This is my first post so please forgive any mistakes! I’m a 57 yr old woman, post menopause. I’ve had to gradually reduce my oestrogen hrt over the past couple of years as I find it seems to exacerbate brain fog if it’s above a low level. Over the past year or so my fatigue and brain fog have become debilitating, so I recently had some blood tests to rule out a thyroid problem. In addition to the now daily constant brain fog and lethargy, I seem to have what feels like an adrenaline surge at 5pm and 11pm. My morning coffee makes me more tired than before I drink it. Some really odd things happening and I need to get some answers. My GP says the test results are all satisfactory but I really don’t feel satisfactory. I’d be really grateful for any pointers and hope I’ve included all the info necessary.
TSH 0.88 (0.2-4.5)
FT4 12 (9-21)
FT3 4.97 (3.1-6.8)
Ferritin 34 (20-300)
B12 412 (180-2000)
Folate 11.9 (2.8-20)
Transferritin 2.14 (2-4)
%sat 32
Iron 17.8 (10-28)
Written by
Jamima
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Your Ferritin is too low and you need to raise it. When mine was low I would eat pate a couple of times a week and I think I took Spantone. This was a few years ago now because my Ferritin is too high now because I have inflammation. Hopefully greygoose will comment on your Thyroid results because she knows more about that than me.
I had a hysterectomy due to endo last Feb and feel exactly the same. I resisted HRT but the insomnia and sweats became too much so tried Everol 50 which helped but I have experienced lots of weird and strange ailments since September. I came off HRT in November to see if it made a difference to symptoms but it didn’t so back on it now. My bloods kept showing large red blood cells but the GP’s are adamant nothing is wrong. I take B12 as an oral spray and joint multi vitamin which has made a small improvement. The GP is now saying she believes it’s all menopause related and that I should up the HRT to Everol 75. It’s just draining and I feel I’m just going around in circles. I’m now looking into alternative therapies to see if that will help xxx
Hi Thompson36 - if you’re surgical meno and had ovaries removed you’d probably benefit from testosterone replacement. It’s not licensed in uk but some enlightenment gp’s and most private gynaecologists will prescribe it. Have you looked at menopause matters and hystersisters sites? They have surgical women who give great advice and share their stories.
Doctors only look at the TSH, they don't understand anything else. And, your TSH is good. Your FT3 is also good, but your FT4 is rather low. So, although there's nothing glaringly obvious in your thyroid results, it might be a good idea to keep an eye on levels, retesting from time to time.
Your ferritin is low. But your iron is good, so not sure you need to supplement. Iron is complicated, and I don't understand much about it. Perhaps SeasideSusie or humanbean will come along later and say what they think.
I would be more concerned about the B12. Might be a good idea to get yourself a good B complex and try and raise it a little. And, by a 'good' B complex, I mean one with methylcobalamin (B12) rather than cyanocobalamin, and methylfolate rather than folic acid. If your B12 is too low for you, it can make you feel terrible.
It would also be a good idea to get your vit D tested.
I don't think there's much point in retesting until you've improved your nutrients a bit. But, it might be good to get your vit D tested in the meantime. You cannot just assume that you have good levels just because you spend a lot of time outdoors. It doesn't always follow. Even people living in sunny Mediterranean areas like Greece, can be vit D deficient.
It might also be a good idea to think about cortisol/DHEA testing. What you said in your original post about 'adrenaline rushes' and reaction to coffee makes me wonder how your adrenals are doing. The best way to test adrenals is a 24 hour saliva cortisol test, which you can do privately - the NHS won't do it - but I'm a bit vague about where to have it done. Might be a good idea to post a new question asking people to advise on that.
My reason for suggesting that - apart from the coffee - is that your TSH result does not correspond with your FT4 result - one would expect it to be higher. So, I'm wondering if there could be a pituitary problem - the pituitary secretes TSH. If your pituitary is sluggish, it could affect your adrenals, causing your cortisol to be low.
As to what you should do if your FT4 doesn't rise, I think it's best to cross that bridge when you come to it.
Thank you grey goose. I agree, I had wondered about cortisol as that’s what it feels like, I get a 2nd wind around 5pm, well, actually it’s the 1st wind as I’m just not in the game until then! I’ll post asking for best cortisol tests.
And many thanks for passing on my message, I’m a newbie here so apologies.
That’s the B12 I use, I do feel a little better for taking it. Holland and Barrettes were doing it buy one and get one for half price last week. I take the maximum 4 sprays. Better You also do other sprays but I forgot to check the B12 in them but it might be worth a look.
B12 412 (180-2000) 13% of the way through the range
Folate 11.9 (2.8-20) 53% of the way through the range
Ferritin 34 (20-300) 5% of the way through the range
Transferritin 2.14 (2-4) 7% of the way through the range
%sat 32
Iron 17.8 (10-28)43% of the way through the range
Vitamin B12
Your Vitamin B12 is low in range. You've also been supplied with a reference range which allows for a much higher level of B12 than would be normally seen in the UK, so I'm assuming the tests were done elsewhere. I think this is a good thing - UK doctors are happy to leave people very deficient in B12 and the top of the reference ranges are very low. I would suggest aiming to raise your B12 to the top half of the reference range i.e. roughly 1000 - 2000.
Folate
Optimal = top half of the range i.e. 11.4 - 20. Yours is fine, but only just.
Other B Vitamins
You haven't got test results for other B vitamins - few of us ever test them and I'm not suggesting that you do. What would be a good idea is for you to buy a good quality B Complex containing activated B vitamins i.e. B vitamins already in a form that the body can easily absorb. The B Complex products most often mentioned on this forum are :
The Thorne product is a higher dose product than the Igennus. Thorne dose is one a day, the Igennus product is two a day. Many of us save money by buying the Igennus product and taking two a day for the first bottle then reducing to one a day for subsequent bottles.
If your B12 persists in staying below optimal despite the B Complex then you could add a methylcobalamin supplement, at a dose of 500mcg or 1000mcg per day for a month or two.
Be aware that B vitamins are water soluble and are excreted in urine if taken in excess of requirements. The only exception to this is vitamin B6 - it causes problems in deficiency and toxicity and it can be difficult to determine which is which in terms of symptoms.
Personally I wouldn't take more than 20mg of vitamin B6 per day, and I wouldn't take that much for more than a month or two and would then reduce to 10mg or less per day.
Iron and related tests
Optimal levels of iron and related tests are described in this link :
Ferritin - yours is much too low in range suggesting you need more iron.
Transferrin - low in range suggests you have plenty of iron, although low transferrin can also be seen in protein malnutrition according to wikipedia.
Saturation - there is no range, but according to the link I gave yours is just a smidgen under optimal
Iron - yours is not too bad, although it is a bit under optimal.
...
Optimal results to aim for :
Ferritin (iron stores) - with the range you've supplied mid-range is 160 and is what you should aim for.
Transferrin - looking at your results as a group I would suggest this might be low because of protein malnutrition rather than a result of an iron problem. Eat more protein if you can, which should also help your iron levels generally. You'll have to do your own research on what protein sources you can fit into your diet. In the absence of other recommendations I would suggest that optimal is assumed to be roughly mid-range i.e. about 3.
Saturation : Optimal is 35% - 45%. Improving your iron / ferritin levels will increase this.
Iron - Optimal is 55% - 70% of the way through the range. For the range you've given this would be approx 20 - 23.
...
To improve iron with food see this link for some suggestions :
If you want to improve iron by taking supplements then it really depends on how well you can tolerate them. Have you ever tried supplementing iron before? And how did you get on?
Thanks so much humanbean, that’s a lot of really helpful info. I do eat a lot of protein but will increase. I’m mostly pescatarian with occasional red meat but will start to eat more red meat. I’d prefer to eat my iron than supplement if possible. I’d imagine my vit d is ok as I’m in the sun all summer and supplement with vit d spray autumn to spring. I’ll get onto the b vits too.
There are people on the forum who have spent years living in hot, sunny climates and have discovered they are low or deficient in vitamin D. I would suggest you test it once in autumn and once in spring. Then you will know how well you absorb vitamin D in the summer, and whether your supplementing is adequate over winter. If both results come back okay then you can carry on as you are without testing again. Most of us need to take a maintenance dose of vitamin D at least in winter. Doses I've read of people taking are usually 2000 iU to 5000 iU per day, possibly only in winter, or possibly all year round.
If you test vitamin D only then this is the cheapest place I know of to provide fingerprick-tests :
Thank you humanbean, I’m going to test it and also cortisol. Beginning to feel like a hypochondriac but I know I’m not right and nhs seem to be woeful with any help. Do you think a private endo is worth it or should I persevere with trying to raise my vits and iron?
But then I've had so many bad experiences at the hands of doctors, and have never liked or trusted them as a result, so I'm not really the person to ask on the subject.
If you went to see an endo with the results you've given in your first post they would most likely tell you that they are all in range, therefore you are fine. Any symptoms you have are likely to be blamed on your mental health (and they will suggest CBT), or "something else" and they can do nothing to help you.
Thank you. My gp has already hinted at depression and the go to anti depressants, I know it’s not depression as I have clear fluctuations throughout the day. I will keep going with vits replacement.
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