9/L [0 - 0.01]

Serum alanine aminotransferase level (XaLJx) 8 iu/L [10 - 35]

Red blood cell count (426..) 4.57 10^12/L [4 - 5.5]

Platelet count - observation (42P..) 497 10^9/L [150 - 450]

Neutrophil count (42J..) 4.7 10^9/L [1.7 - 7.5]

Haemoglobin concentration (Xa96v) 13.6 g/dL [11.5 - 16.6]

Total white blood count (XaIdY) 8.1 10^9/L [3.7 - 11]

Eosinophil count - observation (42K..) 0.4 10^9/L [0.04 - 0.5]

Basophil count (42L..) 0.1 10^9/L [0 - 0.2]

Lymphocyte count (42M..) 2.1 10^9/L [1 - 4]

Monocyte count - observation (42N..) 0.8 10^9/L [0.2 - 0.8]

Serum globulin level (XE2eB) 37 g/L [20 - 39]

Serum alkaline phosphatase level (XE2px) 95 iu/L [40 - 150]

Serum inorganic phosphate level (XE2q4) 1.3 mmol/L [0.8 - 1.5]

Serum adjusted calcium concentration (Xabpk) 2.47 mmol/L [2.1 - 2.55]

Serum urea level (XM0lt) 5.4 mmol/L [2.5 - 6.7]

Serum creatinine level (XE2q5) 60 umol/L [50 - 98]

Serum sodium level (XE2q0) 142 mmol/L [136 - 145]

Serum potassium level (XE2pz) 4 mmol/L [3.5 - 5.1]

Serum albumin level (XE2eA) 41 g/L [35 - 50]

Serum calcium level (XE2q3) 2.49 mmol/L [2.1 - 2.55]

GFR calculated abbreviated MDRD (XaK8y)

Serum total protein level (XE2e9) 78 g/L [64 - 83]

Serum folate level (42U5.) 1.4 ng/ml [3.1 - 20.5]

Serum vitamin D level (XE2e7) < 20 nmol/L [80 - 150]

Haemoglobin A1c level - IFCC standardised (XaPbt) 35 mmol/mol [20 - 41]

Serum vitamin B12 level (XE2pf) 154 ng/L [187 - 883]

Any help will be much appreciated.

[SeasideSusie Remembering]

Serum folate level (42U5.) 1.4 ng/ml [3.1 - 20.5]

Serum vitamin D level (XE2e7) < 20 nmol/L [80 - 150]

Serum vitamin B12 level (XE2pf) 154 ng/L [187 - 883]

I'm off out for the rest of the day in a minute so don't have time for an in depth reply, but just want to point out that you have severe deficiencies of all these - what's your doctor doing about them?

You should be tested for B12 deficiency/pernicious anaemia and you should be given loading doses of Vit D. Maybe you have a malabsorption problem and need testing for this. Nutrient deficiencies are common with Hashimoto's, you should have TPO and Tg antibodies checked.

Where's your ferritin result? That's likely to be low too.

[Haze1975 in reply to SeasideSusie]

That’s all they post on this morning. It normally comes back quickly because of the T3 level. I also Facebook one of the girls in the sugary as well, she normally helps me out or if she doesn’t know the answer she normally finds out or asked the doctors. She turned around and said the doctor needs to see me as soon as possible.(Monday the same doctor in, the girls will get me an appointment.) and id find out then what they are going to do.

And normally when I post it on here there are other that will advise what to do as well. Or point me in the right way.

[SeasideSusie Remembering in reply to Haze1975]

I would normally make suggestions and point people in the right direction when levels are low or sub-optimal. But you have severe deficiencies, those are not a DIY fix, they need further investigation and serious treatment and this is probably why the doctor wants to see you.

[Haze1975 in reply to SeasideSusie]

That’s why I like this website so much. And would recommend it to anyone going through the same. That there are other out there that understand and will help out anyone who asked for it.

[Haze1975 in reply to Haze1975]

And also great. More appointment again. I was hoping for no more. I’ve had to go to see skin doctors because of abnormal lumps on my back. And to see if my family carry for a brca gene as well. Hope that was the end for this year in June. And then back to normal.

[galathea]

Lowering your meds wont improve your t3. Have you got in a muddle? Usually doctors lower meds in an attempt to increase tsh. Its not a good idea and any doctor who does this is probably ill informed.

You need some d3, at least 5000 iu daily as well as some methyl folate and b12.

X

[Haze1975 in reply to galathea]

I think it’s is tsh level. I’m getting confused. To many appointment at the moment for different things. And was hoping for the last one in June. As just finished the last one on my back yesterday. Just waiting for results.xx

[galathea in reply to Haze1975]

If tsh was 4 then you need an increase in meds.

[SlowDragon Ambassador]

Your terrible vitamin levels are almost certainly due to the lowering of your levothyroxine

Poor gut function is direct result of being hypothyroid

Improving vitamin levels to optimal is essential for good thyroid function

GP should prescribe loading dose of vitamin D

That’s 300,000iu over 6-8 weeks and retest at end of the course

Will add link later

[Haze1975 in reply to SlowDragon]

So that explains my stomach problems as well. But I was only getting at one time in the month. And overtime it’s been getting worse.

[shaws]

If you are unable to convert T4 (levothyroxine) into sufficient T3, they should be kind and prescribe a combination for you, i.e. T4/T3.

Quite a number of researchers have found that a combination is helpful for quite a number of people.

By lowering dose, they're not helping the patient at all. I believe many 'supposed to be' doctors/experts concentrate on the TSH alone and try to 'manouvre' dose so that it will make your TSH look good. Considering the TSH is from the pituitary gland and not the thyroid gland, we need TSH to be 1or lower but most of all we need the Free T4 and Free T3 to be in the upper part of the ranges. Maybe ask your GP to give you a Full Thyroid Function Test which is TSH, T4, T3, Free T4, Free T3 and thyroid antibodies (and blood draw should be at the very earliest, fasting (you can drink water) and a gap of 24 hours between last dose and test and take it afterwards. This helps keep the TSH at its highest and may prevent an unnecessary reduction.

SeasideSusie is very knowledgeable about vitamins/minerals and I'd take this up with the GP. We cannot function or recover our health without optimum of everything, i.e. thyroid hormones, vits/minerals.

[Haze1975 in reply to shaws]

Oddly enough my endo said January he didn’t care about tsh results. Only t3 and t4 was the important ones to him. And he was going to keep an eye on the bloods and the drop in medication. But I’ve been on 150/175 since 2015 and it’s never caused a problem before now. It was advised by endocrine team that I went down to 125. But he had a chat with my endo before doing this. And rang me and told me.

[shaws in reply to Haze1975]

You may be interested to read the following:-

thyroiduk.org.uk/tuk/thyroi...

[SlowDragon Ambassador]

As you have had thyroidectomy you have no thyroid function

GP is wrong to reduce dose of Levothyroxine

Low vitamin levels almost always cause low TSH

Inadequate dose of Levothyroxine, causes low vitamin levels

Getting vitamins levels dramatically improved will enable TSH to rise and dose of Levothyroxine increased

Vitamin D at under 20nmol is extremely deficient

Vitamin D needs to be at least around 80nmol and around 100nmol may be better

You need GP to prescribe LOADING dose - see guidelines here

Local CCG guidelines

clinox.info/clinical-suppor...

GP will only prescribe to bring levels to 50nmol. You will need to self supplement to improve futher

Once you Improve level, very likely you will need on going maintenance dose to keep it there.

Vitamin D mouth spray by Better You is good as avoids poor gut function.

Retesting twice yearly via vitamindtest.org.uk

B12 at 157 is extremely low, below range

You need full testing for Pernicious Anaemia before starting loading dose injections of B12.

Folate is below range

GP should prescribe Folic acid supplements, however these should not be started until 48 hours after first B12 injection

You mention in another post you have been taking Teva Levothyroxine

If you are not lactose intolerant Teva is best avoided, it upsets many, many people

Always make sure to get same brand of Levothyroxine at each prescription. ALWAYS double check content of bag before leaving pharmacy

Levothyroxine dose should be increased slowly in 25mcg steps upwards until TSH is under 2 and FT4 in top third of range and FT3 at least half way in range

If GP can't/ won't test FT3 you need to get TSH, FT4 and FT3 tested together privately

[Haze1975]

it’s not the GP that lower or higher the medication without approval. They won’t touch it because I’ve still have an endo for 5 more years. They normally leave it down to him and got me to asked in him in January if it could be lower it a bit. And he said yes to a 150 with a blood test after 6 weeks. He said then I wouldn’t go any lower than that. The doctors had put me in a new group witch I didn’t understand why I had to go and see them. But I do what I’m told. Endocrinology Team. It’s was him that said lower it even more, After talking to my endo as well. To see what both teams would come up with to try and help. They both agreed to lower even more. It was only that id got a blood test like this because I was under the weather and the doctor I saw wanted to make sure that there wasn’t anything else going wrong on me.

[SlowDragon Ambassador in reply to Haze1975]

They are completely missing the point

Your low vitamins are due to inadequate thyroid treatment causing poor gut function

Your Thyroid results hide how hypothyroid you are when vitamins are low

You may well need the addition of small dose of T3. Many patients do after thyroidectomy

FT4 needs to be at least in top third of range

FT3 ALSO needs to be at least in top third of range

Getting vitamins treated as a matter of some urgency is next step, plus Levothyroxine dose increased and bloods retested in 6-8 weeks

Email Dionne at Thyroid Uk for list of recommended thyroid specialists

[e-mail]

Roughly where in the UK are you?

Professor Toft recent article saying, T3 may be necessary for many especially after thyroidectomy

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

New NHS England Liothyronine guidelines November 2018

Note that it says test should be in morning BEFORE taking Levothyroxine

Also to test vitamin D, folate, B12 and ferritin

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

Politely INSIST that iron and ferritin are tested too as these are very likely too low as well

[Haze1975 in reply to SlowDragon]

I do have a thyroid specialist. He was the one that did my surgery. Last year I had a choice to make. I could stay with one group. The man that did the surgery or the man that dealt with cancer. Because I liked the surgery guy more because he was easy to talk to and that it would be him all the time and not someone else and closer to home as well, I’d stay with him.

I live in between Milton-Keynes and Luton in a small town called Leighton.

They never taken a vitamin test since 2016. The doctors only took one because I wasn’t well and wanted to make sure there wasn’t nothing else going on. That’s how they found it now.

[SlowDragon Ambassador in reply to Haze1975]

So first step is to get your vitamins sorted

When are you seeing GP?

They should prescribe loading dose vitamin D ASAP

GP should urgently you tested for Pernicious Anaemia before arranging several B12 injections over next 2-3 weeks

Folic acid supplements should be prescribed, but not started until 48 hours after first B12 injection

Perhaps ask advice on PAS healthunlocked about your very low B12 and folate

healthunlocked.com/pasoc

Once vitamin levels start to pick up, you will be better able to use your thyroid hormones

Likely you will need the addition of small dose of T3.....but not until vitamins are at GOOD levels

We need all our "ducks in a row" first

Make sure to ALWAYS get same brand of Levothyroxine

Unless you know you are lactose intolerant, best to avoid Teva

[Haze1975 in reply to SlowDragon]

Monday. One of the girls are going to try and get me an appointment with the same doctor. As it was him that found it.

[SlowDragon Ambassador in reply to Haze1975]

What brand of Levothyroxine are you currently taking?

[Haze1975 in reply to SlowDragon]

Normally I’d get it from Tesco. They normally give me teva brand on both of them. But this time it’s mercury pharma and almus brand.

[pennyannie]

Hello Haze

just as a point of reference a fully functioning working thyroid would be supporting you on a daily basis with approximately 100 T4 + 10 T3.

Since you are without a thyroid I think it is only fair that both these vital hormones are on your prescription. Some people can get by on T4 alone, some people at some point in time simply stop converting T4 to T3 and some people need both these essential hormones dosed independently and monitored to bring them into balance and to a level of wellness acceptable to the patient.

Why was your medication reduced - what did the blood test look like - were you with symptoms of over medication ?

I would think the lowering of your medication, for what ever reason, has resulted in your being under medicated which in turn means your ability to metabolise had been compromised causing the knock on problems of these vitamin and mineral deficiencies.

It is essential that a ferritin blood test is incorporated with the above, and the chances are this will be too low, as are the others for Levothyroxine to actually work effectively.

[Haze1975 in reply to pennyannie]

This was taken in 20th if November.

Serum free T4 level (XaERr) 20.4 pmol/L [9.01 - 19.05]

Serum TSH level (XaELV) < 0.01 miu/L [0.35 - 4.94]

The 12 October

Serum TSH level (XaELV) < 0.01 miu/L [0.35 - 4.94]

Serum free T4 level (XaERr) 17.8 pmol/L [9.01 - 19.05]

The doctors surgery was worried about these reports. I’ve had a lot of blood test last year. And most of the time t4 has been to high and t3 was to low. But I’ve always been thought that t3 had to be low because of the cancer that I’d had. But we had a new doctor in the surgery and my normal doctor was of sick. She was red hot on blood test.

[pennyannie in reply to Haze1975]

Hey there

It is the TSH that needs to be low - and yours is - that's ok.

Your T4 is at the top of the range and this is also ok - but without a T3 result these tests do not show the full picture.

I think you may have confused T3 with TSH ?

My TSH is where your is at 0.01 - and my T4 has also gone slightly over the top of the range - and I get " told off for this " - like we have any control over it anyway ???

Your T4 is up and over the range a little - this is of little importance - what is important is where your T3 is in relation to the T4 that makes the numbers make sense, or not.

It seems to me you are being dosed to fit into ranges - like a tick box exercise - with no thought given to your symptoms or medical records.

[SlowDragon Ambassador in reply to Haze1975]

It's the TSH should be kept suppressed (i.e. Around zero) after Thyroid cancer

its always essential to test FT3. FT3 should be in top third of range

All Levothyroxine is FT4 and has to be converted in liver and cells into FT3

High FT4 and extremely low FT3 shows you are very poor converter

Poor conversion of FT4 to FT3 can be genetic, due to age, gut issues, eg coeliac or gluten intolerance, low vitamins or simply because after a total thyroidectomy many, many patients need the addition of small dose of T3

Getting you seriously low vitamins sorted is first step

Do you have any gut issues?

Many many people with thyroid issues find strictly gluten free diet helps. I don't suggest it now. But maybe something to consider in future

Only ever make one change at a time

So most likely

vitamin D supplements is first

Then B12 testing and injections

Then folate supplements started

Checking iron and ferritin levels

Getting thyroid and vitamins retested in 6-8 weeks