Thyroid/Extremely tired!

[sueoathall]

Hi I have an underactive thyroid and am so so tired. I had a blood test last week. Just picked the results. Would really love some advice please.

Serum free T4 level 14.7 pmol. Range 12.0 -22.0pmol

Serum free T3 level 5.2 pmol Range 3.10-6.80pmol

Serum TSH level 0.04 mu/l Range 0.27-4.20 mu/l

Vit D , 250H, total serum (GWYR) normal

Serum total 25-OH vit D level 60 mol Range 50.00 - 120nmol/L

Serum ferritin (GWYR) - normal

Serum ferritin 16.7 ug/L Range 13.00- 150.00ug/L

Serum C reactive protein level 4 mg/L Range 0.00-5.00mg/L

B12 /Folate level -(GWYR)- normal

Serum vitamin B12 629 ng/L Range 197.00- 771.00ng/L

Serum folate 6.8 ug/L Range 1.90 - 25.00ug/L

They also did liver function test, urea and electrolytes, bone profile, glucose, white cell count, haemoglobin and other stuff.

If any of the others are relevant please say and I'll provide the results. It's just that this is getting long!

Many thanks

P.S. I'm on 100mg of levothyroxine a day

[Nanaedake]

Although ferritin is not below range, it is very low. Could you now ask your doctor for a full iron panel? If iron is low it could explain your exhaustion.

Vitamin D is on the low side of normal and we're only at the start of winter so it's likely to drop lower, if not already supplementing then you would benefit from vitamin D3. The vitamin D Council website has good advice although check unit of measurements used which may be USA.

Folate is on the low side, increase foods containing folate and consider taking 3 months of methylfolate supplement to raise levels. I took 400mcg daily for 3 months to raise levels and now take a B complex a couple of times a week.

[sueoathall in reply to Nanaedake]

Thank you, I thought the ferritin was low too. I used to take D3 and folate and stupidly got out of the habit! What do you think about the thyroid levels?

[NatChap in reply to sueoathall]

I would definitely supplement iron with that ferritin result. When mine was that low I felt dreadful! I would agree also that a vit D supplement would be a good idea, particularly through winter. Aim to get ferritin retested in the new year after supplementing with a good quality brand.

[sueoathall in reply to NatChap]

Thank you.

[Nanaedake in reply to sueoathall]

Could you have a conversation with GP regarding iron levels before supplementing iron? I just think it would be worth getting more accurate iron tests and if GP refuses you could explain that you don't know how much or whether to supplement without full iron panel because iron can be high when ferritin is low. They don't always correlate.

[sueoathall in reply to Nanaedake]

Oh ok. Thanks. It's so complicated!

[SlowDragon Administrator]

Recommended on here that all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .

Last dose of Levothyroxine 24 hours prior to blood 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)

Is this how you do your tests?

Your low vitamin levels will likely be causing low TSH

Low FT4 suggests you need dose increase in Levothyroxine. You appear to be very good converter of FT4 to FT3

FT4 only 27% through range

FT3 is 57% through range

Look at SeasideSusie many detailed replies on vitamin levels. Your vitamin D, folate and ferritin all need improving

[sueoathall in reply to SlowDragon]

Yes I did the test at 10.30am , fasting one. What does it mean FT4 only 27% through range etc.

Thanks

[SeasideSusie Remembering in reply to sueoathall]

You are now on Levo whereas before you were on NDT?

How long have you been on Levo only?

When on Levo only most people feel best when TSH is 1 or below with FT4 and FT3 in the upper part of their ranges if that is where you feel well.

"What does it mean FT4 only 27% through range etc."

0% is bottom of range, 100% is top of range. 27% is just over 1/4 of the way through the range so it's low. The aim is upper part of the range when on Levo only so that would be classed as about 70% through range or above and with FT4 range of 12-22 that would be 19+

[sueoathall in reply to SeasideSusie]

Yes I was on NDT, been on levothyroxine only for about 3 months I think. How much should I increase my levo dose by? Thanks

[SeasideSusie Remembering in reply to sueoathall]

Any change in dose should be no more than 25mcg.

However you need to address your poor nutrient levels and optimise them which is needed for thyroid hormone to work properly. The following levels are recommended:

Vit D - 100-150nmol according to the Vit D Council/Vit D Society

B12 - top of range for Total B12

Folate - at least half way through range

Ferritin - half way through range

Low Ferritin can suggest iron deficiency anaemia so you need to ask your GP for an iron panel and full blood count. Ferritin as low as yours should not be self treated with iron supplements, those further tests should be done.

[sueoathall in reply to SeasideSusie]

On thank you

[sueoathall in reply to sueoathall]

I've just realised theres a break down of full blood count on my results, can you help with this please?

Haemoglobin estimation 126 g/L Range 115-165g/L

Total white cell count 5.3 10☆9/L Range 4.00 -10 10☆9/L

Nucleated red blood cell count 0 10☆9/L Range <0.1010☆9/L

Platelet count 168 10☆9/L Range 150-410

Red blood cell count 4,48 10☆12/L Range 3.80-4.80

Hematocrit 0.401 Range 0.35-0.47

Mean corpuscular volume 89.5 fl Range 83.00-101.00fl

Mean Corp haemoglobin 28,1 pg Range 27-32pg

Mean Corp Hb. Conc 314 g/L Range 310-360gl

[sueoathall in reply to sueoathall]

I've just rung the doctors to try to get the tests you guys have suggested, in particular the iron panel.

Receptionist said your ferritin is low but in range. I said yes but I'm not happy about it and want to speak to someone. So shes booked me a phone consultation for next Tuesday. Earliest they have.

God this is frustrating! Plus she said my thyroid levels are fine! Grrrrr!

[silverfox7]

If you are supplementing Vit D you also need the Co factors K2 and magnesium. Increasing D also raises calcium and too much in the blood puts you at risk of gall and kidney stones and calcified muscle. The K2 with take out the excess and put it in the bones and teeth and the magnesium locks it in there.

[sueoathall in reply to silverfox7]

Thanks silverfox7