Advise on blood works

[gsheila]

Hello lovely people....It’s been a year since I got back to you’ll, my apologies!! I recently went for a rotator cuff tear surgery about two months ago and for the past month my thumb, index finger feels stiff with swelling and my wrist swells up slightly off and on. Along the side of my thumb, right up to my wrist feels very painful when I move my hand. I can’t hold anything too. My orthopaedic surgeon says it’s trigger finger and he gave me a thumb splint to wear along with my hand sling. He says to give it some time as the swelling will go down. I’m having slight pain now, can’t sleep comfortably at night too. I’m confused if it’s actually trigger finger or something else. I’m a hypothyroid with Hashimoto and currently on 50mg of levothyroxine. I recently managed to find an endocrinologist specialist, his appointments are fully booked and mine is on the 9th of July 2019. Hopefully this doctor will work with me as the others are not helpful. I did my blood test privately a week ago, please help me as I’m feeling lost, tired, in pain, really depending on your for advice on what I should do next till I see the endocrinologist.

TSH 6.62 mlU/L ( 0.30 - 4.64 )

Free T4 15.2 pmol/ L ( 9.1 - 24.4 )

Free T3 3.19 pmol/L ( 2.23 - 5.35 )

Vitamin B12 523 pmol/L ( 187 - 1059 )

Folate 5.5 nmol/L ( 5.3 - 20.7 )

Ferritin 28.1 ng/mL ( 14.0 - 233.1 )

Total Cholesterol 6.6 mmol/L ( < 5.2 )

Total Vitamin D/25-hydroxyvitamin D 51.95 nmol/L ( 50 - 125 )

Anti-thyroid peroxidase (Anti-TPO/AMC) 101.6 lU/mL ( < 34.0 )

Anti-Thyroglobulin (Anti-TG) 1000.0 lU/mL ( < 115.0 )

6 years ago my Anti-TG was 4000 IU/mL

Thanking you’ll so much for your time, advise and help 🙏🏻

[Hidden]

Hi

Could it be repetitive strain injury? Just a thought. Love and hugs Lynne xxxx

[gsheila in reply to Hidden]

Hi Lynne, yes could be cos going for physio three times a week...doctor’s instructions. Love and hugs to you too!! 🌸

[Hidden in reply to gsheila]

Thank you. Take care. Love and hugs Lynne xxxx

[SlowDragon Administrator]

Your results show you are very hypothyroid and need 25mcg dose increase in Levothyroxine

The aim of Levothyroxine is to increase the dose slowly in 25mcg steps upwards until TSH is under 2. Many need it under one. FT4 in top third of range and FT3 at least half way in range

Your vitamin levels are low as direct result

Vitamin D is not low enough for GP to treat, but needs improving to at least 80nmol by self supplementing

B12 and folate on the low side. Folate only just within range Supplementing a good quality daily vitamin B complex, one with folate in not folic acid may be beneficial.

chriskresser.com/folate-vs-...

B vitamins best taken in the morning after breakfast

Recommended brands on here are Igennus Super B complex. (Often only need one tablet per day, not two. Certainly only start with one tablet per day after breakfast. Retesting levels in 6-8 weeks ).

Or Jarrow B-right is popular choice, but is large capsule

If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before any blood tests, as biotin can falsely affect test results

endo.confex.com/endo/2016en...

endocrinenews.endocrine.org...

Ferritin is low. Ask GP to do full iron panel test for Anaemia

Eating liver or liver pate once a week should help improve levels

Bloods should be retested 6-8 weeks after each dose increase in Levothyroxine

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)

Always take Levo on empty stomach and then nothing apart from water for at least an hour after.

Many take Levothyroxine early morning, on waking, but it may be more convenient and possibly more effective taken at bedtime.

verywell.com/should-i-take-...

Other medication at least 2 hours away, some like HRT, iron, calcium, vitamin D or magnesium at least four hours away from Levothyroxine

Many people find Levothyroxine brands are not interchangeable.

Once you find a brand that suits you, best to make sure to only get that one at each prescription. Watch out for brand change when dose is increased or at repeat prescription.

Many patients do NOT get on well with Teva brand of Levothyroxine. Though it is the only one for lactose intolerant patients

[SlowDragon Administrator]

Trigger finger is possibly/likely due to being hypothyroid at moment and in need of Levothyroxine dose increase

nhs.uk/conditions/trigger-f...

See GP for 25mcg dose increase in Levothyroxine

[SlowDragon Administrator]

Rotator cuff tear may also be linked to being under treated for hypothyroidism

ncbi.nlm.nih.gov/pmc/articl...

bjsm.bmj.com/content/47/10/...

ncbi.nlm.nih.gov/pubmed/276...

NHS guidelines on dose of Levothyroxine required when hypothyroid

Typically most people eventually need somewhere between 100mcg and 200mcg Levothyroxine

Also including what foods to avoid (note recommended to avoid calcium rich foods at least four hours away from Levo)

nhs.uk/medicines/levothyrox...

[gsheila]

Hi SlowDragon, sorry for the delayed reply cos of the time difference, I’m from Malaysia. You must be on bed now, sorry for the trouble. I’m so glad for your response, Thank you so much for taking your time to explain in detail 🙏🏻😊 I increased the levothyroxine by 25mg this morning. Will be going to the pharmacy to get the vitamins which you have suggested and in 6 weeks time will do a blood test as you requested. I’m more confident now and understand what I should do. Really appreciate you help and again thank you. 🌸 🙏🏻 😘