Advice on confusing results

[ILR2019]

I would really appreciate one of you lovely forumites giving me feed back on these blood results please?

After waiting 4.5 weeks to see a GP and going armed with an ammo of facts and figures all gleaned from previous posts, advice, suggested links and personal research I was bowled over to finally find that the GP I saw recently was very up to date on thyroid disorders (I didn't even need to refer to my notes). He is more favourable of a pragmatic approach to treatment and we dicussed all the function, vitamin and a few pther tests suggested here on these forums. Very surprised to see Ferritin was not included and although a full thyroid function tests were ordered only TSH was tested. He was very clear that he wanted to know T4 as this was very low when last tested in September 2018. Are labs now overriding GPs?

Immunoglobulin A level 2.04 g/L [0.65 - 4.21]

Serum vitamin B12 level 268 ng/L [187.0 - 883.0]

Serum folate level 8.2 ug/L [3.1 - 20.0]

Serum total 25-hydroxy vitamin D level 45

Serum TSH level 2.9 miu/L [0.35 - 4.94]

Notes: B12 has increased slightly from 18th April when it was 230 ng/L. Folate has decreased since last test from 9.3. Vit D is low, but why has my TSH dropped from 4.4 on 27th April when there has been no changes in dosage, consumption, test time etc)?.

These may or may not be relevant as I have no idea what they are...

Serum sodium level 140 mmol/L [133.0 - 146.0]

Serum potassium level 4.4 mmol/L [3.5 - 5.3]

Serum creatinine level 64 umol/L [50.0 - 98.0]

Serum total protein level 70 g/L [60.0 - 80.0]

Serum globulin level 28 g/L [18.0 - 36.0]

Serum total bilirubin level 6 umol/L [1.0 - 20.0]

Serum alanine aminotransferase level 19 iu/L [1.0 - 55.0]

Serum calcium level 2.30 mmol/L [2.1 - 2.5]

Serum adjusted calcium concentration 2.32 mmol/L [2.1 - 2.55]

Serum alkaline phosphatase level 86 iu/L [30.0 - 130.0]

Serum albumin level 42 g/L [35.0 - 50.0]

[SlowDragon Ambassador]

Yes, unbelievably GP requests are frequently overruled by lab

However your TSH is too high for someone on Levothyroxine.

So you need 25mcg dose increase in Levothyroxine and bloods retested in 6-8 weeks

Official NHS guidelines saying TSH should be between 0.2 and 2.0 when on Levothyroxine

(Many of us need TSH nearer 0.2 than 2.0 to feel well)

See box

Thyroxine replacement in primary hypothyroidism

pathology.leedsth.nhs.uk/pa...

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and fasting. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

Last Levothyroxine dose should be 24 hours prior to test, (taking delayed dose immediately after blood draw).

Have you ever had both TPO and TG thyroid antibodies tested? If not, they need testing

Vitamin D is too low. GP will only prescribe to bring vitamin D up to 50nmol. Aiming to improve by self supplementing to at least 80nmol and around 100nmol may be better .







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




Retesting twice yearly via vitamindtest.org.uk




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




It's trial and error what dose each person needs. Frequently when hypothyroid we need higher dose than average

Local CCG guidelines

clinox.info/clinical-suppor...

B12 and folate on the low side. 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...

Obviously need ferritin tested too

[ILR2019 in reply to SlowDragon]

Thank you for responding. I had a GP appointment (telephone call) yesterday to discuss my results. Apparently the full antibodies screening has been requested, but these results will take up to a month to come back. My GP has suggested a three month dosage of Vit D and multi-vitamins.

With regards to TSH because my current level 'sits nicely in the middle range and has dropped slightly since my last test' he will not increase my dosage from 50mg until he has seen the antibody results.

[SlowDragon Ambassador in reply to ILR2019]

Multivitamins are never recommended on here

Far too little of what we do need and loads of things that can make situation worse

Suggest you start with just vitamin D mouth spray by Better You (it avoids poor gut function and is well absorbed). Needs to be at least an hour away from taking Levothyroxine.

Perhaps try 1000iu or 2000iu daily. Retesting in 2-3 months

Retest here

vitamindtest.org.uk

Then look at adding 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...

Low vitamin D and B vitamins often go together as explained here

drgominak.com/sleep/vitamin...

[ILR2019 in reply to SlowDragon]

Just checked online and it seems that the outstanding test results are actually for Intrinsic Factor Antibodies (Requested), Methylmalonic Acid which I think is for pernicous anemia.

[SlowDragon Ambassador in reply to ILR2019]

Intrinsic factor antibodies are indeed test for Pernicious Anaemia

So it doesn't look like you got right test

Suggest you get TSH, FT3, FT4 and both TPO and TG antibodies tested via Medichecks or Blue Horizon

If TPO or TG antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).

About 90% of all primary hypothyroidism in Uk is due to Hashimoto's.

Low vitamins are especially common with Hashimoto's. Food intolerances are very common too, especially gluten. So it's important to get TPO and TG thyroid antibodies tested at least once .

NHS will only test TG antibodies, if TPO are high. Yet we see many people on here who only have high TG antibodies

NHS Lab often refuses to even test TPO antibodies

Just testing TsH and not testing FT3 and FT4 is completely inadequate

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and fasting. This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip, best not mentioned to GP or phlebotomist)

Last Levothyroxine dose should be 24 hours prior to test, (taking delayed dose immediately after blood draw).

Obviously you need ferritin tested too

You need to work on improving low vitamin D, folate and B12

[ILR2019 in reply to SlowDragon]

Thank you. I have just ordered the "thyroid checks plus" from medichecks. Funnily enough at my physical appt last week GP ruled out Hashi's despite antibodies never being checked 😔

[SlowDragon Ambassador in reply to ILR2019]

Perhaps GP is psychic? LOL

UK medics only consider autoimmune thyroid disease is Hashimoto's if we have goitre as well

Many of us have opposite - ord's Thyroiditis where Thyroid is shrunken and shrivelled - cause is same - autoimmune attack