HELP WITH NEW BLOOD REST RESULTS

[Ladybex]

Just had these results through ... my new GP said I need Folic Acid

Any advice would be so much appreciated 😊

[SeasideSusie Remembering]

Ladybex

There's nothing on there that's related to your folate level.

Are there other results that you haven't posted?

Your TPO antibodies are over range, did you know you have Hashi's?

[SlowDragon Administrator]

You can only add one photo per post

[Ladybex in reply to SlowDragon]

Still has unlocked post in comment bar so I can’t get blood test result on ..?

How can I clear it as it’s stopping me posting 😔

[SlowDragon Administrator in reply to Ladybex]

Start another post and attach new photo

Or simply type up results and ranges

We need results (and ranges) for

TSH

FT3

FT4

Vitamin D

Folate

B12

Ferritin

[SlowDragon Administrator]

So your high TPO antibodies confirm that the cause of your hypothyroidism is due to autoimmune thyroid disease also called Hashimoto's

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

Low vitamin levels are extremely common with Hashimoto's

Your GP should prescribe folic acid

You also need coeliac blood test

Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels

Low vitamin levels affect Thyroid hormone

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

nuclmed.gr/wp/wp-content/up...

In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned

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...

[Ladybex in reply to SlowDragon]

Wow ... thank you so much ... had coeliac test and that came back negative.. new GP has given me 2 months of folic acid ... she has told me to stay on levothyroxine 25mcg ...

Thanks again will try to keep to a gluten free diet ....

[SlowDragon Administrator in reply to Ladybex]

Standard starter dose is 50mcg Levothyroxine (unless over 60 years old)

However even if start on 25mcg due to age, dose should still be increased slowly after initial 2 months on 25mcg

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

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...

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)

All four vitamins need to be regularly tested and frequently need supplementing to maintain optimal levels

B12 at least over 500

Ferritin at least half way in range

Essential to test vitamin D too as this is almost always low with Hashimoto's......especially if under medicated on too small dose of Levothyroxine as you currently are

Ask GP to test vitamin D or use NHS postal kit test £29

vitamindtest.org.uk

GP should prescribe to bring vitamin D up to 50nmol.

Local CCG guidelines

clinox.info/clinical-suppor...

Aiming to improve vitamin D 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 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 with Hashimoto's we need higher dose than average

Government recommends everyone supplement vitamin D October to April

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

ncbi.nlm.nih.gov/pubmed/286...

Vitamin D deficiency is frequent in Hashimoto's thyroiditis and treatment of patients with this condition with Vitamin D may slow down the course of development of hypothyroidism and also decrease cardiovascular risks in these patients. Vitamin D measurement and replacement may be critical in these patients.

endocrine-abstracts.org/ea/...

Evidence of a link between increased level of antithyroid antibodies in hypothyroid patients with HT and 25OHD3 deficiency may suggest that this group is particularly prone to the vitamin D deficiency and can benefit from its alignment.

[SeasideSusie Remembering]

Ladybex

You appear to have deleted your other post rather than resubmit your photo.

I noted your results before it was deleted and my comments are:

Renal profile all within range so no problems showing there.

TSH is high at 2.56, how much Levo do you take?

FT4 and FT3 haven't been tested. Testing TSH alone is inadequate as TSH is not a thyroid hormone, it's a signal from the pituitary to tell the thyroid to produce thyroxine if it detects there's not enough. Your TSH is saying there's not enough thyroxine, it would be near the bottom of the range if there was.

Ferritin is below range at 16 (20-275). GP should be testing for iron deficiency anaemia so you need a full blood count and an iron panel.

B12 is very low at 212ng/L. Do you have symptoms of B12 deficiency - check here

b12deficiency.info/signs-an...

Many people with B12 in the 300s have been found to need B12 injections. You should be tested for B12 deficiency/pernicious anaemia.

** IMPORTANT - DO NOT start your folic acid until further testing of B12 has been carried out, it will mask signs of B12 deficiency and skew results.

Folate as you know is low.

Other tests are in range and fine.

Your low nutrient levels are most likely connected to your Hashi's.

[SlowDragon Administrator]

Totally agree with SeasideSusie

Absolutely essential to test TSH, FT4 and FT3 together. Suggest you do so privately via Medichecks or Blue Horizon ASAP

medichecks.com/thyroid-func...

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)

Ferritin is extremely low and needs full iron panel testing for Anaemia

Likely to need iron supplements

Iron is complex. You can have low ferritin and normal iron levels so full testing recommended

Meanwhile Eating liver or liver pate once a week, plus other iron rich foods like black pudding, prawns, spinach, pumpkin seeds and dark chocolate, plus daily vitamin C can help improve iron absorption

B12 is right at bottom of range and you need full testing for Pernicious Anaemia before most likely starting on B12 injections or B12 supplements

Suggest you post your folate and B12 results on Pashealthunlockec

healthunlocked.com/pasoc

Folate, ferritin and B12 are all most certainly extremely low because of being very under medicated and left on far to small a dose at just 25mcg Levothyroxine for months and months

If GP refuses to increase Levothyroxine dose you need to see a recommended thyroid specialist endocrinologist

Email Dionne at Thyroid Uk for list of recommended thyroid specialist endocrinologists

Some are NHS

thyroiduk.org.uk/tuk/About_...

[SilverAvocado]

Hi Ladybex, sounds like you have a few vitamin deficiencies and your GP is not doing a good job at treating them. Unfortunately we often have to fight to get full testing a treatment. If you have an assertive friend see if they will go with you to ask for the things SeasideSusie suggests.

Your TSH is much lower than in the Summer results I discussed in your previous post, but 2.56 is still raised. I can't understand why your GP hasn't given you an increase. You may have to fight about that, too.

Being hypothyroid trashes our vitamin levels, so the two are related.

[Ladybex in reply to SilverAvocado]

GP said my thyroid result is in range ? She has put me in folic acid and now wait 6 weeks for retest ? When I ask about increase in Levo I’m told I don’t need it as I’m in range ??

Appreciate your thoughts hun thank you 😊

[SilverAvocado in reply to Ladybex]

Hmm... Sounds like this is such a bad situation that I hadn't even guessed it

All you've got here is the TSH test. You result is inside the range, but it often goes up all the way to 4.5 or even 5. There is no way a person could feel well with high numbers like that, the range is extremely wide and allows people to go on being sick.

Most people on thyroid hormone replacement will need it to be low in range to feel well.

TSH is just a very bad result to dose you on

I'm in a hurry so got to rush!

[SeasideSusie Remembering in reply to Ladybex]

GP said my thyroid result is in range ? ..... When I ask about increase in Levo I’m told I don’t need it as I’m in range ??

Yes, but that doesn't mean they're optimal and where they need to be for you to feel well. I haven't read through your previous posts so I don't know whether this has been mentioned before but the aim of a hypo patient generally, when on Levo, 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.

To support your request for an increase in Levo, use the following information:

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

[e-mail]

print it and highlight question 6 to show your doctor.

*****

You can also refer to 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

**

She has put me in folic acid

As mentioned in my previous reply, your B12 result suggests possible B12 deficiency/pernicious anaemia. Did you check the link for symptoms? With your B12 level you should push for further testing and do not take the folic acid until further testing has been completed as it will mask signs of B12 deficiency and skew results (as mentioned).

**

Also your below range ferritin needs to be investigated, as mentioned, you could possibly have iron deficiency anaemia.

You know you have Hashi's and Hashi's often causes low nutrient levels or deficiencies.

We have to be our own advocate when we have doctors who ignore such poor results. Either take someone with you to your appointment or find another doctor who will take your results seriously, and please take them seriously yourself.

[Angel_of_the_North]

Well., that just shows you have autoimmune thyroid disease aka hashimoto's. Doesn't show folate levels and it's important not to supplement folate until you have had B12 tested. You need to see (and tell us) your entire set of blood test results

[SlowDragon Administrator]

This post shows you needed 25mcg dose increase in levothyroxine

Are you managing to be absolutely strictly gluten free?

[Ladybex in reply to SlowDragon]

Trying hard ... maybe not 💯

Percent... just put up my blood test results with message ...

So appreciate your time ...