Results back, GP says 'normal' and no increased... - Thyroid UK

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Results back, GP says 'normal' and no increased Levo needed, gutted...

HC17 profile image
HC17
21 Replies

Those have come back some far are:

28th Jan 2020

Test: Serum TSH

Results: Normal

Serum TSH 1.2 mlU/L

Serum total 25-hydroxy vitamin D level: 53.0

Results: normal

FT4 - awaiting results

FT3 - awaiting results

TPO and TG thyroid antibodies - awaiting results

Nov 2019

Tests: Serum TSH level

Results: normal

Serum TSH level 3.6 mIU/L [0.27 - 4.2]

•Following bloods (B - D) taken at 4.30pm, 21st January 2020

•Levothyroxine taken that morning, 50ml (2 x 25 ml tablets, which is my prescribed total daily amount)

•Had eaten breakfast, lunch and various drinks, including filter coffee throughout the day.

•Levothyroxine Brand is: Wockhardt

•Levothyroxine Brand changes every couple of months

Tests: Serum ferritin level AND Thyroid function test

Results: Normal

Serum ferritin level 59 ug/L [15.0 - 150.0]

Serum TSH level 1.2 mIU/L [0.27 - 4.2]

Serum free T4 level 13.4 pmol/L [12.0 - 22.0]

Serum free triiodothyronine level 4.7 pmol/L [3.1 - 6.8]

Tests: Full Blood count

Results: Borderline

Specimen Type: EDTA

Full blood count

Haemoglobin concentration 119 g/L [110.0 - 147.0]

Total white blood count 5.8 10*9/L [3.5 - 9.5]

Platelet count - observation 292 10*9/L [150.0 - 400.0]

Red blood cell count 3.76 10*12/L [3.75 - 5.0]

Mean cell volume 100.3 fL [80.0 - 98.1]

Outside reference range

Haematocrit 0.377 L/L [0.32 - 0.43]

Mean cell haemoglobin level 31.6 pg [27.0 - 33.0]

Mean cell haemoglobin concentration 316 g/L [335.0 - 370.0]

Outside reference range

Neutrophil count 2.31 10*9/L [1.7 - 6.5]

Lymphocyte count 2.32 10*9/L [1.0 - 3.0]

Monocyte count - observation 0.49 10*9/L [0.25 - 1.0]

Eosinophil count - observation 0.57 10*9/L [0.04 - 0.5]

Outside reference range

Basophil count 0.06 10*9/L [0.0 - 0.25]

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21 Replies
Lora7again profile image
Lora7again

I think you need an increase because your TSH should be 1 or lower and your T4 and T3 should be in the upper third of the range. I would change Doctors because yours has no idea how to treat thyroid disease. Also your ferritin is too low and should be over 80 and your vitamin D should be about 100 because we need our vitamin levels to be optimal for levothyroxine to work. This is just my opinion I am not medically trained but I have been studying thyroid disease for over 10 years now and I have been a member of a lot of sites in the US and the UK. Elaine Moore's is very a good site and you should join and post your results on there because she helped diagnose me over 10 years ago.

elaine-moore.com/

SlowDragon profile image
SlowDragonAdministrator in reply to Lora7again

Isn’t Elaine Moore’s site mainly for Graves’ disease and hyperthyroid patients?

Lora7again profile image
Lora7again in reply to SlowDragon

Yes, but she does advise people with hypothyroid because she told me I was underactive.

SlowDragon profile image
SlowDragonAdministrator in reply to Lora7again

With hashimoto’s it’s usually recommended to read The thyroid pharmacist or Dr K

But with hashimoto’s or Graves’ disease it’s always worth trying strictly gluten free diet

thyroidpharmacist.com/artic...

drknews.com/changing-your-d...

restartmed.com/hashimotos-g...

chriskresser.com/the-gluten...

amymyersmd.com/2018/04/3-re...

Lora7again profile image
Lora7again in reply to SlowDragon

I have tried going gluten free but it did not work for me. I don't eat a lot of bread because I don't like it but I do know about a gluten free diet because I have tried it in the past.

fairydogmother profile image
fairydogmother in reply to SlowDragon

you're right Elaine Moore's site is directed at Graves disease but she is very good on interpreting blood test results, she is a retired clinical scientist with years of experience.

Her own involvement is from having RAI years ago and being hypothyroid after that, so she is authoritative on both sides.

I am Graves hyper but easily fall into hypo if overmedicated, which the doctors here don't seem to understand and love telling people they are 'normal' when they are just sitting on the edge of the reference ranges.

Her advice is very much in line with this site concerning lower TSH and higher T3/T4 readings being optimal.

Doctors don't, in my experience, acknowledge the difference between 'normal' (i.e. functional enough you're unlikely to die in the next week - unless you drive your car into a bollard like I did) and 'optimal' which means you actually feel good.

MCR77 profile image
MCR77

Hi, I've never replayed to anyone before but looking at your blood test results and am quite concerned. Have you had a serum B12 and foliate tested test? Your MCV is high. As with the previous reply your vitamins need to be optimal. B12 deficiency/pernicious anaemia can can make you feel rotten and doctors just don't test for it, but they should have with your test results.

Please get these tested and I really hope you get better soon!

SlowDragon profile image
SlowDragonAdministrator

You don’t have Ft4 or Ft3 results yet

Most people on levothyroxine need TSH well under 1

See what the results are like when they arrive

The fact you are on high dose propranolol is likely causing issues too

Vitamin D

GP will only prescribe to bring levels to 50nmol. But improving to around 80nmol or 100nmol may be better

ncbi.nlm.nih.gov/pubmed/218...

vitamindsociety.org/pdf/Vit...

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

Test twice yearly via vitamindtest.org.uk

Vitamin D mouth spray by Better You is very effective as it avoids poor gut function

It’s trial and error what dose we need, with hashimoto’s we frequently need higher dose than average

Local CCG guidelines

clinox.info/clinical-suppor...

Government recommends everyone supplement October to April

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

Propranolol lowers magnesium

Hypothyroid patients are frequently low in Magnesium

betterbones.com/bone-nutrit...

medicalnewstoday.com/articl...

livescience.com/61866-magne...

sciencedaily.com/releases/2...

Suggest you start by supplementing magnesium

Lots of different types available

Calm vitality magnesium powder is cheap and easy to use

Best taken early or late evening as is relaxing and improves sleep. Must be four hours away from taking levothyroxine, so if taking levothyroxine at bedtime take about 6-7pm. Good for constipation. Best start on low dose as too much can cause diarrhoea

After couple of weeks add in vitamin D

SlowDragon profile image
SlowDragonAdministrator

SeasideSusie or humanbean may pop along re all iron related results

Low MCHC and High MCV

verywellhealth.com/mean-cor...

Low MCHC is significant

healthline.com/health/low-m...

High MCV

Suggest low folate or B12

en.wikipedia.org/wiki/Mean_...

Suggest you add in supplementing

Your folate levels are quite low

Two weeks after starting on vitamin D

Suggest you start 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

When 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...

Ferritin a little low

Eating iron rich foods like liver or liver pate once a week plus other red meat, pumpkin seeds and dark chocolate, plus daily orange juice or other vitamin C rich drink can help improve iron absorption

dailyiron.net

Links about iron and ferritin

healthunlocked.com/thyroidu...

healthunlocked.com/thyroidu...

drhedberg.com/ferritin-hypo...

restartmed.com/hypothyroidi...

SlowDragon profile image
SlowDragonAdministrator

November result clearly indicates you needed dose increase in levothyroxine

Especially as test was afternoon after eating and had taken levothyroxine

TSH far too high

Ft4 only 14% through range

Ft3 at 43% through range

Propranolol likely affects ft3 results

Skeeter1956 profile image
Skeeter1956

Please feel free to take my comments with a large pinch of salt . My GP once told that not everything is related to my thyroid . Looking at your results from November they suggest to me that you are anemic , raise MCV , low MCHC and bottom of range RBC point in that direction . Might be worth looking at .

Hope you are feeling better soon .

Regards Skeeter .

in reply to Skeeter1956

Not everything related to thyroid. Absolutely true. But thyroid is related to almost everything.

Hypothyroidism often causes B12 deficiency etc. But is that the cause this time.? That's the question.

Chicken and egg situation 🤔

fairydogmother profile image
fairydogmother in reply to

gosh that is so true, thyroid being related to everything ... described as a 'systemic' condition affecting every cell in your body

in reply to fairydogmother

That's what makes it so difficult to recognise it, and whether other conditions are caused by the hypothyroidism or something else

fairydogmother profile image
fairydogmother in reply to

Of course you're right, and that's why intelligent interpretation of blood tests are so important. If your thyroid levels are ok (and that doesn't always mean 'normal') then it's time to start looking further.

The advice given repeatedly on this forum, and on Elaine Moore's forum, is very good indeed, sometimes medics don't agree and it can cause conflict which shouldn't arise.

Many people are, quite reasonably, nervous about appearing confrontational or argumentative with qualified medics and that's a shame because they are the ones who have to live with sometimes not-so-good advice.

in reply to fairydogmother

"sometimes medics don't agree and it can cause conflict which shouldn't arise"

That's normal in any scientific discipline. Which SHOULD mean that a doctor - including a specialist in the field - should not mind admitting he doesn't know it all and listen to his patients once in a while. I finally found one such gem, almost by accident on the recommendation of one of the receptionists. (They may not know that much about medicine, but they know the doctors).

To be fair, doctors must have to put up with many truly difficult patients who don't have much of a clue about their ailments beyond what they read in the newspapers and demand inappropriate, or even dangerous, treatments as their absolute right. There needs to be respect on both sides and some give and take.

fairydogmother profile image
fairydogmother in reply to

certainly agree with everything you say here, I also have a gem of a GP who didn't have a hissy fit when I didn't want to be pushed into thyroidectomy and has supported me ever since

what I wanted to emphasise is how difficult it is for ordinary people to inform themselves, the NHS in particular is so stretched it's easy to see why the common denominator is the preferred route and why patients are directed that way, I'm sure it's done with the best of intentions

humanbean profile image
humanbean

Serum ferritin level 59 ug/L [15.0 - 150.0] 33% of the way through the range

Haemoglobin concentration 119 g/L [110.0 - 147.0] 24% of the way through the range

Red blood cell count 3.76 10*12/L [3.75 - 5.0] 1% of the way through the range

Mean cell volume 100.3 fL [80.0 - 98.1] Over the range

Mean cell haemoglobin concentration 316 g/L [335.0 - 370.0] Under the range

Your ferritin(iron stores) level is not optimal. Most of us on the forum feel best when it is mid-range, i.e. 80 - 90 approx with the range you've given. However, your ferritin isn't actually that bad so I don't think you need to supplement iron for now. Supplementing iron is really not a good idea unless iron and ferritin levels are low. Excess iron in the body is poisonous and the body can't get rid of it very easily.

You might find this research paper of interest for future reference :

ncbi.nlm.nih.gov/pmc/articl...

Title : Effect of iron supplementation on fatigue in nonanemic menstruating women with low ferritin: a randomized controlled trial

You can try to improve your iron levels with food. See this website for specific information on how to do that :

dailyiron.net/

Your doctor would never agree to give you an iron panel with a ferritin level like yours (it's too good). But you can buy a full iron panel privately that just requires a finger-prick sample of blood and you don't have to see a doctor :

medichecks.com/iron-tests/i...

You can get 10% off the test price - see this link for the discount code :

thyroiduk.org.uk/tuk/testin...

Sometimes medichecks has this test available with a higher discount, but not very often. If you register with them you will receive emails giving you details of any special offers they have.

Anecdotal info : Increasing my serum ferritin to optimal improved my Haemoglobin and my Red Blood Cell count.

...

Your over the range MCV (Mean Cell Volume) tells you that your blood cells are bigger than normal - this is a condition called macrocytosis.

en.wikipedia.org/wiki/Macro...

This in turn suggests your vitamin B12 and folate levels are likely to be too low but they would need to be tested to be sure. There are other reasons for high MCV but low B12 and folate are common causes, particularly in people who are hypothyroid. And if your B12 and folate are particularly low you might have Pernicious Anaemia (PA). Don't start supplementing B vitamins until you know for sure. Testing for PA is not 100% reliable, and supplementing before the testing will reduce the chances of accurate results.

You can get further information on the likelihood of you having PA by joining and reading posts on this forum :

healthunlocked.com/pasoc

As for your MCHC - Mean Cell Haemoglobin Concentration - I don't pay much attention to this. It is calculated based on haemoglobin and haematocrit. But haematocrit is also often calculated from other results too. So, clearly neither the haemoglobin and haematocrit are optimal, but both are affected by iron, B12 and folate. But you don't know what your B12 and folate are. If you can find out, then you should be able to improve these other things. You might find this summary of different types of anaemia useful :

irondisorders.org/Websites/...

Good luck. :)

Skeeter1956 profile image
Skeeter1956

Hi Londinium , You would expect the iron levels to be on the lower side with lower MCHC . It's one for the Doctor, my limited knowledge of blood counts comes from my wife having a blood cancer . I know that red blood cells dying off prematurely can lead to raised iron levels . Also blood transfusions can have same effect .

Sorry I couldn't offer any help .

Cheers Skeeter

Skeeter1956 profile image
Skeeter1956

Wishing you good luck with it . It's one of those situations where the GP had to decide which department to refer you to .

Regards Skeeter .

HC17 profile image
HC17

Hi,

Thank you for the huge amount of messages, advice and support. I am reading through them bit by bit (I have to keep referring back as it is very difficult for me to retain information at present), and taking systematic action.

My recent bloods that were requested, I have discovered today that the most important bloods that were requested, FT3, FT4, Antibodies etc, have not been tested, test again. I received no advice from my GP other than bloods are normal, if symptoms persist call back end of Feb see if this, what must be a other bug, has cleared up. After reading all of your messages and advice over the last week or so, and remembering that my health problem is not just some unknown odity, I contacted Medichecks earlier, and requested to get all my bloods, package should be sent in a few days to get them taken locally. I will not let any GPor so called specialist leave suffering any longer. In addition, I am ensuring that I am having a well balanced diet, with lots of foods and drinks that contain iron, vitamin C, B12 and D, as well as cutting out dairy. Over the weekend I will rebook at all advice given to plan what else I need to do and not do, and keep you updated. Thank you all for your amazing continued support, your are helping me have so much hope to fight on...

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