Could someone please help me understand the following lab results
TSH 3.91mlU/L (0.40-4.00)
Free T3 3.5 pmol/L (2.9-4.9)
Free T4 11.8 pmol/L (9-19)
TPOAt 635.8 iU/ml (0-6) HIGH
TgAt 21.8 lU/L (0-4) HIGH
PTH 3.9 (1.3-8.2)
Vit D 58.5 nmol/L (optimal >50
Serum Ferritin 8.6 ug/L (15-260) LOW
I take 150 mcg Levothyroxine
masa2333
You appear to be undermedicated. How do you feel?
The aim of a treated hypo patient generally is for TSH to be 1 or below or wherever it needs to be for FT4 and FT3 to be in the upper part of their reference ranges, if that is where you feel well. So your TSH is too high, your FT4 is just 28% through it's range and your FT3 is just 30% through range.
Your raised antibodies confirm Hashimoto's, which you already know about.
Vit D 58.5 nmol/L (optimal >50) = 23.4ng/ml
This is not optimal, it is in the "Sufficient" category. However, "sufficient" is not enough.
The Vit D Council recommends a level of 125nmol/L (50ng/ml) and the Vit D Society recommends a level of 100-150nmol/L (40-60ng/ml).
To reach the recommended level from your current level, based on the Vit D Council's suggestions you could supplement with 3,700iu D3 daily (nearest is 4,000iu).
vitamindcouncil.org/i-teste...
Retest after 3 months.
As you have Hashi's, for best absorption an oral spray is recommended (eg BetterYou) or sublingual liquid as these are absorbed through the mucous membranes in the oral cavity and bypass the stomach.
When you've reached the recommended level then you'll need a maintenance dose to keep it there, which may be 2000iu daily, maybe more or less, maybe less in summer than winter, it's trial and error so it's recommended to retest once or twice a year to keep within the recommended range. You can do this with a private fingerprick blood spot test with an NHS lab which offers this test to the general public:
There are important cofactors needed when taking D3 as recommended by the Vit D Council
vitamindcouncil.org/about-v...
D3 aids absorption of calcium from food and K2-MK7 directs the calcium to bones and teeth where it is needed and away from arteries and soft tissues where it can be deposited and cause problems such as hardening of the arteries, kidney stones, etc.
D3 and K2 are fat soluble so should be taken with the fattiest meal of the day, D3 four hours away from thyroid meds if taking tablets/capsules/softgels, no necessity if using an oral spray
Magnesium helps D3 to work. We need Magnesium so that the body utilises D3, it's required to convert Vit D into it's active form. So it's important we ensure we take magnesium when supplementing with D3.
Magnesium comes in different forms, check to see which would suit you best and as it's calming it's best taken in the evening, four hours away from thyroid meds if taking tablets/capsules, no necessity if using topical forms of magnesium.
naturalnews.com/046401_magn...
drjockers.com/best-magnesiu...
Check out the other cofactors too (some of which can be obtained from food).
Serum Ferritin 8.6 ug/L (15-260) LOW
Below range so your GP should be testing for iron deficiency anaemia and should do a full blood count and iron panel.
PTH 3.9 (1.3-8.2)
This is within range, it's not something I know anything about so can't comment any further.
Hi SeasideSusie and thank you for taking time to reply. I feel sleepy, brain fog, trouble with memory and concentration... my blood pressure is also very low (90/50) with pulse being around 55 (little less or more depending on what I’m doing) I also have very hard time losing weight no matter what I eat or how much I eat. I also feel chest pressure but not know if that’s because of thyroid or anxiety.
My TSH was 1.89 just two months before. I am already on the highest dose available (150mcg Levo), I’m worried about these results as I’m only 21 year-old-college-student and am wondering what my results will be in 10 years when I see this now.
I am taking Vit D in oral spray, but stopped in May as my endo said there is no need to take it during summer when we naturally get it from sun (and in my country, there is A LOT of sunny days). My levels actually did improve, last time they were 40ish. I will continue to take my spray tho, as I can read 58 is still low. I am taking Magnesium direct before bed (300mg)
Do you think gluten and diary free diet would help? I read so much about it but can’t seem to find much food without those sneaky ingredients...
my endo prescribed me some ferritin tablets to drink, but ONLY DURING menstruation, so 5 days a month.
Thank you again very much for replying!
Masa2333
The symptoms you list are of hypothyroidism so you are in need of an increase in dose.
List of signs/symptoms of hypothyroidism:
thyroiduk.org/tuk/about_the...
Print it and tick off what applies to show your doctor you are still experiencing symptoms.
I can only give you information from the UK but here is some that shows you are undermedicated:
From NHS Leeds Teaching Hospitals who say
pathology.leedsth.nhs.uk/pa...
Scroll down to the box
Thyroxine Replacement Therapy in Primary Hypothyroidism
TSH Level .................. This Indicates
0.2 - 2.0 miu/L .......... Sufficient Replacement
> 2.0 miu/L ............ Likely under Replacement
Also, Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine (the magazine for doctors):
"The appropriate dose of levothyroxine is that which restores euthyroidism and serum TSH to the lower part of the reference range - 0.2-0.5mU/l. In this case, free thyroxine is likely to be in the upper part of its reference range or even slightly elevated – 18-22pmol/l. Most patients will feel well in that circumstance. But some need a higher dose of levothyroxine to suppress serum TSH and then the serum-free T4 concentration will be elevated at around 24-28pmol/l. This 'exogenous subclinical hyperthyroidism' is not dangerous as long as serum T3 is unequivocally normal – that is, serum total around T3 1.7nmol/l (reference range 1.0-2.2nmol/l).*"
*He recently confirmed, during a public meeting, that this applies to Free T3 as well as Total T3.
You can obtain a copy of the article by emailing Dionne at
tukadmin@thyroiduk.org
print it and highlight question 6 to show your doctor.
I am already on the highest dose available (150mcg Levo),
There is no "highest dose". We need what we need. I was on 200mcg at one time, a neighbour of mine was on 300mcg, so there is no upper limit.
I’m worried about these results as I’m only 21 year-old-college-student and am wondering what my results will be in 10 years when I see this now.
As you have Hashi's, your immune system will continue to attack and destroy your thyroid and during this time your results and symptoms will fluctuate with these attacks. Eventually, when your thyroid is completely destroyed, things will settle down into full blown hypothyroidism and you wont have the fluctuations.
Do you think gluten and diary free diet would help? I read so much about it but can’t seem to find much food without those sneaky ingredients...
Some members have found that adopting a strict gluten free diet can help, although there is no guarantee.
Gluten contains gliadin (a protein) which is thought to trigger autoimmune attacks so eliminating gluten can help reduce these attacks.
You don't need to be gluten sensitive or have Coeliac disease for a gluten free diet to help.
Gluten/thyroid connection: chriskresser.com/the-gluten...
stopthethyroidmadness.com/h...
stopthethyroidmadness.com/h...
hypothyroidmom.com/hashimot...
thyroiduk.org.uk/tuk/about_...
Supplementing with selenium l-selenomethionine 200mcg daily can also help reduce the antibodies, as can keeping TSH suppressed.
You don't have to just buy gluten free foods, if you make you meals from scratch you can eliminate gluten that way. There are lots of posts about gluten free that you can read through:
healthunlocked.com/thyroidu...
I am taking Vit D in oral spray, but stopped in May as my endo said there is no need to take it during summer when we naturally get it from sun (and in my country, there is A LOT of sunny days).
We don't all make enough Vit D from the sun. One of our members has lived in Crete for many years and she needs to take Vit D supplements.
my endo prescribed me some ferritin tablets to drink, but ONLY DURING menstruation, so 5 days a month.
Have you been tested for iron deficiency anaemia? If your ferritin is usually low then ask for further testing, what you have been perscribed for your current level is ridiculous.
Thank you once again for taking time to reply.
I will definitely have a good night’s read now. I didn’t even know about all of these symptoms being related to thyroid! I actually had Antidepressants because of panic attacks and anxiety. I was shocked to see it might be related to Hashimoto.
I am curious to know if you have any tips for upping my FT4 and FT3 levels? In my country we don’t have medication for T3, only Levo. Is there any natural way one might be able to improve their levels? My FT4 is also always in the lower range, even when my TSH is perfect* (*perfect for me - I felt the best with TSH being 0.30ish for me)
I expressed myself poorly - I didn’t mean that there is no higher dose, but I was speaking of the highest dose in one single tablet. My mom takes 250mcg of Levo, but she takes one tablet of 100 and one of 150mcg.
And yes, my ferritin is usually this low, I first discovered it in January when my endo first had me tested for ferritin levels. It has always been this low... but she keeps telling me to drink tablets during my menstrual days only... she said that my Hemoglobine levels were okay at 126 (120-156) so she thinks it can’t be anaemia.
I am curious to know if you have any tips for upping my FT4 and FT3 levels?
For thyroid hormone to work properly we need optimal nutrient levels, recommended levels are:
Vit D - 100-150nmol/L or 40-60ng/ml
B12 - top of range for Total B12 or for Active B12 over 100 is a good level (below 70 suggests testing for B12 deficiency)
Folate - at least half way through range
Ferritin - It's said that for thyroid hormone to work properly (that's our own as well as replacement hormone) ferritin needs to be at least 70, preferably half way through range.
So as you can see you have a big problem with your ferritin level and it looks like it's not being taken seriously.
she said that my Hemoglobine levels were okay at 126 (120-156) so she thinks it can’t be anaemia.
Have you had a full blood count including MCV and MCH/MCHC?
My B12 levels were 640 pmol/L (142-725) and folic acid 16.9 nmol/L (2.27-54.4) last time I had those checked. My GP said they were okay and hasn’t checked them anymore.
Do you think it is safe to take ferritin supplements every day? I will ask my endo of course, but I have to wait till she arranges a check up, and I don’t know what do to until that happens.
And yes, I have had those checked - I had a full blood count
MCV - 87 fL (80-96)
MCH - 28.3 pg (27-32)
MCHC - 325 g/L (310-350)
Hematocrite 0.388 L/L (0.35-0.47)
OK, so they're all within range and don't suggest iron deficiency anaemia. I would suggest asking for an iron panel and you can then see what your serum iron is like. Ferritin is your iron store and it is obviously very depleted.
I'm afraid I can't advise on taking iron tablets but I would suggest that it would lbe a good idea to include iron rich foods in your diet. I have no idea what is available in your country but here in the UK I'd be advising to eat liver (max 200g per week due to it's high Vit A content), liver pate, black pudding and other iron rich foods: apjcn.nhri.org.tw/server/in...
Thank you. I will ask my endo to have me tested for those as my GP doesn’t want to test me further, she said my blood count was okay.
I have a question tho... does lymphocytes have anything to do with thyroid? Mine were a little high on my blood count and my GP told me it could be a virus but I didn’t have any symptoms of flu or virus.
You also need folate and B12 testing
These are frequently low too
Ask GP to test
Hello, thanks for reaching out.
I had those tested a while ago and they came back normal...
What were the actual results and ranges
B12 usually needs to be at least over 500
Folate at least over ten
Your antibodies are high this is Hashimoto's, (also known by medics here in UK more commonly as autoimmune thyroid disease).
Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels
Low vitamin levels affect Thyroid hormone working
Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances. Most common by far is gluten. Dairy is second most common.
According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps, sometimes significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link)
Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies
While still eating high gluten diet ask GP for coeliac blood test first or buy test online for under £20, just to rule it out first
Assuming test is negative you can immediately go on strictly gluten free diet
(If test is positive you will need to remain on high gluten diet until endoscopy, maximum 6 weeks wait officially)
Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse
chriskresser.com/the-gluten...
amymyersmd.com/2018/04/3-re...
thyroidpharmacist.com/artic...
scdlifestyle.com/2014/08/th...
drknews.com/changing-your-d...
restartmed.com/hashimotos-g...
Vit B12 640 pmol/L (142-725)
Folic acid 16.9 nmol/L (2.27-54.4)
I understand. That may be the reason why I keep having stomach aches, sometimes I literally feel like someone’s cutting my intestines with a knife! But my GP gave me some tablets for calming stomach down and that was it.
I will try to implement gluten free diet in my life. Are the foods labeled as ‘’may contain gluten in traces’’ safe to eat?
Yes, I know about Hashimoto’s, my antibodies were high ever since I first discovered it at the age of 8. So almost 15 years I’ve had raised antibodies, and I learned that that is normal. I also learned that they could be different depending on time of the same day!
Thank you for useful links, I will be sure to check it out now.
Many, many Hashimoto's patients find TPO antibodies slowly reduce on strictly gluten free diet
Often symptoms improve too, but sometimes it's only the slow reduction in antibodies
Others find they need dairy free diet instead or as well
Yes ideally you should aim for strictly gluten free, especially to see if its effective
With Hashimoto's low stomach acid is extremely common. Often causes acid reflux. Frequently medics misdiagnose as high stomach acid
thousandsof posts about low stomach acid on here
Links on web
articles.mercola.com/sites/...
thyroidpharmacist.com/artic...
stopthethyroidmadness.com/s...
scdlifestyle.com/2012/03/3-...
naturalendocrinesolutions.c...
Ppi is frequently prescribed by GP for high acid
Useful calculator for % through range
This shows you are good converter as
FT4 is 28% through range
FT3 is 30% through range
But you likely need 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 TSH significantly under one) and most important is that FT4 in top third of range and FT3 at least half way in range
All four vitamins need to be regularly tested and frequently need supplementing to maintain optimal levels
NHS guidelines on Levothyroxine including that most patients eventually need somewhere between 100mcg and 200mcg Levothyroxine.
nhs.uk/medicines/levothyrox...
Also what foods to avoid (eg recommended to avoid calcium rich foods at least four hours from taking Levo)
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