Confused & Frustrated after seeing GP about recent blood tests, would appreciate your thoughts please

[ShonaGreen]

Hi,

I had a follow-up appointment with my new GP this morning. But due to an error I was booked in with another GP, and no appointments available for the new GP. We discussed results from recent blood tests, he was quite flippant and said that although the original blood tests showed a possible thyroid problem, that as the recent blood tests showed that my free T4 had increased and other results in normal range then I should be fine (all result below).

I asked about my low Free T3 level, he said that it didn't really matter what the level was, as it was the free T4 that was important as it converted into T3, and it was good that my free T4 was increasing so the Levothyroxine must have started to work (started on 50mg on 12/3/19) . He also said that the lab wouldn't necessarily re-test Free T3 anyway.

I then asked about the TSH being in the low point of the normal range, but again he said that so long as I was in the normal range, then it wasn't a problem.

I also queried the overall low levels from the original blood test and whether there could be a problem with my pituitary. He said that recent resultshowed my FSH and LH at normal levels, not menopausal and thyroid seems to be working OK.

I was supposed to be tested for thyroid antibodies too, but the results haven't come back yet. He said it didn't really matter whether or not it was autoimmune as would still be treated in the same way.

The other GP suggested that I re-test the TSH, free T3 and free T4 in 2 weeks time (before I go on holiday). This GP said that no point having them tested again until 3 months as would take that long to see the effect of the Levthyroxine. He also said that if I still felt unwell in 3 months time then it's unlikely to be a thyroid issue.

My final question was whether I should be taking any further vitamins or supplements apart from standard multivitamin. He said so long as I didn't have a "beige" diet and eat a wide variety of food then I shouldn't need to take anything else.

I feel very confused and questioning whether I even have a thyroid problem?

29 March 2019:

Free T3 - 2.8 (range 3.9 - 6.8)

Free T4 - 11.8 (range 11 - 26)

TSH - 1.92 (range 0.35 - 4.50)

Vitamin D - 72 (range 50 - 200)

Ferritin - 184 (range 13 - 150)

Folate 16.72 (range 3.10 - 18.3)

Vitamin B12 489 (range 180 - 2000)

MCV 99 (range 80 - 100)

MCH 32.8 (range 27 - 32)

Haemoglobin 148 (range 120 - 150)

Haematocrit 0.445 (range 0.37 - 0.47)

Platelets 189 (range 150 - 400)

Albumin 55 (range 35-50)

16 April 2019:

Free T4 - 14.5 (range 11-24)

Vitamin D - 57.9 (range >50)

Ferritin - 193 (range 13 - 150)

Serum iron level - 13.2 (range 10.6 - 28.6)

Serum TIBC - 44.7 (range 45 - 81)

Serum sat iron binding capacity - 30% (range 20-55%)

Prolactin - 298 (range 102 - 496)

Serum calcium - 2.44 (range 2.10 - 2.55)

Calcium adjusted level - 2.36 (range 2.10 - 2.55)

Serum total protein - 73 (range 60 - 80)

Serum Albumin - 48 (range 35-50)

Serum globulin - 25 (range 20 - 30)

Thanks for your help!

[SlowDragon Administrator]

Bloods should be retested 6-8 weeks after each dose change

So this second test was rather too soon

Your first test results would suggest central hypothyroidism as FT4 and FT3 were both very low yet TSH had remained low

2nd test in April....couldn't see TSH result

Folate was good result

Vitamin D on low side and dropping so you might want to start supplementing. Aiming to improve vitamin D to at least 80nmol and around 100nmol may be better

Keep an eye on B12, this may need improving

Ferritin can be high due to inflammation

You do definitely need TPO and TG thyroid antibodies tested. Private tests available if you can't get GP to do so

[ShonaGreen in reply to SlowDragon]

Hi, thanks for your response. The recent blood tests were just to check for thyroid antibodies and pituitary function. He must have asked for Free T4 too, but not TSH or Free T3. I was going to have all of these re-tested in a few weeks time, so this would be about 6 weeks from original blood test, but GP today said to wait for 3 months.

I'm Just wondering what would cause the Free T4 to increase so much within 3 weeks, could this be the Levothyroxine taking effect? I'm thinking of doing a Medicheck test myself.

I'd appreciate any suggestions for Vit D supplement too.

[SlowDragon Administrator in reply to ShonaGreen]

On Levothyroxine the aim is to increase the dose of Levothyroxine slowly. Retesting 6-8 weeks after each dose increase. This continues until TSH is under 2 (many need it under 1) and FT4 is in top third of range and FT3 at least half way in range

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

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




It's trial and error what dose of vitamin D each person needs. Perhaps try 1000iu daily. You may need more or less

Frequently if you have Hashimoto's we need higher dose than average

Retesting after 2-3 months and then twice yearly until you work out how much you need

Then annual testing

vitamindtest.org.uk

Local CCG guidelines

clinox.info/clinical-suppor...

Government recommends everyone supplement October to April

gov.uk/government/news/phe-...




[Treepie]

Multivitamins are not much use as they contain to little of anything you need. Your B12 is low and D3 looks low .

[ShonaGreen in reply to Treepie]

Thanks for all your advice Treepie and Slow Dragon. I'm going to buy Better You Dlux 1000 Vitamin D Spray 15ml and Better You Boost B12 Oral Spray now!

[Angel_of_the_North]

I'm not sure that your doctor actually knows what he is talking about. Yes, your thyroxine should convert to T3, but if your free T4 is increasing and your free T3 is still low, it shows that you are not converting. Since your free T3 has not been tested, he can't know. Both B12 and vitamin D could do with being higher

[ShonaGreen in reply to Angel_of_the_North]

Thanks for your message Angel_of_the_North. I was thinking the same thing about the conversion. But as I'm new to this I've been wondering if maybe I'm not hypothyroid and original blood tests just unusually low? I think I just need to do another private blood test and take it from there. Also going to try the B12 and Vitamin D sprays. As I've been feeling poorly for a while I'm just keen to get the right diagnosis so I can do what I can to feel better, hopefully soon!

[Angel_of_the_North in reply to ShonaGreen]

Make sure not take any supplement that contains biotin for a week before the test

[ShonaGreen]

Didn’t know about biotin, does it interfere with the thyroid blood tests? it’s in the Centrum multivitamin I take. But funnily enough I didn’t take it for a few weeks awhile ago as I had ran out, and think that was same time as original blood test with low results.