Results help please

[Dizzy938]

Sorry yet more results. please help

Was diagnosed 3 years ago and finally got round to posting results. Am currently on 50micrograms levo. Sublingual vit D and Vit B12 once a week. No Iron tabs.

I am concerned about the Ferritin results and the Thyroid peroxidase antibodies.

would also like to know if the T3 and conversion is ok please

Medichecks results

CRP HS 1.48 mg/L (Range: < 5)

Iron Status

Ferritin X 202 ug/L (Range: 13 - 150)

Vitamins

Folate - Serum 5.19 ug/L (Range: > 3.89)

Vitamin B12 - Active 77.400 pmol/L (Range: > 37.5)

Vitamin D 107 nmol/L (Range: 50 - 175)

Thyroid Hormones

TSH 2.81 mIU/L (Range: 0.27 - 4.2)

Free T3 3.34 pmol/L (Range: 3.1 - 6.8)

Free Thyroxine 13.300 pmol/L (Range: 12 - 22)

Autoimmunity

Thyroglobulin Antibodies 70.800 kIU/L (Range: < 115)

Thyroid Peroxidase Antibodies X 56.3 kIU/L (Range: < 34)

NHS RESULTS

FULL BLOOD COUNT

Haemoglobin concentration 131 g/L [115.0 - 165.0]

Total white blood count 7.1 10*9/L [3.7 - 11.0]

Platelet count - observation 390 10*9/L [150.0 - 450.0]

Neutrophil count 3.7 10*9/L [1.7 - 7.5]

Lymphocyte count 2.6 10*9/L [1.0 - 4.0]

Monocyte count - observation 0.6 10*9/L [0.2 - 1.0]

Eosinophil count - observation 0.1 10*9/L [0.04 - 0.5]

Basophil count 0.0 10*9/L [0.0 - 0.1]

Red blood cell count 4.38 10*12/L [4.0 - 5.5]

Haematocrit 0.396 L/L [0.36 - 0.44]

Mean cell volume 90.4 fl [80.0 - 100.0]

Mean cell haemoglobin level 29.9 pg [27.0 - 32.0]

Mean cell haemoglobin concentration 331 g/L [320.0 - 360.0]

Nucleated red blood cell count 0.0 10*9/L [0.0 - 0.01]

LIVER FUNCTION TESTS

Serum total protein level 72 g/L [64.0 - 83.0]

Serum albumin level 37 g/L [35.0 - 50.0]

Serum alanine aminotransferase level 13 U/L [10.0 - 35.0]

Serum alkaline phosphatase level 65 U/L [40.0 - 150.0]

Serum bilirubin level 14 umol/L [0.0 - 21.0]

Serum globulin level 35 g/L [20.0 - 39.0]

THYROID STIMULATING HORM.

Serum TSH level 2.67 mIU/L [0.35 - 4.94]

Comment Euthyroid or adequate replacement.

Rarely, patients with pituitary/hypothalamic

hypothyroidism can have a normal TSH.

Urea and electrolytes

Serum sodium level 140 mmol/L [136.0 - 145.0]

Serum potassium level 4.4 mmol/L [3.5 - 5.1]

Serum urea level 4.0 mmol/L [2.5 - 6.7]

Serum creatinine level 69 umol/L [50.0 - 98.0

[greygoose]

You're under-medicated. 50 mcg is just a starter dose. Your TSH is too high, should come down to 1 or under. Your Frees are much too low. And, we won't be able to tell how well you convert until you get more T4 into you.

Your ferritin is rather high, yes. You should maybe see your doctor about that. But, your folate and B12 are on the low side. If it were me, I'd want them higher. Your vit d is good.

Did you know you have Hashi's?

[Dizzy938 in reply to greygoose]

Thank you for such a swift reply. Yes I did know I have Hashi's and have been on the 50 miligram dose for 3 years with all the associated problems cold, hair loss, dry skin etc. I have an appt with doc on 10th Sept do you think I should show her the medichecks results?

[greygoose in reply to Dizzy938]

You can show her, but she might not accept them because they show up how neglected you've been! On 50 mcg for 3 years! That's criminal! It should have been increased to 75 mcg after six weeks. She has kept you grossly under-medicated and should be shot! You need an increase in dose and you need it now.

[Dizzy938 in reply to greygoose]

Thank you it probably accounts for all the aches and pain I have. I never realised because she always said the results were in the normal ranges and never discussed an increase. I will let you know what happens.

[greygoose in reply to Dizzy938]

I'm sure it does account for it! Doctors just do not understand that just being 'in-range' isn't good enough. Levels need to be in the right place in the range to make you well. You can't expect to feel the same if your FT3 is at 3.1 as you would if it were at 6.8. It's just not logical. Most people feel better when it's in the top half of the range. But, we're all individuals, and the levels have to be in the right place for us as individuals. Not just anywhere in-range. Perhaps you can explain that to her?

[SlowDragon Administrator]

You are extremely under medicated

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

Your FT4 is only 13% through range

FT3 only 6.5% through range

Helpful calculator for working out % through range

chorobytarczycy.eu/kalkulator

See you GP and get new prescription for 25mcg dose increase to 75mcg daily

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

NHS guidelines on Levothyroxine including that most patients eventually need somewhere between 100mcg and 200mcg Levothyroxine.

nhs.uk/medicines/levothyrox...

Your raised antibodies confirms cause of your hypothyroidism is due to autoimmune thyroid disease also called Hashimoto's

High ferritin can be due to inflammation of Hashimoto's

Folate is on low side

I would've imagine you feel pretty grim

Dr Toft, past president of the British Thyroid Association and leading endocrinologist, states in Pulse Magazine,

"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)."

You can obtain a copy of the articles from Thyroid UK email print it and highlight question 6 to show your doctor

please email Dionne at

[e-mail]

Levothyroxine should always be taken on empty stomach and then nothing apart from water for at least an hour after

Many people take Levothyroxine soon after waking, but it may be more convenient and more effective taken at bedtime

verywellhealth.com/best-tim...

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. Teva is the only brand that makes 75mcg tablet.

No other medication at same as Levothyroxine, leave at least 2 hour gap. Some like calcium, magnesium, HRT, omeprazole or vitamin D should be four hours away

(Time gap doesn't apply to Vitamin D mouth spray)

[SlowDragon Administrator]

Do you supplement vitamin D, because this is a good level, which is surprising considering how hypothyroid you are?

[Dizzy938 in reply to SlowDragon]

Yes I use the sublingual spray about three times a week. I felt dreadful before I started it I cant remember what the level was now but it was so low the doc recommended that I get some and I couldnt believe the difference once I started taking it.

Thank you for all your good advice I have a doc appointment on 10th Dec so I will post again then. I feel armed and ready for battle now with your support.

[SlowDragon Administrator in reply to Dizzy938]

New NICE guidelines published recently may also help you

nice.org.uk/guidance/ng145/...

1.3.6 Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

They are clear that dose required is going to be roughly 1.6mcg Levothyroxine per kilo of your weight

So work out your weight in kilo and multiply by 1.6

Dose should be increased in 25mcg steps upwards. Bloods should be retested 6-8 weeks after each dose increase

Your 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

Igennus Super B complex are nice small tablets. 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 Thorne Basic B or jarrow B-right are other options that contain folate, but both are large capsules

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 B12 symptoms

b12deficiency.info/signs-an...

Low vitamin D and low B vitamins may be linked as explained here

drgominak.com/sleep/vitamin...

healthunlocked.com/thyroidu...

[Dizzy938 in reply to SlowDragon]

Thank you for the links and advice. According to the weight to tablet ratio I should be on 125 per day so that was really useful. Does taking B12 have any effect on the Ferritin that I seem to be accumulating?

[SlowDragon Administrator in reply to Dizzy938]

Obvious you will need to increase Levothyroxine slowly in 25mcg steps upwards

Retesting 6-8 weeks after each dose increase

Always stick to same brand of Levothyroxine

Hashimoto's causes inflammation.....this often causes higher ferritin

[Dizzy938 in reply to SlowDragon]

Thank you that makes sense Wilco